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HomeMy WebLinkAboutMiscellaneous - 100 VEST WAY 4/30/2018 (2)9 �Gs�9�s"�. �.,�n�Krr��C�o;rrc�cvcv s� ✓/� North Andover Board of Assessors Public Access 1 ORTy R SLE F `� ��iGH11 gS, y Return to the Home page click on loco New Search Sales Summary Residence Detached Structure Condo Commercial Comparable Sales '14ovm of North Axkdkovev Dowd Of ALrssessxmm Page 1 of 1 Property Record Card Parcel ID: 210/104.D-0019-0000.0 Community: North Andover SKETCH PHOTO Click on Sketch to Enlarge Click on Photo to Enlarge r. n� C 100 VEST WAY Location: 100 VEST WAY Owner Name: STONE, KENNETH M PATRICIA A STONE Owner Address: 100 VEST WAY City: NORTH ANDOVER State: MA ZIP: 01845 Neighborhood: 7 - 7 Land Area: 1.15 acres Use Code: 101 - SNGL-FAM-RES Total Finished Area: 2738 sqft ASSESSMENTS CURRENT YEAR PREVIOUS YEAR Total Value: 603,400 629,900 Building Value: 377,500 392,200 Land Value: 225,900 237,700 Market Land Value: 225,900 Chapter Land Value: LATEST SALE Sale Price: 330,000 Sale Date: 10/08/1987 Arms Length Sale Code: Y -YES -VALID Grantor: LOOSMORE, DONALD J Cert Doc: Book: 02605 Page: 0076 http://csc-ma.us/NandoverPubAcc/jsp/Home.jsp?Page=3&Linkld=1180586 2/12/2008 Commonwealth of Massachusetts W City/Town of System Pumping Record Form 4 r N%3V202U12 T0I/VR' OE hi.�R �;'I A; CCI'ER L HE. LTH 0L RT : NT . s. DEP has provided this form for use by local Boards of Health. Other forms may be used, but the 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: Left/ Right front of house, Left/ Right rear of house, Left/ ht a of house eft / Right side of building, Left / Right front of building, Left / Right rear of building, Under deck Address � % OO V e<. l�l� _ AzJ 0 Cityrrown 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): Zip Code State JaZip Code -q- ��� Telephone Number —� Dat�2. uantity Pumped: Cesspool(s) Septic Tank 4. Effluent Tee Filter present? 5. Condition of System: 6. System Pumped By: Neil Bateson Name Bateson Enterprises Inc- Company ncCompany Yes ❑ No W 7. Locgtiakwhere contents were disposed: Lowell Waste Water I, So i-') Gallons ❑ Tight Tank If yes, was it cleaned? ® Yes ❑ No F5821 Vehicle License Number IC'(gt Date t5form4.doc• 06/03 System Pumping Record • Page 1 of 1 .C-\ Commonwealth of Massachusetts _ a City/Town of R System Pumping Record , Form 4� 41.010 TOWN OP NORTH ANCAyER DEP has provided this form for use by local Boards of Health. Ot er WA1X WOMIM1159TIJU the information must be substantially the same as that provided here. a ore using i 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 front of house, right front of house, left side of housright side of house, eft rear of house, right rear of house, left side of building, right rear of building, un er e [©o �) �2'� �kj Cityrrown State Zip Code 2. System Owner: Name Address (if different from location) City/Town Zin "C e� Telephone Number B. Pumping Record 1. Date of Pumping Date 2. Quantity Pumped: 3. Type of system: ❑ Cesspool(s) eptic Tank ❑ Other (describe): 4. Effluent Tee Filter present? Yes ❑ No 5. Condi ai".of 6. System Pumped By: Neil J. Bateson rj Name Bateson Enterprises Inc. Company Gallons ❑ Tight Tank If yes, was it cleaned? es No -�A �-k--6c ao e contents were disposed: 7n" L.S.Q. owell WaAtekVater of F5821 Vehicle License Number Date 't +Z:;;(� —r 5 --cc) t5form4.doc• 06/03 System Pumping Record • Page 1 of 1 Commonwealth of Massachusetts City/Town of ° System Pumping Record Form 4 DEP has provided this form for use by local Boards of Health. information must be substantially the same as that provided h local Board of Health to determine the form they use. The Sys the local Board of Health or other approving authority. A. Facility Information 1. System Location: Left front of hous rright front of hi rear of house, right rear of house, le Cityrrown 2. System Owner: Name Address (if different from location) City/Town B. Pumping Record 1. Date of Pumping 3. Type of system: ❑ ❑ Other (describe): erW-Iy`Te'used, ut the �o.� *Ddvnm check with your IltTiast'be submitted to left side of house, right side of house, Left hf ria-mr of ha dWinn i tnAcr r1onL State Zip Code CAAS Telephone Number CC -1 5---1 v Date 2. Quantity Pumped: Cesspool(s) Septic Tank Gallons ❑ Tight Tank 4. Effluent Tee Filter present? ❑ Yes No If yes, was it cleaned? ❑ Yes ❑ No 5. Condi 'on of System: fu 6. System Pumped By: Neil J. Bateson Name Bateson Enterprises Inc. Company 7. LocationNhere contents were disposed: L. F5821 Vehicle License Number Date t5form4.doc• 06/03 System Pumping Record • Page 1 of 1 V PUBLIC HEALTH DEPARTMENT fommunity Development Division C�E1�7IE7CAZE OrF C0914PLI,39WE As of: September 4, 2009 This is to cert that the individuafsukurface d�.sposaCsystem received a S,9q ST,9C` 0RT1AS(ECg70 V'of the. Complete ftair of tFie Septic Vsposal'System By: James KPffett At: 100 Vest Way Slap —1040; Tarcel —19 NorthAndover, 91A 01845 The Issuance of this certificate shaft not 6e construed as a guarantee that the system will' function sat actoricy. Yfeafth (Director 1600 Osgood Street, North Andover, Mossachusetts 01845 Phone 918.688.9540 Fax 918.688.8416 Web www.townofnorfhandover.com �L\ Commonwealth of Massachusetts City/Town of NORTH ANDOVER Certificate of Compliance Form 3 M y y Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. IQ DEP has provided this form for use by local Boards of Health. Other forms may be used, but the information must be substantially the same as that provided here. Before using this form, check with the local Board of Health to determine the form they use. This is to Certify that the following work on an On -Site Sewage Disposal System ❑ Construction of a new system ® Repair or replacement of an existing system ❑ Repair or replacement of an existing system component Has been done in accordance with Title 5 and the Disposal System Construction Permit (DSCP): DSCP NumberDSCP Date Facility Owner 100 VEST WAY Street Address or Lot # NORTH ANDOVER MA 01845 Cityrrown State Zip Code Designer Information: BENJAMIN C OSGOOD JR. Na Name of Company i 9-2-09 Signatur Date Installer Information: G( c Na Name of Company l-2 Sido6ture Date Use of this system is conditioned on compliance with the provisions set forth below: The issuance of this certificate shall not be construed as a guarantee that the system will function as designed. Approving Authority Signature Date t5form3.doc• 06/03 Certificate of Compliance • Page 1 of 1 Blank DelleChiaie, Pamela Page 1 of 1 From: Marianne Peters[mpeters@millriverconsulting.com] Sent: Wednesday, July 16, 2008 3:44 PM To: 'Daniel Ottenheimer'; Isaac Rowe; Grant, Michele; DelleChiaie, Pamela; 'Randy Burley'; Sawyer, Susan Subject: Construction Inspection Report -100 Vest Way -July 1, 2008 Attached is the construction inspection report for 100 Vest Way; call if questions. nx Right -click here to download pictures. To help protect your privacy, Outlook prevented automatic download of this pictu Marianne Peters Office Manager ph 800-377-3044 ph 978-282-0014 fx 978-282-0012 web: }pww.millriverconsWting.com 7/17/2008 pORTM O� aD r6 q�0 OL O A� n !y O'O_ GGKWGWwKx , 7' PUBLIC HEALTH DEPARTMENT (ommunity Development Division ONSITE WASTEWATER SYSTEM CONSTRUCTION NOTES LOCATION INFORMATION ADDRESS: 100 Vest Way MAP: 104D LOT: 19 INSTALLER: Jim Kellett DESIGNER: Ben Osgood PLAN DATE: 3/25/08 BOH APPROVAL DATE ON PLAN: 6/3/08 INSPECTIONS TANK INSPECTION: DATE OF BED BOTTOM INSPECTION: bl)41 DATE OF FINAL CONSTRUCTION INSPECTION: 7/1/08 DATE OF FINAL GRADE INSPECTION: SITE CONDITIONS Comments: SEPTIC TANK ® Contractor reports any changes to design plan ® Existing septic tank properly abandoned ® Internal plumbing all to one building sewer ® Topography not appreciably altered — raised building Sewer at house ® Building sewer in continuous grade, on compacted firm base ❑ Cleanouts per plan (N/A) ❑ Bottom of tank hole has 6" stone base ® Weep hole plugged ® 1500 gallon tank has been installed H-10 loading mono concrete construction ❑ Watertightness of tank has been achieved by 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 978.688.9540 Fox 978.688.8476 Web www.townofnorthandover.com Inspection Form June 2008 Comments: PUMP CHAMBER NORTH O� 41"D '61 gtiO 6 OL O cocNliriwaw . 1' PUBLIC HEALTH DEPARTMENT Community Development Division testing ® Inlet tee installed, centered under access port ® Outlet tee installed, centered under access port effluent filter Zabel ® 24" cover to within 6" of final grade installed over one access port, must be to grade and over outlet of tank if effluent filter is present ® Hydraulic cement around inlet & outlet ® Separate circuits pump/alarm ® Weep hole plugged ® 1000 gallon Pump Chamber installed H-20 loading monolithic construction) ® Inlet tee installed, centered under access port ® Pump(s) installed on stable base ® Alarm float working ® Pump On/Off floats working ® Separate on/off floats ® Drain hole in pressure line ® 24" cover at final grade installed over pump access port ❑ Water tightness of tank has been achieved by testing ® Hydraulic cement around inlet & outlet Comments: Hydramatic pump DISTRIBUTION -BOX 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 918.688.9540 Fax 918.688.8416 Web www.townofnorthandover.com Inspection Form June 2008 tAORTH q O 4""D '6s 6 OL O As t` 'A O C OCMKMIwKN 1� PUBLIC HEALTH DEPARTMENT Community Development Division ® Installed on stable stone base ® Inlet tee (if pumped or >0.08'/foot) ® Hydraulic cement around inlet & outlets ® Observed even distribution Comments: SOIL ABSORPTION SYSTEM (General) Bottom of SAS excavated down to 6 in into C soil layer, as provided on plan Size of SAS excavated as per plan ® Title 5 sand installed, if specified on plan ® 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 ❑ Retaining wall (boulder / concrete / timber/ block) ❑ Final cover as per plan Comments: Barrier at top of chambers. SOIL ABSORPTION SYSTEM (Gravel -less Chambers) ® Brand and Model of Chamber: Infiltrator Standard Quick 4 ® Number of chambers per row: 12 ® Number of rows (trenches): 6 Comments: 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com Inspection Form lune 2008 p'tt�ac ,6=•NO\ �? �'` ' l� O H � � O urs q_ COCMICMIwKN . 