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HomeMy WebLinkAboutMiscellaneous - 100 JOHNNY CAKE STREET 4/30/2018rt ti (D (D fi ti ti tj e u t' w 9 O OD 3 r w DO WOW O W LODO O � O ti ti �4 PC o v a� ~ 'wl o o � � 0 3a� b U � M � O O N O � N V CQ a �an0 0 0 •o '� L L aA�3aa O z � a v LAI e u t' w 9 O OD 3 r w TOWN OF SYSTI DATE:�- (�-65 SYSTEM OWNER & ADDRESS X03 ���3 CCA, kf PUMPING RECO SYSTEM LOCATION (example: left front of house) o-- '' RECEIVED APR 2 5 2005 TOWN OF NORTH ANDOVER HEALTH DEPARTMENT �Ous-( DATE OF PUMPING: --n QUANTITY PUMPED: �7,�0� G ONS CESSPOOL: NO YES EPTIC TANK: NO YES NATURE OF SERVICE: ROUTINE EMERGENCY OBSERVATIONS: GOOD CONDITION HEAVY GREASE ROOTS EXCESSIVE SOLIDS SOLIDS CARRYOVER FULL TO COVER BAFFLES IN PLACE LEACHFIELD RUNBACK FLOODED OTHER (EXPLAIN) SYSTEM PUMPED BY: Bateson Enterprises, Inc. COMMENTS: coNTENTs TRANsFERRED To: G.L.S.D V Lowell Waste J M is M ,1 I 9 �. V w NEW ENGLAND ENGINEERING SERVICES lk INC r F December 11, 2003 North Andover Board of Health Town Hall Annex 27 Charles Street North Andover, MA 01845 RE: TITLE V REPORT: 103 Johnnycake Street, North Andover, MA Dear Sirs: Enclosed is a copy of the Title V report for the above referenced property. The system PASSED our inspection. If there are any questions please call me at my office, 686-1768. Sincerely Benjamin C. Osgoo, Jr. 60 BEECHWOOD DRIVE - NORTH ANDOVER, MA 01845 - (978) 686-1768 - (888) 359-7645 - FAX (978) 685-1099 COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION TITLE 5 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: /0 ' 0 -;w44% _Aia2iN 4A/Q0000--,tff Owner's Name: ,To M I.: 1!>2'Et— Owner's Address: 0:3, HP)U y C,4A F Si- p✓E �►'+R Date of Inspection: Name of Inspector: (please print) Benjamin C. Osgood, Jr. CompanyName:New England Engineering Services Inc. Mailing Address: 60 Beechwood Drive, North Andover, MA 01845 Telephone Number: 978-686-1768 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000). The system:. _asses _ Conditionally Passes _ Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature: A..., C D_ ) Date: 17-11o)0 The system inspector shall submit a copy of this inspecti& report to the Approving Authority (Board of Health or DEP) within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Notes and Comments ""This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. Page 2 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: /03 J-oKutijc6?kC- i Owner: - -OHly 0- Avp Date of Inspection: j 2 /to I u 3 Inspection Summary: Check A B C,D or E / ALWAYS complete all of Section D A.. System Passes: ✓ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B.� /SSystem Conditionally Passes: /�' 0 One or more system components as described in the "Conditional Pass" section need to be replaced or repaired The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Answer yes, no or not determined (Y N ND) in the for the following .statements. If "not determined" please explain. The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if (with approval of Board of Health): broken pipe(s) are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if (with approval of the Board of Health): broken pipe(s) are replaced obstruction is removed ND explain: Property Address: 1o3 . �f ffA)i j 4 c c;� A c 5T. A)o ,2 -t -H ! p o,,eA- -"A Owner: J_0J4 N i3 Ef t.,qND Date of Inspection: j z 1 1 :,./ 0-2, C. Further Evaluation is Required by the Board of Health: AOConditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(l)(b) that the system is not functioning in a manner wbkh will protect public health, safety and the environment: Cesspool or privy is within 50 feet of a surface. water _ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: _ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. _ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. —The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. _ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a Private water supply well". Method used to determine distance "This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: Page 4 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: j o_3 Owner: ' l bgN Sr—NIA t "o Date of Inspection: /2-_-j/o a D. System Failure Criteria applicable to all systems: You must indicate `yes" or "no" to each of the following for all inspections: Yes No s� Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool _17 Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool +� Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool _✓ Liquid depth in cesspool is less than 6" below invert or available volume is less than %Z day flow J Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped _ ✓ Any portion of the SAS, cesspool or privy is below high ground water elevation. Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface ✓ water supply. _ Any portion of a cesspool or privy is within a Zone 1 of a public well. _ Any portion of a cesspool or privy is within 50 feet of a private water supply well. Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [ This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria A r are triggered. A copy of the analysis most be attached to this form.] � O. (Yes/No) The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 SPd. You most indicate either "yes" or `ono" to each of the following: (The folio criteria apply to large systems in addition to the criteria above) yes no _ _ the system is within.400 feet of a surface drinking _ the system is within 200 feet'of a dbutarypto a surface drinking water supply _ the system is located in a.nitrogen sensitive area (Interim Wellhead Protection Area – IWPA) or a mapped Zone II of a public water supply well If you have_answered "yes" to any question in Section E the system i copsidered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator-ofany large system considered a significant threat under Section E or failed under Section D shall upgrade the systems -in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. Page 5 of 11 OFFICIAL INSPECTION FORM -- NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: /c,3 T vy,�cJ iu Y Ccw v si, iv) RT}f AAD ovFR "V4 Owner:i DN N B 2 EikA j p Date of Inspection:_I%iT 3 Check if the following have been done. You must indicate `fires" or "no" as to each of the following: Yes No v*"'-- Pumping information was provided by the owner, occupant, or Board of Health ,Were any of the system components pumped out in the previous two weeks ? Has the system received normal flows in the previous two week period ? Have large volumes of water been introduced to the system recently or as part of this inspection ? Were as built plans of the system obtained and examined? (If they were not available note as N/A) V= Was the facility or dwelling inspected for signs of sewage back up ? Was the site inspected for signs of break out ? Were all system components, excluding the SAS, located on site ? Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffies or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum ? Was the facility owner (and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems ? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: Yes no Existing information. For example, a plan at the Board of Health. _✓/ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(3)(b)] Page 6 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: ro 3 T .> it N. M u jL" e�i- 'U :;, 21 flN7t��� lL �-•fl Owner: -TOIYA) Date of Inspection: z t o d TLOWCONDITIONS RESIDENTIAL Number of bedrooms (design): Number of bedrooms (actual): DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x # of bedrooms): C 6 Number of current residents: 7 Does residence have a garbage grinder (yes or no): O Is laundryon a separate sewage system (yes or no): &FQ [if yes separate inspection required] Laundry system inspected (yes or no):— Seasonal o):=Seasonal use: (yes or no)t ApO Water meter readings, if available (last 2 years usage (gpd)): Sump pump(yes or no): Last date of occupancy C rE�-------- ----- - ----------- --- ----- -- - - COMMERCIAIA NDUSTRIAL Type of establishment: Design flow (based on 310 CMR 15.203): and Basis of design flow (seats/persons/sgft,etc.) Grease trap present (yes or no): _ Industrial waste holding tank present (yes or no): — Non -sanitary waste discharged to the Title 5 system (yes or no): _ Wates' meter readings, if available: Last date of occupancy/use: OTHER (describe): GENERAL . INFORMATION Pumping Records Source of information: D 2_oC> 0 P E (Z C:,vN G (2 - Was system pumped as part of the inspection (yes or no):' If yes, volume