7� PUBLIC HEALTH DEPARTMENT (ommunity Development Division CONTROL PANEL Z Alarm & Pump are on separate circuits ® Alarm sounds when float is tripped Z Location of control panel: basement ❑ Rated for exterior if placed outside Z Alarm signal located inside Comments: SYSTEM ELEVATIONS 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.towoofnorthondover.com Inspection Form June 2008 INVERT IN FIELD PLAN INVERT ELEV. Benchmark 100 Building Sewer OUT 98.00 Septic Tank IN 97.25 97.90 Septic Tank OUT 96.99 97.73 Pump Chamber IN 96.95 97.70 2" Pump Chamber OUT 97.31 97.95 4" Distribution Box IN 101.65 101.62 Distribution Box OUT 101.47 101.45 Chambers IN 101.29 101.35 Bottom SAS 100.65 100.68 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.towoofnorthondover.com Inspection Form June 2008 v'tt`ec l6'.NO\ 0 A� PUBLIC HEALTH DEPARTMENT (ommunity Development Division CRITICAL SETBACK DISTANCES Mark those distances checked in the field against the design plan and regulatory setback ® Property line ® Cellar wall ® Deck, on footings, etc ® Waterline ❑ Bordering Vegetated Wetland , Salt Marsh, Inland / Coastal Bank2 Tank SAS Sewer 10 10 -- 10 20 -- 5 10 -- 10 10 101 75 <100 but > than 50 1 Suction line 222(2) 2 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 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com Inspection Form June 2008 r t NOR4rr, Commonwealth of Massachusetts Map -Block -Lot 104. D- 0019 - ? -------- Board of Health Permit No a BHP -2008-0137 A North Andover • e� .. - . ' P.I. FEE �ss�cwustc F. 1. $250.00 ----------------------- Disposal Works Construction Permit Permission is hereby granted James Kellett ----------------------------------------- ---------------------------------------------- to (Repair) an Individual Sewage Disposal System. at No 100 VEST WAY - - - -------------------------------------------------------------------- as shown on the application for Disposal Works Construction Permit No. BHP -2008-013 Dated __June 16,_2008 j -- ---------------------- 1ssued On: Jun -16-2008 Board of Health 3 t , v :•:��L f F Town of North Andover �M'•:• HEALTH DEPARTMENT ,SSwCHU$ CHECK #: _9 DATE: LOCATION: x0o..S v / H/O NAME: d/ CONTRACTOR NAME: Type of Permit or License: (Check box) ❑ Animal ❑ Body Art Establishment ❑ Body Art Practitioner ❑ Dumpster ❑ Food Service - Type: ❑ Funeral Directors ❑ Massage Establishment ❑ Massage Practice ❑ Offal (Septic) Hauler ❑ Recreational Camp ❑ Sun tanning ❑ Swimming Pool ❑ Tobacco ❑ Trash/Solid Waste Hauler ❑ Well Construction SEPTIC Systems: ❑ Septic - Soil Testing ❑ Septic - Design Approval eptic Disposal Works Construction (DWC) ❑ Septic Disposal Works Installers (DWI) ❑ Title 5 Inspector ❑ Title 5 Report ❑ Other: (Indicate) $ Health Agent Initials White - Applicant Yellow - Health Pink - Treasurer Of NOioT;,tio Application for Septic Disposal System �: °�'� �� `� `Construction Permit — TOWN OF ORTH ANDOVER. MA 01845 Important: Application is hereby made for a permit to: When filling out ❑ Construct a new on-site sewage disposal system* forms on the computer, use Repair or replace an existing on-site sewage disposal system* only the tab key to move your ❑ Repair or replace an existing system component — What? cursor - do not use the return key. A. Facility Information ioo V est woi Y VQ Address or Lot # No tk ANJOU121L City/Town 2.- *TYPE OF SEPTIC SYSTEM*: A2ump ❑ Gravity (choose one) ***If pump system, attach copy of electrical permit to application*** nent ❑ Conventional System (pipe and stone system) ,Infiltrator or Biodiffuser (Gravel -Less) (Attach a copy of your certification to install this type of system. ❑ Pressure Distribution S.A.S. (No D -Box) (Attach Draft Maintenance Agreement) ❑ Pressure Dosed (D -Box Present) S.A.S. 2. Owner Information Ken 'Shone— Name Address (if different from above) 016-7,5 - &'04t Ayubu t'l 01944 City/Town State Zip Code '� -7 G 5?- Telephone Number 3. Installer Information ` ame Z%VU �Gi%Cr� �f Name of Company Address Cityrro(vn State Zip Code Telephone Number (Cell Phone # if possible please) 4. Designer Information �J i Name Name of Company 01 2- y Address City/Town State Zip Code i7,)'- / 7 Telephone Number (Best # to Reach) Application for Disposal System Construction Permit • Page 1 of 2 *� pE NOF7rq Application for Septic Disposal Svstem �r `AConstruction Permit - TOWN OF *� • ORTH ANDOVER, MA 01845 PAGE 2OF2 A. Facility Information continued.... 5. Type of Building: Residential Dwelling or ❑Commercial B. Agreement __ TODA 'S DAIrE $ 250.00 - Full Repair $125.00 - Component 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 NorA Andover, and not to place the system in operation until a Certificate of Compliance has bedp Yssued by this 13odrd of,Health. Name hgh � Date Applica i n Approved By: and of Health Representative) f,Na `` Date Application Disapproved for the following reasons: For Office Use Only: 1. Fee Attached. 2. Project Manager Obligation Form Attached. 3. Pump System? Ifso, Attach copy ofElecuical Permit 4. Foundation As-Buiit? (new construction ronly): (Same scale as approved plan) 5. Floor Plans? (new construction only): Yes C✓ No Yes No Yes v No No No Application for Disposal System Construction Permit • Page 2 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: !to Qes� wav� (.-Address of septic system) Y For plans by (Engineer) Relative to the application of ��) }n Ke I I l (Installer's name) And dated 3 ` Zs– — O Y ngma ate Dated l U � 1 L_ 0 D o ay s 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 compan,. a. Bottom of Bed — Generally, this is the first (ls� 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 septic 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 ofHealth 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 approved plans. No instructions by the homeowner, eeneral contractor, or any other persons shall absolve me of this obligation. Undersigned Licensed Septic Installer: GAl Sa� pi 1 ee- 40 arae —Print) d d r1 (Today's 16 Date ......0.: ��.... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that . ........ ...... ................................................ .. has permission to perform . wiringin the building of................................................................................. .......... .............................. . North Andov . F ................ Lic. No !¢................................................. ....... . ... �,ecrivcN, irsracroa Check # 9/0 8179 Sawyer, Susan From: benjaminosgood@comcast.net Sent: Wednesday, August 26, 2009 7:45 PM To: stonekm@comcast.net Cc: Sawyer, Susan Subject: 100 Vest Way Ken, I am in receipt of your email regarding the certificate of compliance for your property. I will tell you what really happened. 1.We did an as built survey of the septic system and found that Jim had installed the septic tank lower than designed which would possibly be in violation of the requirement that the inverts of the septic tank be above the ground water. 2. We prepared an as built plan and submitted the plan to the board of health with a notation regarding the problem. I did not sign a certification because I can not sign off stating that the system is in compliance when it is not. 3. 1 discussed the situation with either Susan Sawyer or Michelle Grant at the time and it was decided that a test pit should be done in the area of the septic tank to verify the exact elevation of the water table. If the water table was below the inverts then I could make a notation on the as built and sign the certificate of compliance. 4. 1 contacted Jim Kellet regarding the situation and he said that he did not want to bring a backhoe on the site so he would have to dig by hand. He was going to get back to me as to when he was available and we would arrange to have the Board of Health on site at the same time to verify what we found. That was the last discussion I had regarding the issue and I was never contacted by Jim. As you may or may not know I closed my business and now work for Pennoni Associates. What this means is that I am limited as to when I could be at your house to perform any type of soil exploration. The only time I can be available that meets your time table is Friday afternoon or Saturday. If we were to do the excavation on Friday or Saturday I could have the revised as built and certification to you by Monday. One other issue, the mistake was not caused by New England Engineering or myself. Therefore I will need to be paid for my time. This should not take more than 2 hours which would mean the fee would be 300 dollars. You are welcome to contact me tomorrow by email at bosgood ,pennoni.com or on my cell phone at 978-435-1324. Ben Sawyer, Susan From: stonekm@comcast.net Sent: Wednesday, August 26, 2009 5:05 PM To: Sawyer, Susan Subject: Re: 100 Vest Way Thank you, Susan. I have also telephoned Jim Kellett who said he remembers this issue addressed satisfactorily. Regards, Ken Stone ----- Original Message ----- From: "Susan Sawyer"<ssawyer@townofnorthandover.com> To: "Benjamin C.' 'Osgood" <BOsgood@Pennon i.com> Cc: "stonekm@comcast.net" <stonekm@comcast.net>, "Michele Grant" <mgrant@townofnorthandover.com> Sent: Wednesday, August 26, 2009 4:30:41 PM GMT -05:00 US/Canada Eastern Subject: 100 Vest Way Hello Ben, I am contacting you about 100 Vest Way. Mr. Stone is looking for his Certificate of Compliance. I checked our files and found that the installation final inspection was conducted on July 1, 2008 by our consultant. Your As -built dated July 9, 2009 noted the elevations of the tank invert at elevation 97.22 and the estimated ground water at 97.59. 1 have a handwritten note stating that you had been contacted and would get back to us on what Mr. Kellett was going to do about the issue. The file has no other additions after that. We are missing: 1) An answer to the initial question above 2) The installation certification form which both you and Jim Kellett would sign. 3) And finally the issuance of the COC This is extremely important to the owner that we close this file as soon as possible. Please contact the office tomorrow morning if possible. Thank you Susan Sawyer 978 688-9540 rage 1 of 1 DelleChiaie, Pamela From: DelleChiaie, Pamela Sent: Tuesday, June 03, 2008 2:47 PM To: 'stonekm@comcast.net' Cc: Osgood Ben (bosgood@neengineeringinc.com); Kimberly J. Brown (KBrown@NEengineeringinc.com); Sawyer, Susan Subject: FW: 100 Vest Way - Plan Approval Letter with Local Upgrades Importance: High From: noreply@yourcopier.com [mailto:noreply@yourcopier.com] Sent: Tuesday, June 03, 2008 3:42 PM To: DelleChiaie, Pamela Subject: 100 Vest Way - Plan Approval Letter with Local Upgrades 6/3/2008 o * � yy �•4_ LOLM�L ML KM � 1 T PUBLIC HEALTH DEPARTMENT Community Development Division June 3, 2008 Ken Stone 100 Vest Way North Andover, MA 01845 RE: Subsurface Sewage Disposal System Plan for 100 Vest Way, Map 104D, lot 19, North Andover, Massachusetts Dear Mr. Stone, The North Andover Board of Health has completed the review of the septic system design plans, for the above referenced property, submitted on your behalf by New England Engineering Services, Inc. dated March 25, 2008, last revised April 16, 2008. The design has been approved for use in the construction of a replacement onsite septic system. The time period for which this plan is valid is two years from the date of a septic system inspection that did not meet the acceptable criteria in the state regulations, February 8, 2008. During this time, a licensed septic system installer must obtain a permit and complete this work, and a Certificate of Compliance be endorsed by the installer, designer and the Town of North Andover. In the event an imminent health problem such as sewage backup into the dwelling is occurring, the North Andover Board of Health may reduce the time period for which this plan is valid. The following local upgrades were approved at the May 22, 2008 Board of Health meeting: 1) Reduction in separation distance between the ESHGW and septic tank inverts from 12 inches required by Title 5 to 1 inch 2) Allow the use of a sieve analysis to determine loading rate in lieu of a percolation test. 3) Reduction in separation distance between the bottom of the leach field and the ESHGW from 4 feet required by Title 5, to 3 feet. This approval is also subject to the following conditions: 1. Please keep the attached DEP Form 9b for your records 2. 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)). 3. 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 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 978.688.9540 Fox 978.688.8476 Web www.townofnorthandover.com i . 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. 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. Sincerely Su an Y. Sawyer, REHS/RS Public Health Director cc: Ben Osgood, Jr., P.E. file 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: DelleChiaie, Pamela Sent: Tuesday, June 03, 2008 9:12 AM To: Sawyer, Susan Subject: FW: Draft Minutes - May 22, 2008 Hi Susan, Ken Stone, the homeowner from 100 Vest Way called looking for a plan approval letter with the decision from the meeting. Attached are the draft minutes if you want to cut and paste into the approval letter. Pam From: DelleChiaie, Pamela Sent: Friday, May 30, 2008 11:46 AM To: Anne L. Brennan (abrennan@wingatehealthcare.com); Francis P. MacMillan (fpmacmillan@comcast.net); Joseph McCarthy (joemccvam@comcast.net); Larry Fixler (Ifboardofhealthnorthandover@yahoo.com); Thomas Trowbridge (tat.boh@comcast.net) Cc: Sawyer, Susan Subject: Draft Minutes - May 22, 2008 Please review and send back any comments within the next couple of weeks. Thanks. Pamela 6/3/2008 Motion 1 Mr. McCarthy made a motion to accept the Clerk Magistrate's decision to negate the fine. The motion was seconded by Dr. MacMillan. Motion 2 Mr. McCarthy made a motion to suspend the tobacco license for seven -days. The motion was seconded by Dr. MacMillan. III. APPROVAL OF MINUTES A. Meeting Minutes from April 17, 2008 to be presented for approval— Mr. Fixler was not present at the meeting. The minutes will be signed at the June 26`" Board'meeting. \ IV. OLD BUSINESS A. Update on the TBI Process The last Board of Selectmen meeting rendered an approval for the license for the recyclable agreement between the Town of North Andover and TBI. The Attorney, Jonathan Klavens, prepared a summary of the negotiations. Dr. Trowbridge passed the information around. The Board of Health was empowered by the Town to act as a liaison, but is not directly involved in implementing all the tasks with TBI. Recycling pickup will start in mid-June. Dr. MacMillan asked about updates on, `the traffic light. ,There were some notations that were discussed. Dr. Trowbridge and Ms. Sawyer made a list of items.that BOH needs to work on. Some items pertain to Conservation or Police. There are 10 items that need to be addressed in the near future. The facility may start building by the end of the summer. V. NEW BUSINESS A. 100 Vest Way— Local Upgrade Approval'requests by Ben Osgood Jr., New England Engineering 1. Reduction in separation distance between the ESHGW and Septic Tank inverts from 12" required by Title 5 Section 15.227 (5) to 1 " This site has very high groundwater. The dashed lines on the plan represent the existing topography. The elevations were noted. There is a slope with exposed bedrock. This is a reason there was no % additional'soil suitable for testing. Therefore, they needed to keep the system close to the house. ' There are wetlands to the right and left of the home. This is to be I" above the water table. Dr. Trowbridge asked what the invert is. The invert is the bottom elevation of the pipe. The invert should \.not be below the water. Concrete and plastic do not mix well where the pipe comes through the wall of the tank, so that groundwater is not infiltrating the septic system. 2. \ Allow the use of a sieve analysis to determine loading rate in lieu of a percolation test. Allowed by DEP Policy #BRP/DWM/PeP-Poo-1 and Title 5, Section 15.405(1 i) In February a hole was excavated, and water poured in. A sample of the soil was sent to U -mass and they do a grain size analysis. They classify the soil. That gives them the loading rate, which was determined,,to be Class 2 soil. When there is no percolation test, they take the worst loading rate, which is .33 gallons per square foot. 3. Reduction in separation distance between the bottom of the leach field and the ESHGW from 4' required by the Title 5 Section 15.212 (la) to 3'. Dr. MacMillan noted that there are some site specific issues in the back yard that would justify this reduction. Way 22, 2008 North Andover Board of Health Meeting — Meeting Agenda Page 2 of 6 Note: The Board of Health reserves the right to take items out of order and to discuss and/or vote on items that are not listed on the agenda. Board of Health Members: Thomas Trowbridge, DDS, MD, Chairman, Larry Fialer, Member/Clerk, Anne Brennan, Member, Joseph McCarthy, Member, Francis P. MacMillan, Jr., M.D., Health Department Staff: Susan Sawyer, Health Director; Debra Rillahan, Public Health Nurse; Michele Grant, Public Health Inspector; Pamela DelleChiaie, Health Department Assistant Commonwealth of Massachusetts City/Town of Local Upgrade Approval Form 913 4tM SV By,w Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. —I� DEP has provided this form for use by local Boards of Health if they choose to do so. The Local Upgrade Approval is to be completed by the local Board of Health and a signed copy provided to the system owner. A. Facility Information 1. Facility Name and Address Ken Stone Name 100 Vest Way Street Address North Andover City/Town 2. Owner Name and Address (if different from above): MA State Name Street Address City/Town State Zip Code 3. Type of Facility (check all that apply): ® Residential ❑ Institutional 4. Design flow per 310 CMR 15.203: gpd Ben Osgood Jr. Name North Andover 01845 Telephone Number ❑ Commercial ❑ School 440 5. System Designer: 1600 Osgood Street Address B. Approval City/Town 1. Local Upgrade Approval is granted for: ❑ Reduction in setback(s) — specify: ❑ Reduction in SAS area of up to 25%: State, ZIP 01845 Zip Code SAS size, sq. ft. % reduction 100 Vest Way 9b 5.16.08 • rev. 7/06 Local Upgrade Approval* Page 1 of 2 Commonwealth of Massachusetts City/Town of a a o Local Upgrade Approval Form 9B �lly SBy`' B. Approval (continued) ® Reduction in separation between the SAS and high groundwater: Separation reduction Percolation rate Depth to groundwater ❑ Relocation of water supply well (explain): 1 ft. >5 min min./inch 3 f ft. ® Reduction of 12 -inch separation between inlet and outlet tees and high groundwater ❑ Use of only one deep hole in proposed disposal area ® Use of a sieve analysis as a substitute for a perc test List local variances granted not requiring DEP approval per 310 CMR 15.412(4): List variances granted requiring DEP approval: North Andover Board of Health Ap2mving Authority Print or Type Name and Title c-YA- //2 J`i-A-N Date 100 Vest Way 9b 5.16.08 • rev. 7/06 Local Upgrade Approval* Page 2 of 2 Commonwealth of Massachusetts --- City/Town of No. Andover - Form 9A — Application for Local Upgrade Approval DEP has provided this form for use by local Boards of Health. Other forms may be used, but the 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. Form 9A is to be submitted to the Local Board of Health for the upgrade of a failed or nonconforming septic system with a design flow of less than 10,000 gpd, where full compliance, as defined in 310 CMR 15.404(1), is not feasible. Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. System upgrades that cannot be performed in accordance with 310 CMR 15.404 and 15.405, or in full compliance with the requirements of 310 CMR 15.000, require a variance pursuant to 310 CMR 15.410 through 15.415. NOTE: Local upgrade approval shall not be granted for an upgrade proposal that includes the addition of a new design flow to a cesspool or privy, or the addition of a new design flow above the existing approved capacity of an on-site system constructed in accordance with either the 1978 Code or 310 CMR 15.000, A. Facility Information 1. Facility Name and Address: Ken Stone Name 100 Vest Way Street Address No. Andover CitylTown 2. Owner Name and Address (if different from above): Same as Above Name City/Town Zip Code 3. Type of Facility (check all that apply): ® Residential ❑ Institutional 4. Describe Facility: Single Family Dwelling 5. Type of Existing System: MA State Street Address State Telephone Number ❑ Commercial ❑ School 01845 Zip Code ❑ Privy ❑ Cesspool(s) ® Conventional ❑ Other (describe below): 6. Type of soil absorption system (trenches, chambers, leach field, pits, etc): Leach Field Form 9A Application for Local Upgrade Approval revised.doc • rev. 7106 Application for Local Upgrade Approval* Page 1 of 4 Commonwealth of Massachusetts City/Town of No. Andover Form 9A - Application for Local Upgrade Approval DEP has provided this form for use by local Boards of Health. Other forms may be used, but the 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. A. Facility Information (continued) 7. Design Flow per 310 CMR 15.203: Design flow of existing system: Design flow of proposed upgraded system Design flow of facility: S. Proposed Upgrade of System 1. Proposed upgrade is (check one): 440 gpd 440 gpd 440 ❑ Voluntary ❑ Required by order, tetter, etc. (attach copy) ® Required following inspection pursuant to 310 CMR 15.301: Unknown date of inspection 2. Describe the proposed upgrade to the system: Replace leach field and system components 3. Local Upgrade Approval is requested for (check all that apply): ❑ Reduction in setback(s) — describe reductions: ❑ Reduction in SAS area of up to 25%' SAS size, sq. ft. Reduction in separation between the SAS and high groundwater: Separation reduction 1 Percolation rate Depth to groundwater ft. >.5 minlinch min./inch 3 ft. % reduction Form 9A Application for Local Upgrade Approval revised.doc • rev. Application for Local Upgrade Approval* Page 2 of 4 Commonwealth of Massachusetts City/Town of No. Andover -= a Form 9A — Application for Local Upgrade Approval pp pg pp DEP has provided this form for use by focal Boards of Health. Other forms may be used, but the 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. B. Proposed Upgrade of System (continued) ❑ Relocation of water supply well (explain): ® Reduction of 12 -inch separation between inlet and outlet tees and high groundwater ❑ Use of only one deep hole in proposed disposal area ® Use of a sieve analysis as a substitute for a perc test ❑ Other requirements of 310 CMR 15.000 that cannot be met —describe and specify sections of the Code: If the proposed upgrade involves a reduction in the required separation between the bottom of the soil absorption system and the high groundwater elevation, an Approved Soil Evaluator must determine the high groundwater elevation pursuant to 310 CMR 15.405(1)(h)(1). The soil evaluator must be a member or agent of the local approving authority. High groundwater evaluation determined by: Randy Burley Evaluator's Name (type or print) C. Explanation Signature 2-26-08 Date of evaluation Explain why full compliance, as defined in 310 CMR 15.404(1), is not feasible. (Each section must be completed) 1. An upgraded system in full compliance with 310 CMR 15.000 is not feasible: No other location on the lot 2. An alternative system approved pursuant to 310 CMR 15.283 to 15.288 is not feasible: An alternative system is not cost prohibitive. Form 9A Application for Local Upgrade Approval revised.doc • rev. Application for Local Upgrade Approval* Page 3 of 4 7/08 Commonwealth of Massachusetts City/Town of No. Andover - = Form 9A — Application for Local Upgrade pgrade Approval = DEP has provided this form for use by local Boards of Health. Other forms may be used, but the 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. C. Explanation (continued) 3. A shared system is not feasible: No other adjacent is available 4. Connection to a public sewer is not feasible: Public sewer is not available in the area. 5. The Application for Local Upgrade Approval must be accompanied by all of the following (check the appropriate boxes): ❑ Application for Disposal System Construction Permit ❑ Complete plans and specifications ❑ Site evaluation forms ❑ A list of abutters affected by reduced setbacks to private water supply wells or property lines. Provide proof that affected abutters have been notified pursuant to 310 CMR 15.405(2). ❑ Other (List): D. Certification "I, the facility owner, certify under penalty of law that this document and all attachments, to the best of my knowledge and belief, are true, accurate, and complete. i am aware that there may be significant consequences for submitting false information, including, but not limited to, penalties or fine and/or imprisonment for deliberate violations." Facility Owner's Signature Benjamin C. Osgood Jr. P.E. (Agent for Owner) Print Name New England Engineering Services, Inc. 1600 Osgood Streeet Preparer's address 01845 State/ZIP Code Form 9A Application for Local Upgrade Approval revised.doc • rev. 7/06 — . 3/Z 64911 Date 3125108 Date No. Andover, MA City(rown (978)686-1768 Telephone Application for Local Upgrade Approval- Page 4 of 4 G Health Department April 11, 2008 Mr. Benjamin C. Osgood, Jr., P.E. 1600 Osgood Street Building 20, Suite 2-64 North Andover, MA 01845 Re: Septic System Repair Plan for 100 Vest Way - Man 104D, Lot 19 Dear Mr. Osgood: The proposed wastewater system design plan for the above site dated March 25, 2008 and received on April 1, 2008 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 clearly indicate the name and address of the record owner (NA 8.02j) 2. Please depict the location of the water line which serves the dwelling and also confirm the water line meets the required setback distances (15.220(4)(m)) 3. Please cite Title 5 for Local Upgrade approval 42 on the plan (220(4)) 4. Please indicate if the system is to be located in a nitrogen sensitive area or not (214 & 215) 5. Please revise General Note #6 to read, "There are no bordering vegetated wetlands within 115 feet..." 6. Please indicate whether there are any public wells within 400 feet of the system (211) 7. As leaching trenches are the preferred system please provide and explanation as to why a design utilizing trenches was not chosen (15.240(6)) 8. Please list the building sewer pipe to the septic tank diameter (222(1)) 9. Please provide the building sewer elevation 10. Note 12 of the construction notes states the plumbing is to be modified to a new invert shown; the note on the system profile states the invert is to remain the same; please clarify 11. Please depict an effluent filter on the septic tank detail 12. Please indicate the septic tank covers are to be "child -proof' (221 & 228(1)) 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 0 13. Buoyancy calculations for the septic tank and pump chamber seem to be incorrect; it appears a water -table of 2.4 feet below grade was used; TP -1, which is closest to the tanks had a water -table of 14 inches; please revise or clarify 14. Sheet 1 indicates for the septic tank to be "reversed"; sheet 2 calls for the existing septic tank to "remain"; please clarify 15. Please specify protection for the system vent from precipitation and animal entry (15.241(1)(b)) 16. In the design data it is stated, "0.33 gallons per day/440=1,333.33"; please revise 17. In the system profile TP -2 is cited for the groundwater reference; though TP -1 should be used as it is the more restrictive data of the two test pits 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. Sincerel , F S san Y. Sa r, REH S Public Health Director 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 2 of 2 Fax: 978.688.8476 r aSQ i vi i Sawyer, Susan From: Dan Ottenheimer [info@milIriverconsulting.com] Sent: Thursday, May 15, 2008 11:41 AM To: Sawyer, Susan Subject: 100 Vest Way As requested I had an opportunity to look at the 100 Vest Way wastewater system design plan, and specifically the Local Upgrade Approval requests associated with that design. - LUA for ESHGW and tank inverts — this is generally unavoidable unless the basement would allow the plumbing to be re-routed to exit elsewhere. Assuming the tanks need to be placed where depicted then I would recommend the Board grant the LUA and think about a condition which would be that the tanks be manufactured with cast -in-place rubber boots. This will help assure watertightness. - LUA for sieve analysis — this is unavoidable and should be granted. If the designer wishes to try go back and perform a percolation test when the ground might be drier they might be able to use a higher loading rate and reduce the size of the SAS. This is not a requirement of the Board's but could be brought up as a suggestion. - LUA for reduced groundwater offset — the applicant has not provided any reason for this LUA to be granted. It seems the SAS could be designed to be fully complying with Title 5 and not need this LUA. Compliance could be achieved wither with a 4' separation to GW using a conventional system or a 2' separation to GW using a treatment unit either would be acceptable. The latter option might end up with improved aesthetics and likely even a reduce construction cost — but that is only a suggestion not a requirement. I did not see the LUA Application form in our files. It is possible it got misplaced but it would certainly need to have been submitted by the designer to accompany this plan for the Board to act on the matter. Dan Mill River. 