pumped: _gallons — How was quantity pumped determined? _ Reason for pumping: TYPE OF SYSTEM Septic tank, distribution box, soil absorption system — Single cesspool _ Overflow cesspool Privy _ Shared system (yes or no) (if yes, attach previous inspection records, if any) _ InnovativelAlternative technology. Attach a copy of the current operation and maintenance contract (to be obtained from system owner) Tight tank _ Attach a copy of the DEP approval — Other (describe): Approximate age of all components, date installed (if known) gand source of information: ( V l ( "L P65 - Were sewage odors detected when arriving at the site (yes or no): &0 Page 7 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: IC3 --,;-r ,1/041y !-1-^/2uc0z MA Owner: 111–oH/fit31 FI -1 I1 -v(2 Date of Inspection: / Q%%!3 BUILDING SEWER (locate on site plan) Deptkbelow grade: 1 g Materials of construction: _V4ast iron 40 PVC other (explain): Distance from private water supply well or suction line: Comments (on condition of joints, venting, evidence of leakage, etc.): SEPTIC TAMC: — (locate on site plan) Depth below grade: Material of construction: jconcxete metal fiberglass _polyethylene other(explain) — If tank is metal list age: _ Is age confirmed by a Certificate of Compliance (yes or no): — (attach a copy of certificate) Dimensions: Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: How were dimensions determined: Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): rA N V\ I AJ &.0 > 7 C 6 j-'; -a .T u e1 _ �„n i � �' i?% 7> AN A C GREASE TRAP: Aocate on site plan) Depth below grade: — Material of construction: concrete metal _fiberglass _polyethylene other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Page 8 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM . PART C SYSTEM INFORMATION (continued) Property Address: / 03`/�Fl�NyGAf�i t -67 Owner: Aj?4--1tg4A,,o Date of Inspection: TIGHT or HOLDING TANK: j8jLtank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: concrete metal fiberglass _polyethylene other(explain): Dimensions: Capacity: gallons Design Flow:allons/day Alarm present (yes or no): Alarm level: Alarm in working order (yes or no): Date of last pumping: Comments (condition of alarm and float switches, etc.): DISTRIBUTION BOX: (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): - ��x (,y 1, v z-- !c1 ►.l n %-1-( rt, &I AJo rc✓r0F_,,.L1 d� 5 o i- t eS etenz`i Oy G.L wiz J-FRXe4G-/e !N Atz nUu, PUMP CHAMBER: (locate on site plan) . Pumps in working order (yes or no): Alarms in working order (yes or no): Comments (note condition of pump umber, condition of pumps and appurtenances, etc.): Page 9 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: /03 oyLy y Ctfg c" S% aa)711 D uFX 0,4 Owner: z-7-0 A/ L3�/14,411-P Date of Inspection; SOIL ABSORPTION SYSTEM (SAS): (locate on site plan, excavation not required) If SAS not located explain why: Type leaching pits, number: _ leaching chambers, number: leaching galleries, number: leaching trenches, number, length: c/leaching fields, number, dimensions: overflow cesspool, number: innovativetalternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): AREA r(c -a CV VE CESSPOOLS; (cesspool must be pumped as part of inspectionxlocate on site plan) Number and configuration: Depth -top of liquid to inlet invert: Depth of solids layer: Depth of sawn layer: _ Dimensions of cesspool: _ Materials of construction: Indication of groundwater inflow (yes or no): Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): PRIVY: "-(locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Page 10 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: f03 �JoNuNyc�I�E S Owner: T�Hti' valeF/`Av7 Date of Inspection: 2 O.2_ SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. ',o -c Page 11 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: /ate QDbI 1 �6di4 r Owner: Toy �V ",C&W v a Date of Inspection: i z/ /!?zy SITE EXAM Slope Surface water 4, 2,,,,cl Check cellar -4L,,-,P PM? P4, se A Shallow wells -, ;,v c% Estimated depth to ground water --� feet Please indicate (check) all methods used to determine the high ground water elevation: Obtained from system design plans on record - If checked, date of design plan reviewed: Observed site (abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health -explain - Checked with local excavators, installers- (attach documentation) Accessed USGS database -explain: You must describe how you established the high ground water elevation: i�AA o/ Art/ �2ei9 > N F- RNs n�-/,9-s d gf�J t 2 Oc EXi S i .v (� 1,-2G- ►.t N: �... LG ��G-� cue=s �Mc� :794EXEf�lLc k -,5H6 w• 'C'\ Commonwealth of Massachusetts = City/Town of a a' System Pumping Record APR 27 2010 Form 4 TOWN OF NORTH ANDOVER 4�M HEALTH DEPARTMENT DEP has provided this form for use by local Boards of Health. Other Torms m e information must be substantially the same as that provided here. Before using this form, check 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: eft side�housRight side of house, Left front of house, Right front of house, Left rear of house, Right rear of house. Left rear of building. Right rear of building. Address 6 0f v \ I „�� C� d City/Town v V State 2. System Owner: Name Address (if different from location) City/Town B. Pumping Record 1. Date of Pumping 3. Type of system: ❑ ❑ Other (describe): Date Cesspool(s) 4. Effluent Tee Filter present? ❑ Yes No 5. Condition of SZ�J. ��� ►10r 6. System Pumped By: Neil Bateson Name Bateson Enterprises Inc Company 7. Locatio ere contents were disposed: �.L�S.D n ,% Lowell Waste Water of Zip Code StatQ., � ✓ �� _Zip Code Telephone Number /`f! ls� — 2. Quantity Pumped: Gallons 2-!�e`ptic Tank ❑ Tight Tank If yes, was it cleaned? ❑ Yes ❑ No F5821 Vehicle License Number Date t5form4.doc• 06/03 System Pumping Record • Page 1 of 1 FORM - SYSTEM PUNIPL\G RECORD Commonwealth of Massachusetts , Massachusetts System Pumping Record 'stem Owner Date of Pumpin@ L �-'� � � Quantity Pumped: Cesspool: No ,�/ ties ❑ SPntir Tanl•• X1- El Yes System Pumped by: License #: Contents transferred to: ? L ' Date Inspector A/, Commoof Massachusetts Massachusetts System Pumping Record System Owner System Location (03 71) k 1� 6z� Date of Pumping: Quantity Pumped: (52e-�gallons Cesspool: No Yes U Septic Tank: No U Yes System Pumped by: fat`edert 6(f&nh' m a License # Contents transferrred to : Greater Lawrence Sanitary District Date: Inspector: '17 F-- Board of Health North And_Over2JHaas. OK SEPTIC SISTER INSTA.d.ATICK CHECK LIST 1. Distance Tot ';'5 Re wetlands b. Drains c.. Well 2. Water Line Location 3. No .-VC Pipe 4. Sep Gia Tank a. _ "ees -_Length & To Clean Oat Corers b. .1ement Pipe to Tank On Both Sides of Tank 5. Distribution Boa a. Covers & Boic - No Cracks b. All. Lines ' Flowing Equal Amounts c. No Back Flow 6. beach n44 or Trench a. Dimensions b. Stone Depth c. Capped Inds d. Clean Double -Washed Stone 7. LF ich Pits. a. Dimensions b. Stone Depth c., Sp'.sh Pads d. Tees e. Cement Pipe to Pit - Both Sides f. lean DoubYe Washed Stone 8. No Garbage Disposal 9. -Fir al Grading Inspection 10. Barricading Covered System 11. As Built Submitted a. Lot Location b. Dimensions of System c. Location with Regard -to Pere Test d. Elevations e. Water Table 117 ... 14 AVATI Cit Old WL j 1 f• f Z�.�, M 242-303 • •'• I ,x:,95. j >i • •. '' Ib''•l,iilf • • • , f lilt �.l i:;•,' Therefore, the NACC hereby flnds that the following conditions are ; necessary, in accordancewith the Performance Standards set forth In the regulations, to protect those intend ests chocked above .�Tho NACC orders that all work shall be performed in accordance with said conditions and with the Notice of Intent referenced above. To the extent that the lotr lowing conditions modify or differ from the plans, specifications or other proposals submitted with the Notice'? of Intent, the conditions shall control. General Conditions • ! Y1f I 1. Failure to comply with all conditions stated herein, and with all.relatod statutes and other regulatory.meaa• ures. shall be doomed cause to revoke or modify this Order. ; •.r;,:� 2. This Order does not grant any property rights or any exclusive privileges; it does not authorize any Injury' to private property or Invasion of private rights.' '• : s �� �• 3. "This Order dons not rollovo the pormittoo or any other person of the necessity of complyin%g with all fi'ti'3 other applicable federal, state or local statutes. ordinances 'by-laws or regutztlons. 