'consultln ~ Daniel Ottenheimer, President Mill River Consulting, Inc. ©n -Site ff"astewaterAlanagement 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 5/15/2008 DelleChiaie, Pamela From: DelleChiaie, Pamela Sent: Wednesday, April 23, 2008 11:08 AM To: Osgood Ben (E-mail); Kimberly J. Brown (E-mail) Cc: Sawyer, Susan Subject: 100 Vest Way - LUA Importance: High Hi, We have two plans with sheet 1, but no sheet 2. Can you print out two copies of sheet two for plans revised on 4/16/08? You are scheduled to be at the next BOH meeting on Thursday, May 22nd at 7:00 p.m., per your request for an LUA. Thank you. gost Ro#afds, Pw�yaBw DaB�aG�lliwle Health Department Assistant Town of North Andover 1600 Osgood Street Building 20, Suite 2-36 North Andover, MA o1845 `978.688.9540 - Phone A 978.688.8476 - Fax http://www.townofnorthandover.com healthdept@townofnorthandover.com _7 Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. tab r Commonwealth of Massachusetts City/Town of No. Andover Form 9A - Application for Local Upgrade Approval DEP has provided this form for use by local Boards of Health. Other forms may be used, but the 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. Form 9A is to be submitted to the Local Board of Health for the upgrade of a failed or nonconforming septic system with a design flow of less than 10,000 gpd, where full compliance, as defined in 310 CMR 15.404(1), is not feasible. System upgrades that cannot be performed in accordance with 310 CMR 15.404 and 15.405, or in full compliance with the requirements of 310 CMR 15.000, require a variance pursuant to 310 CMR 15.410 through 15.415. NOTE: Local upgrade approval shall not be granted for an upgrade proposal that includes the addition of a new design flow to a cesspool or privy, or the addition of a new design flow above the existing approved capacity of an on-site system constructed in accordance with either the 1978 Code or 310 CMR 15.000. A. Facility Information 1. Facility Name and Address: Ken Stone Name 100 Vest Way Street Address No. Andover MA 01845 City/Town State Zip Code 2. Owner Name and Address (if different from above): Same as Above Name City/ rown Zip Code 3. Type of Facility (check all that apply): ® Residential ❑ Institutional 4. Describe Facility: Single Familv Dwel 5. Type of Existing System: ❑ Privy ❑ Cesspool(s) Street Address State Telephone Number ❑ Commercial ❑ School ® Conventional ❑ Other (describe below): 6. Type of soil absorption system (trenches, chambers, leach field, pits, etc): Leach Field Form 9A Application for Local Upgrade Approval revised.doc • rev. Application for Local Upgrade Approval* Page 1 of 4 7/06 • 4L'4 Commonwealth of Massachusetts City/Town of No. Andover Form 9A - Application for Local Upgrade Approval DEP has provided this form for use by local Boards of Health. Other forms may be used, but the 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. A. Facility Information (continued) 7. Design Flow per 310 CMR 15.203: Design flow of existing system: Design flow of proposed upgraded system Design flow of facility: B. Proposed Upgrade of System 1. Proposed upgrade is (check one): 440 gpd 440 gpd 440 gpd. ❑ voluntary ❑ Required by order, letter, etc. (attach copy) ® Required following inspection pursuant to 310 CMR 15.301: 2. Describe the proposed upgrade to the system: Replace leach field and system components 3. Local Upgrade Approval is requested for (check all that apply): ❑ Reduction in setback(s) — describe reductions: ❑ Reduction in SAS area of up to 25%: SAS size, sq. ft. Reduction in separation between the SAS and high groundwater: Separation reduction 1 Percolation rate Depth to groundwater ft. >.5 min/inch min./inch 3 ft. Unknown date of inspection % reduction Form 9A Application for Local Upgrade Approval revised.doc • rev. Application for Local Upgrade Approvals Page 2 of 4 ' Commonwealth of Massachusetts City/Town of No. Andover u Form 9A - Application for Local Upgrade Approval DEP has provided this form for use by local Boards of Health. Other forms may be used, but the 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. B. Proposed Upgrade of System (continued) ❑ Relocation of water supply well (explain): ® Reduction of 12 -inch separation between inlet and outlet tees and high groundwater ❑ Use of only one deep hole in proposed disposal area ® Use of a sieve analysis as a substitute for a perc test ❑ Other requirements of 310 CMR 15.000 that cannot be met — describe and specify sections of the Code: If the proposed upgrade involves a reduction in the required separation between the bottom of the soil absorption system and the high groundwater elevation, an Approved Soil Evaluator must determine the high groundwater elevation pursuant to 310 CMR 15.405(1)(h)(1). The soil evaluator must be a member or agent of the local approving authority. High groundwater evaluation determined by: Randy Burley Evaluator's Name (type or print) Signature C. Explanation 2-26-08 Date of evaluation Explain why full compliance, as defined in 310 CMR 15.404(1), is not feasible. (Each section must be completed) 1. An upgraded system in full compliance with 310 CMR 15.000 is not feasible: No other location on the lot 2. An alternative system approved pursuant to 310 CMR 15.283 to 15.288 is not feasible: An alternative system is not cost prohibitive. Form 9A Application for Local Upgrade Approval revised.doc • rev. Application for Local Upgrade Approval* Page 3 of 4 7/06 Commonwealth of Massachusetts City/Town of No. Andover y Form 9A - Application for Local Upgrade Approval DEP has provided this form for use by local Boards of Health. Other forms may be used, but the 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. C. Explanation (continued) 3. A shared system is not feasible: No other adiacent is available 4. Connection to a public sewer is not feasible: Public sewer is not available in the area. 5. The Application for Local Upgrade Approval must be accompanied by all of the following (check the appropriate boxes): ❑ Application for Disposal System Construction Permit ❑ Complete plans and specifications ❑ Site evaluation forms ❑ A list of abutters affected by reduced setbacks to private water supply wells or property lines. Provide proof that affected abutters have been notified pursuant to 310 CMR 15.405(2). ❑ Other (List): D. Certification "I, the facility owner, certify under penalty of law that this document and all attachments, to the best of my knowledge and belief, are true, accurate, and complete. I am aware that there may be significant consequences for submitting false information, including, but not limited to, penalties or fine and/or imprisonment for deliberate violations." K 4 � C /- �) / - -%A/; 90-hil Facility Owner's Signature IfDate Benjamin C. Osgood Jr. P.E. (Agent for Owner) Print Name New England Engineering Services, Inc. 1600 Osgood Streeet Preparer's address 01845 State/ZIP Code Form 9A Application for Local Upgrade Approval revised.doc • rev. 7/06 3/25/08 Date No. Andover, MA City/Town (978)686-1768 Telephone Application for Local Upgrade Approval* Page 4 of 4 NORT 3228 10 9 Town of North Andover HEALTH DEPARTMENT ,SSAC NUst� d CHECK #: DATE: OO LOCATION: H/O NAME: ` 1 CONTRACTOR NA -`ME: L-,�& P Type of Permit or License: (Check box) ❑ Animal $ ❑ Body Art Establishment $ ❑ Body Art Practitioner $ ❑ Dumpster $ ❑ Food Service - Type: $ ❑ Funeral Directors $ ❑ Massage Establishment $ ❑ Massage Practice $ ❑ Offal (Septic) Hauler $ ❑ Recreational Camp $ ❑ Sun tanning $ ❑ Swimming Pool $ ❑ Tobacco $ ❑ Trash/Solid Waste Hauler $ ❑ Well Construction $ SEPTIC Systems: ❑ Septic - Soil Testing Septic -Design Approval ❑ Septic Disposal Works Construction (DWC) ❑ Septic Disposal Works Installers (DWI) ❑ Title 5 Inspector ❑ Title 5 Report $ $ 9°2 6-e4 ❑ Other: (Indicate) $ C."� Health Agent Initials White - Applicant Yellow - Health Pink - Treasurer TOWN OF NORTH ANDOVER Office of COMMI. ANITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT 1600 OSGOO:D S'I Ri E r; BUILDING 20; SUITE 2-36 � d•{nE �r� , NORTII: ANDOVER, MASSACHUSETTS 0.1.845 978.688.940 — .Phone Susan Y. Sawyer, REHS/.RS Public Health Director SEPTIC PLAN SUBMITTAL FORM 978.688.8476- FAX E-MAIL: liealthdepti(i,townofnorthandover.conl Date of Submission: oy Site Location: looVat AqNo. Andoveil Engineer: In �' R APR 1 2008 T9WN OF Np�PA New Plans? Yes $225/Plan Check # (includes 1St submission and one re- review only) Revised Plans?Yes $75/Plan Check # Site Evaluation Forms Included? Yes ✓ No Local Upgrade Form Included? Yes !/ No Telephone #: g7t b —1 %8 Fax #: E-mail: G> ►1 • �l' Homeowner L - Name:.(a'1 Sine. OFFICE USE ONLY When the submi sion is complete (including check): ➢ _Date stamp plans and letter ➢ Complete and attach Receipt ➢ Copy File; Forward to Consultant ➢ Enter on Log Sheet and Database � r - NEw ]ENGLAND IENGMMNG SERVICES, INC. 1600 Osgood Street Building 20 Suite 2-64 North Andover, MA 01845 Teel: (978) 686-1768 • Fax: (978) 327-6138 March 31, 2008 www.neengineeringinc.com Project # 1494 Ms. Susan Sawyer North- Andover Board of Health 1600 Osgood Street North Andover, MA 01845 Re: 100 Vest Way North -Andover, MA Local Upgrade Approval Request Dear Ms. Sawyer,_ The purpose of this letter is to request that the above referenced property be included in the upcoming Board of Health meeting agenda to discuss the following Local upgrade approval request: Local Upgrade Approvals Required: 1. Allow the use of a sieve analysis to determine loading rate in lieu of performing a percolation test. Title 5, section 15.405(1). 2. Reduction in offset distance between the estimated seasonal high groundwater and the septic tank invert from 12" required by Title 5, Section 15.227(5) to 1". 3. Reduction in separation distance between the bottom of the leach field and the ESHGW from 4' required by the Title 5 Section 15.212(l a) to 3'. If you have any comments or questions please do not hesitate to contact this office. Sincerely, Benlamin C. Osg Abd, Jr. P.E. President Soil and Plant Nutrient Testing Lab West Experiment Station University of Massachusetts Amherst, MA 01003 413.545.2311 htip://www.umass.edu/plsoils/soittest TEXTURAL ANALYSIS RESULTS Customer Name: New England Engineering Services 1600 Osgood Street, Suite 2-64 N. Andover, MA 01845 Sample ID: 75202-1 Customer Designation USDA SIZE FRACTIONS Main Fractions Size (mm) Sand 0.05-2.0 Silt 0.002-0.05 Clay < 0.002 Total < 2.0 100 Vest way N. Andover Percent 70.1 26.6 3.3 100.0 Sand Fractions Size (mm) Percent Very Coarse 1.0-2.0 10.1 Coarse 0.5-1.0 12.2 Medium 0.25-0.5 16.0 Fine 0.10-0.25 25.1 Very Fine 0.05-0.10 6.7 70.1 Silt Fractions Size (mm) Percent Coarse 0.02-0.05 12.4 Medium 0.005-0.02 11.0 Fine 0.002-0.005 3.3 26.6 USDA Textural Class = sandy loam Gravel Content = 32.5% COMMENTS: 03/04/08 PERCENT OF WHOLE SAMPLE PASSING Size (mm) Sieve # % 2.00 #10 67.5 1.00 #18 60.7 0.50 #35 52.4 0.25 #60 41.7 0.10 #140 24.7 0.05 #270 20.2 0.02 20 um 11.8 0.005 5 um 4.4 0.002 2 um 2.2 1 Soil and Plant Nutrient Testing Lab West Experiment Station University of Massachusetts Amherst, MA 01003 413.545.2311 http://www.umass.edu/plsoils/soittest TEXTURAL ANALYSIS RESULTS Customer Name: New England Engineering Services 1600 Osgood Street, Suite 2-64 N. Andover, MA 01845 Sample ID: 75202-1 Customer Designation: 100 Vest Way N. Andover USDA SIZE FRACTIONS Main Fractions Size (mm) Percent Sand 0.05-2.0 70.1 Silt 0.002-0.05 26.6 Clay < 0.002 3.3 Total < 2.0 100.0 Sand Fractions Size (mm) Percent Very Coarse 1.0-2.0 67.5 10.1 Coarse 0.5-1.0 0.50 12.2 Medium 0.25-0.5 #60 16.0 Fine 0.10-0.25 24.7 25.1 Very Fine 0.05-0.10 6.7 20 um 11.8 0.005 70.1 Silt Fractions Size (mm) Percent Coarse 0.02-0.05 12.4 Medium 0.005-0.02 11.0 Fine 0.002-0.005 3.3 26.6 USDA Textural Class = sandy loam Gravel Content = 32.5% COMMENTS: 03/04/08 PERCENT OF WHOLE SAMPLE PASSING Size (mm) Sieve # % 2.00 #10 67.5 1.00 #18 60.7 0.50 #35 52.4 0.25 #60 41.7 0.10 #140 24.7 0.05 #270 20.2 0.02 20 um 11.8 0.005 5 um 4.4 0.002 2 um 2.2 Page 1 of 1 DelleChiaie, Pamela From: Marianne Peters[mpeters@millriverconsulting.com] Sent: Wednesday, February 27, 2008 3:45 PM To: 'Daniel Ottenheimer'; dobrzut@millriverconsulting.com; Grant, Michele; DelleChiaie, Pamela; 'Randy Burley'; Sawyer, Susan Subject: Soil Evals on Thursday; switching order of the 2 Just though I'd let you know that for the 2 evals we're doing tomorrow, N.E. Engineering requested that we switch the order; so we'll be doing 35 Marian first, then 100 Vest Way. Please call if any questions. MARIANNE PETERS OFFICE MANAGER MILL RIVER CONSULTING 2 BLACKBURN CENTER GLOUCESTER, MA 01930 978-282-0014 PH 978-282-0012 FX WWW.MILLRIVERCONSULTING.COM 2/27/2008 Frank C. Gefinas and Associates , Engineers & Architects North Andover Office Park NORTH ANDOVER, MASS. 01845 Phone 687-1483 TO end000r hnd nC Hea 4 DIFU 1EQ VF UIQRZEDUML 1 DATE )N I ❑ JOB NO. ATTENTION RE: ❑ For your use ❑ Approved as noted ❑ As requested ❑ Returned for corrections ❑ For review and comment ❑ ❑ FOR BIDS DUE _ CitIV I LtMtN: WE ARE SENDING YOU ❑l Attached ❑ Under separate cover via ❑ Shop drawings M Prints ❑ Plans ❑ Samples ❑ Copy of letter ❑ Change order ❑ COPIES DATE NO. DESCRIPTION + C THESE ARE TRANSMITTED as checked below: VFor ❑ Approved approval as submitted ❑ For your use ❑ Approved as noted ❑ As requested ❑ Returned for corrections ❑ For review and comment ❑ ❑ FOR BIDS DUE _ 19 REMARKS COPY the following items: ❑ Specifications ❑ Resubmit copies for approval ❑ Submit copies for distribution ❑ Return corrected prints ❑ PRINTS RETURNED AFTER LOAN TO US SIGNED: If enclosures are not as noted, kindly notify us at once. rl iaie, Pamela ?I From: Sawyer, Susan Sent: Friday, August 28, 2009 11:30 AM To: 'stonekm@comcast.net' Cc: benjaminosgood@comcast.net; Grant, Michele; DelleChiaie, Pamela Subject: RE: 100 Vest Way Thank you for the information. It looks like it will be another day as we have not heard either. The check can be delivered to our office at 1600 Osgood street. Thank you From: stonekm@comcast.net [mailto:stonekm@comcast.net] Sent: Friday, August 28, 2009 11:21 AM To: Sawyer, Susan Cc: benjaminosgood@comcast.net Subject: Re: 100 Vest Way Susan, Thank you for the e-mail. I have not received the confirmation from Ben that he and Jim have agreed the day and time to perform the required testing. As of right now Jim has not dug a hole. Do I deliver the $50 check to your office or another town office? I will do this after I know that Ben and Jim have agreed a day and time with your office. Time is of the essence as I have an executed P & S for a September closing. Regards, Ken Stone ----- Original Message ----- From: "Susan Sawyer" <ssawyer@town ofno rth and over. com > To: "be njaminosgood@comcast. net" <benjaminosgood@comcast.net>, stonekm@comcast.net Cc: "Michele Grant" <mg rant@town ofnorthand over. com > Sent: Friday, August 28, 2009 10:26:01 AM GMT -05:00 US/Canada Eastern Subject: RE: 100 Vest Way Ben, Michele is available this afternoon, however neither of us are available on Sat. so I hope this afternoon works for all. Please call us before noon so we can schedule the time. As this is for ground water identification only, not a full soils, the Health Department will waive the full soils test fee of $360, but we will require a $50 check and consider this a re -inspection. Any inspection above and beyond the basic is charged a fee. Ken, we do not accept checks in the field, so please arrange to have this delivered or have Mr. Kellett deliver the check payable to the "Town of N. Andover" If the soils test reveals that the invert is not below the groundwater level than a Certificate of Compliance can be issued as soon as Ben Osgood's As -built is received at the Health Office. If the result is a worse result we will have to consider corrective action to the tank or seek DEP 's consideration of the issue. t 5,VS4n From: benjaminosgood@comcast.net [mailto:benjaminosgood@comcast.net] Sent: Wednesday, August 26, 2009 7:45 PM To: stonekm@comcast.net Cc: Sawyer, Susan Subject: 100 Vest Way Ken, I am in receipt of your email regarding the certificate of compliance for your property. I will tell you what really happened. 1.We did an as built survey of the septic system and found that Jim had installed the septic tank lower than designed which would possibly be in violation of the requirement that the inverts of the septic tank be above the ground water. 2. We prepared an as built plan and submitted the plan to the board of health with a notation regarding the problem. I did not sign a certification because I can not sign off stating that the system is in compliance when it is not. 3. 1 discussed the situation with either Susan Sawyer or Michelle Grant at the time and it was decided that a test pit should be done in the area of the septic tank to verify the exact elevation of the water table. If the water table was below the inverts then I could make a notation on the as built and sign the certificate of compliance. 4. 1 contacted Jim Kellet regarding the situation and he said that he did not want to bring a backhoe on the site so he would have to dig by hand. He was going to get back to me as to when he was available and we would arrange to have the Board of Health on site at the same time to verify what we found. That was the last discussion I had regarding the issue and I was never contacted by Jim. As you may or may not know I closed my business and now work for Pennoni Associates. What this means is that I am limited as to when I could be at your house to perform any type of soil exploration. The only time I can be available that meets your time table is Friday afternoon or Saturday. If we were to do the excavation on Friday or Saturday I could have the revised as built and certification to you by Monday. One other issue, the mistake was not caused by New England Engineering or myself. Therefore I will need to be paid for my time. This should not take more than 2 hours which would mean the fee would be 300 dollars. You are welcome to contact me tomorrow by email at bosgoodCD-Pennon i.com or on my cell phone at 978-435-1324. APPL I CATION FOR SOIL TESTS DATE: 2— -7— 08 MAP & PARCEL: /0 LOCATION OF SOIL TESTS: OWNER: )Jc n., IFib o G Contact # q76— G, 8 7— ©l Y-( APPLICANT: 57b rje Contact# ADDRESS: ENGINEER: EW E,uCTcAN9 d cKeec� -s Contac # 9 -7 R -- 68 fo— 176 5 CERTIFIED SOIL EVALUATOR:ov� Intended Use of Land: Residential Subdivision inge am y-Hiame Commercial IsThis: Repair Testing: Undeveloped Lot Testing: Upgrade for Addition: In the Lake Cochichewick Watershed? Yes No THE FOLLOWING MUST BE INCLUDED WITH THISFORM Proof