4, Tha work authorized hereunder shall be completed within three years from the date of this Order unless eitho� of the following apply (a) the work Is a maintenance dredging project,as provided for In the Act; o,_r :•'•.: (b) the time for completion has been extended to a specified date more than ttye© years, but less than five years, from the date of Issuance and both that date and the special circumstances warranting i the extended tlmo period are sot forth In this Order. tt 5. This Order may no extended by the issuing authority for one or more periods of up'to three years each upon applicatlon to the Issuing authority at least 30 days prior to the expiration date, of U4 Order. ,;.ns 6. Any rill used in connection with this project shall be clean fill, cont2lning no trash, refuse. rubbish or do• S' bris, including but not limited to lumber, bricks, -plaster, wire, lath.",, aper, cardboard, pipe, tires. ashes.' refrigerators. motor vehicles or parts of any of the foregoing.fY 7. No work shall be undertaken until all administrative appeal perlodti 7rom this Order have elapsed or, such an appeal has been flied,, until all proceedings before the Department have been completed. -! 8. No work shall be undertaken until the Final Order has been re-:orded in the Registry of Deeds or the Land - Court for the district In which the land is located. within the chain of Title of the affected property. In the,= — case of recorded land, the Final Order shall also be noted in the Registry's G`canntor Index under the name of the owner of the land upon which the proposed work -is to be doge. In the case of reg(stered land. the Final Order shall also be noted on the Land•Court Certificate of Title of the owner of the land upon which ' NACC __..• ' .. ' the proposed work is to be dono. The recording Information shall be submitted tothe on the form at the end of this Order prior to commencem"t of the worts. _ 9. A sign shall be displayed at the site not less than two square feet or•more than three square feet In slZe, ,' bearing the words, "Massachusetts Department of Environmental Quality Engineering, File Number. ?��.2-303 •" ; 10. Where the Department of Environmental Ouallty Engineering is requested to make a determination and to issue a Superseding Order, the Conservation Commission shall be a party to all agency proceedings is and hearings before the Department. • +' "- -- - 11. Upon completion of the work described herein, the applicant shall forthwith request in writing that a Certificate of Compliance be issued stating that the work has beeh satisfactorily completed. r¢;` • 12. The work shall conform to the following plans and special conditions: FA Health , ...4bdovertMass SUBSURFACE DIVOSAL DESIGN CiEICK LIST APPROVED VATS DISAPPROVED DATE Provided: Reasons: J I Title V Reg 2.5 Reg 6 Reg 10.2 Reg 10.4 MiefflEj LOT The submitted plan must show as a minimums a) the lot to be served-area,diamensions loi #,abutters b location and log deep observation Mee-ii.stance to ties c location and results percolation testa -C atance to ties d design calculations & calculations showilg required leaching area e) location and dimensions of system-in.eluo ;ng reserve area f) existing and proposed contours g) location any wet areas within 100' of at disposal system or disclaimer -check wetlands mapping h) surface and subsurface drains within W, of sewage disposal system or disclaimer i) location any drainage easements within 100- of sewage disposal systema or disclaimer -Planning Hoard filer J) known sources of water supply within 2001 of sewage disposal b . system or disclaimer k) location of any proposed well to serve lot -1001 from leaching facility 1) location of water lines on property -101 from leaching facility m) location of benchmark n) driveways o) garbage disposals p) no PVC to be used in construction q) profile of system -elevations of basement, plumb, pipe, septic tank, distribution box inlets and outlets, distribution field piping and Other elevations r) maximum ground water elevation in area sewage disposal system s) plan must be prepared by a Professional engineer or other professional authorized by law to prepaia such plans Septic Tanks a) capacities -150% of flow, water _table, to Rs, depth of tees, access, pumping b) cleanout c) 101 from cellar wall or inground sui: mi.L,; pool d) 251 from subsurface drains Distribution Boxes a) s ope greater 0.08 b) sump ` a C) p NN Y C