of land ownership (Tac bill, or letter from owner permitting test) 8.5_x 11 —Plot plan & Location of Ting (pleaseindicatetest pit sites on the plan) Fee of $425.00 per lot for new construction. This coversthe 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 A least two deep holes and at least one percolation test, A thediscrcion of the BOH representative. Full payment will be required for all additional testswithin two weeks of testing. Within 45 days of testing, a scA ed plan (no smal I er than 1=100) shsi I be submitted to the Board of Health showing the I ocati on of all tests (i ncludi ng 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 Pate: Signatureof Conservation Agent: Date back to Health Department: (stamp in). UCSI `�-J �y i, T L c, N D E-, I: C __ C T. 1 0 ;1 Q C T G.L. C. 1311 s 40 and under Town of North Andover By Law, Chapter 3 Section 3_5 A & B_-_--'___- CITY/TOWN NORTH 'ANDOVER NAME Classic Builders CERTIFIED MAIL NUMBER PROJECT LOCATION: Address Lot 48 Vest Way FILE NUMBER 242- 176 ADDRESS P.O. Box 244 North Andover, 14A 01845 Recorded at Registry of- North Essex , Book 1605 ,Page 259 Certificate (if registered) REGARDING: Notice of Intent Dated October 8, 1982 and plans titled and dated see conditions eleven (11) THIS ORDER IS ISSUED ON (date) November 5, 1982 Pursuant to the authority of G.L. c. 131, s. 40, the North Andover Conservation Commission has reviewed your Notice of Intent and plans identified a ove, an as der ined that the area on which the proposed work is to be done is significant to one or more of the interests listed in G.L. c.: 131, s. 40. Town of North Andover bylaws, Section 3.5 A & B Wetlands Protection. The North Andover Conservation Commission hereby orders that the following conditions are necessary to protect sai in and all work shall be performed in strict accordance with them and with the Notice of Intent and plans identified above except_where such plans_are modified by_said_conditions. CONDITIONS 1. Failure to comply with all conditions stated herein, and with all related statutes and other regulatory measures, shall be deemed cause to revoke or modify this order. 2. This order does not grant any property rights or any exclusive privileges; it does not authorize any injury to priviate property or invasion of private rights. 3. This order does not relieve the permittee or any other person of the necessity of complying with all other applicable federal, state or local statutes, ordinances, by-laws and/or regulations. 4. The work authorized hereunder shall be completed within one (1) year from the date of this order unless it is for a maintenance dredging project subject to Section 5(9). This order may be extended by the issuing authority for one or more additional one-year eriods uper application to the said issuing authority at least thirty �30) days prior to the expiration date of the order or its extension. S. Eng• fi.11 used in connection with this project shall be clean fill', containing no trash, refuse, rubbish or debris, including without limiting the generality of the foregoing, lumber, bricks, plaster, wire,lath, paper, carboard, pipe, tires, ashes, refrigerators, moto.r vehicles or parts of any of the foregoing. 6. No work may be commenced until all appeal periods have elapsed from the order of the Conservation Commission or from a final order by the .Department of Environmental Quality Engineering. 7. No work shall be undertaken until the final order, with respect to the proposed project, has been recorded in the Registry of Deeds for the district in which the land is located within the chain of title of the affected property. Thi Document number indicating such. recording shall be submitted on the form at the end of this order . to the issuer of this order prior to commencement of work. 8. A sign shall be displayed at the site not less that two square feet or more than three square feet bearing the works, "Massachuseffe Department of Environmental Quality Egnineering. Number 242- ". 9. Where the Department of Environmental Quality Engineering is requested to make a determination and to issue a superseding order, the Conser- vation Commission shall be a party to all agency proceedings and hearings before the Department. 10. 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 been satisfactorily completed. 11. The work shall conform to the following described plans and additional conditions: A. Notice of Intent and Environmental Data Form dated October 8, 1982. Prepared by Kaminski, Gelinas & Associates, Inc., seven (7) pages. B. Plan titled "Subsurface Disposal System Design" for Lot 48 Vest Jay, North Andover, MA. Prepared for Classic Builders Inc., prepared by Kaminski, Gelinas and Associates, Inc., dated Sept. 29, 1982, one (1) sheet. 12. A row of staked hay bales shall be placed between all construction areas and wetland areas. This row of haybales shall remain intact until all disturbed areas have been stabilized to prevent erosion. 13. All disturbed areas shall be graded, foamed and seeded and mulched by S.C.S. standards to provide restabilization of disturbed areas. After restabilization, hay bales shall be removed and sedimentation shall be removed from areas of accumulation. -3 - ORDER OF CONDITIONS: Lot 48 Vest Way 242-176 14. All other erosion prevention and sedimentation protection measures found necessary during construction by the North Andover Conservation Commission will be implemented at the direction of the NACC or Highway Surveyor. 15. Any changes in the submitted plans, Notice of Intent, or resulting from the aforementioned conditions must be sub- mitted to the NACC for approval prior to implementation. If the NACC finds, by majority vote, said changes to be significant and/or deviate from the original'plans, Notice of Intent or this Order of Conditions to such an extent that the interests of the Wetlands Protection act cannot be protected by this Order of Conditions and would best be served by the issuance of additional conditions, then the NACC will call for another public hearing within 21 days, at the expense of the applicant, in order to take testimony from all interested parties. Within 21 days of the close of said public hearing, The NACC will issue an amended or new Order of Conditions. 16. Any errors found in the plans or information submitted by the applicant shall be considered as chmges and procedures outlined for changes shall be followed. 17. The provisions of this Order shall apply to and be binding upon the applicant, its employees, and all successors and assigns in interest or control. 18. Prior to the issuance of a Certificate of Compliance, the applicant shall submit a letter to the Conservation Commission from a registered professional engineer certifying that the work is in compliance with the plans referenced above and the conditions stated above. 191 Members of the NACC shall have the right to enter upon and inspect the premises to evaluate compliance with this Order of Conditions. 20. Generally accepted engineering and construction standards and procedures shall be followed in the completion of the project. 21. Issuance of these conditions does not in any way imply or certify that the site or downstream areas will not be subject to flooding, storm damage, or any other form of damage due to wetness. The Applicant, any person aggrieved by this order, 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 appeal this order of the Department of Environ- mental Quality Engineering. provided the request is made in writing and by certified mail to the Department within ten (10) days from the issuance of this order. '/n ISSUED BY NORTH ANDOVER CONSERVATION COMMISSION On this 5th day of November 19.82 , before me personally appeared Anthony Galvagna to me known to be the person described in, and w o execute , the foregoing instrument and acknowledged that he executed the same as his free act and deed. ,, 'A'z4zL z7- 4'�-Iael"7d My Commission expirea /Wz Z' R DETACH ON DOTTED LINE AND SUBMIT TO THE ISSUER OF THIS ORDER PRIOR TO COMMENCEMENT OF WORK. To NORTH ANDOVER CONSERVATION COMMISSION (Issuing Authority) PLEASE BE ADVISED THAT THE ORDER OF CONDITIONS FOR THE PROJECT AT FILE NUMBER 242 , HAS BEEN RECORDED AT THE REGISTRY OF ON (DATE) If recorded land, the instrument number which identifies this transaction is If registered land, –t-Fe—document number which identifies this transaction is Signed App Iicant j• 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: _100 Vest Way- — North ay__North Andover_ Owner's Name: _Ken Stone_ Owner's Address: _100 Vest Way —North Andover, MA 01845_ Date of Inspection: 2/4/2008_ Name of Inspector: Neil J. Bateson Company Name: Bateson Enterprises Inc._ Mailing Address: _111 Argilla Road_ _Andover, MA 01810_ Telephone Number: _ (978) 475-4786_ RECEIVED FEB 0 8 2008 TOWN OF NORTH ANDOVER HEALTH DEPARTMENT 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: Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fai Inspector's Signature: A _2/4/2008 _ The system inspector shall submit a copy of this inspection 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. j4. Pige 2 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 100 Vest Way _ North Andover_ Owner: _ Stone _ Date of Inspection: _2/4/2008 _ 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 31.0 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: 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 exnlain: Page 3 of I 1 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: _100 Vest Way_ —North Andover— Owner: _Stone Date of Inspection: 2/4/2008 _ C. Further Evaluation is Required by the Board of Health: Conditions 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(1)(b) that the system is not functioning in a manner which 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 I 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: _100 Vest Way_ _ North Andover— Owner: _Stone _ Date of Inspection: 2/4/2008 _ D. System Failure Criteria applicable to all systems: You must indicate "yes" or "no" to each of the following for all inspections: _Yes_ , Backup of sewage into facility or system component due to overloaded or clomed SAS or cesspool _No_ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool _Yes_ _ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool _No_ Liquid depth in cesspool is less than 6" below invert or available volume is 1/2 day flow. _No_ 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. _No_ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. _No_ Any portion of a cesspool or privy is within a Zone 1 of a public well. _No_ Any portion of a cesspool or privy is within 50 feet of a private water supply well. _No_ 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 are triggered. A copy of the analysis must be attached to this form.] _Yes_ (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 gpd- You must indicate either `yes" or "no" to each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no _ the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area — IWPA) or a mapped Zone Il of a public water supply well If you have answered "yes" to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 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: _100 Vest Way _ _ North Andover _ Owner: _Stone Date of Inspection: _2/4/2008 Check if the following have been done. You must indicate "yes" or "no" as to each of the following: Yes No Yes_ Pumping information was provided by the owner, occupant, or Board of Health _No Were any of the system components pumped out in the previous two weeks ? _Yes_ Has the system received normal flows in the previous two week period ? _No Have large volumes of water been introduced to the system recently or as part of this inspection ? Yes _ Were as built plans of the system obtained and examined? Yes_ — Was the facility or dwelling inspected for signs of sewage back up ? _Yes_ _ Was the site inspected for signs of break out ? _Yes Were all system components, excluding the SAS, located on site ? _Yes_ _ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the battles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum ? _Yes_ _ 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 _Yes_ — Existing information. _Yes_ _ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [3 10 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: _100 Vest Way- – North Andover– Owner: _Stone _ Date of Inspection: _2/4/2008 _ FLOW CONDITIONS RESIDENTIAL Number of bedrooms (design): 4_ Number of bedrooms (actual): _4_ DESIGN flow based on 310 CMR 15.203 _600_ Number of current residents: 3 Does residence have a garbage grinder (yes or no): _No Is laundry on a separate sewage system (yes or no): _No _ Laundry system inspected (yes or no): Seasonal use: (yes or no): _No_ Water meter reading: Yes_ Sump pump (yes or no): _No_ Last date of occupancy: , Current_ COMMERCIAIANDUSTRIAL Type of establishment: Design flow (based on 310 CMR 15.203): gpd 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): Water meter readings, if available: Last date of occupancy/use: OTHER (describe): GENERAL INFORMATION Pumping Records Source of information: _Pumped Dec 2002, owner _ Was system pumped as part of the inspection (yes or no): _No_ If yes, volume pumped: gallons -- How was quantity pumped determined? — Reason for pumping: _ TYPE OF SYSTEM X 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) _ Innovative/Alternative 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) and source of information 26 Years old, 11/22/1982, as built plan _ Were sewage odors detected when arriving at the site (yes or no): _No Page 7 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: _100 Vest Way_ _ North Andover _ Owner: _Stone _ Date of Inspection: _2/4/2008 BUILDING SEWER _ X _ (locate on site plan) Depth below grade: _18" Materials of construction: cast iron _X_ 40 PVC other Distance from private water supply well or suction lime: Comments (on condition of joints, venting, evidence of leakage, etc.) _ 4" PVC thru wall, 3" PVC in house, no leaks visible SEPTIC TANK: X Depth below grade: _6" _ Material of construction: X concrete , 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: _10' x 5' x 4' Sludge depth: —3" _ Distance from top of sludge to bottom of outlet tee or baffle: 24" _ Scum thickness: _2" Distance from top of scum to top of outlet tee or baffle: _8"_ Distance from bottom of scum to bottom of outlet tee or baffle: 19" 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. _ Inlet tee ok. Outlet tee badly corroded. Depth of liquid at outlet invert. No evidence of leakage. _ GREASE TRAP: _(locate 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: _100 Vest Way _ _ North Andover_ Owner: _Stone _ Date of Inspection: 2/4/2008 TIGHT or HOLDING TANK: (tank 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: gallons/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 X_ Depth below grade ,36"_ Depth of liquid level above outlet invert: _ 2" 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.) __P -box level & distribution equal.. No evidence of leakage. Evidence of carryover. D -Box badly corroded. Liquid above outlet inverts 2". _ PUMP CHAMBER: _ (locate on site plan) Pump in working order (yes or no): , Alarm in working order (yes or no): _ Comments (note condition of pump chamber, 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: _100 Vest Way _ _ North Andover_ Owner: _Stone Date of inspection: _2/4/2008_ SOIL ABSORPTION SYSTEM (SAS): X (locate on site plan, excavation not required) If SAS not located explain why: Type X leaching pits, number: _2_ leaching chambers, number: leaching galleries, number: _ leaching trench, number, length: leaching field, number, dimensions: _ overflow cesspool, number: innovative/alternative system Typetname of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.):—Liquid above inverts of both pits. Sign of hydraulic failure. No signs of ponding to surface. _ CESSPOOLS: Number and configuration: _ Depth — top of liquid to inlet invert: _ Depth of sludge layer: Depth of scum 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 pian) 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 Property Address: _100 Vest Way _ _ North Andover_ Owner: _Stone _ Date of Inspection: _2/4/2008 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 Page 11 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: _100 Vest Way _ _ North Andover— Owner: _Stone Date of Inspection: _2/4/2008 _ SITE EXAM Slope _ No _ Surface water _ No _ Check cellar _ Dry _ Shallow wells _ No _ Estimated depth to ground water _ >4'_ Please indicate (check) all methods used to determine the high ground water elevation: _X_ Obtained from system design plans on record - If checked, date of design plan reviewed: _5/31/1980_ 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: No water found 4' below system as per test pit data on design plan _ Class 101 Single Family Size Total 1.15 Acres FY 2008 UB Mailing Index Name/Address STONE.KENNETH 100 VEST WAY N. ANDOVER, MA 01845 UB Account Maint. Account No Cycle Bldg Id. 17830.0 - 100 VEST WAY 3170495 03 Cycle 03 UB Services Maint. Service Code MISCFEE ADMIN FEE WTR WATER UB Meter Maintenance Serial No Status 0028643639 a Active Date Reading 12/12/2007 2911 9/6/2007 2890 6/20/2007 2876 3/15/2007 2856 12/13/2006 2836 9/13/2006 2814 6/19/2006 2793 3/9/2006 2767 12/22/2005 2752 9/20/2005 2734 6/28/2005 2718 3/30/2005 2691 12/14/2004 2674 9/29/2004 2657 6/23/2004 2635 4/16/2004 2616 12/17/2003 2582 ndf 11 Town "of North Andover Tax Map # 210-104.D-0019-0000.0 100 VEST WAY STONE, KENNETH 100 VEST WAY N. ANDOVER, MA 01845 ----- —------- – ----Property Type Type Loan Number Active/Inact. From Payor Occupant Name Active/inactive Last Billing Date 1/15/2008 Active 1 Residential Until Rate 0.635/8 Charge Multiplier/Users 7.82 1 / 01 ALL METER SIZE 75.39 /1 Location Y ENC RT Brand Type Size YTD Cons Code Consumption w Water 0.63 0.63 Posted Date 0 a Actual 21 1/22/2008 Variance a Actual 14 10/12/2007 21% a Actual 20 7/20/2007 -13% m Manual estimate 20 4/16/2007 -5% a Actual 22 1/19/2007 -10% a Actual 21 10/20/2006 -1% a Actual 26 7/10/2006 -4% a Actual 15 4/17/2006 31% a Actual 18 1/17/2006 1% a Actual 16 10/14/2005 2% a Actual 27 7/15/2005 -37% m Manual estimate 17 4/5/2005 87% a Actual 17 1/14/2005 -28% a Actual 22 10/8/2004 0% a Actual 19 7/30/2004 -20% a Actual 34 5/17/2004 -1% n New Meter 0 12/17/2003 0% 0% BATESON ENTERPRISES, INC. Excavating -Water& Sewer Lines -Septic Systems & Pumping Service 111 Argilla Road Andover, Mass. 01810 Title 5 Inspection Report Property Address: 100 Vest Way, North Andover Owner: Stone Date of Inspection: 2/4//2008 Tel: (978) 475-4786 Fax: (978) 475-5451 My report contained herein does not constitute a guarantee of future usage and the functionality of the existing septic system. Such report issued herewith is merely based upon my observations, and I hereby disclaim any further operation of your current septic system. Neil J. Bateson Bateson Enterprises, Inc. jjaT 48 54,534 r EXISTit-IG FOOSdOA?ION �s 5 1 I 0 / ELE1 ATION T! 0:. 1,4733 ,: - C '�.. i �t ALL GJTLET i;.'_LT I'932 F,7y2INILE 139=Stj (SHAT:3tr,)) NOTEI CERTIFY TW_T THE SEPTIC SYSTEM VM INSTALLED AS SHOWN.THIS PLAN IS NOT INTENDED AS A WARRANTY Of THE SYSTEM6 i 4+ cli PLAN SHOWING SUBSURFACE SEWERAGE DISPOSAL SYSTEM AS BUILT i LOCATE ON o LOT 48 VEST WAY i OWNER: DON'S DRYWALL DATE It—.22-82 SCALE 140" , —PREPARED BY; FLYNN �,SSOC Di PO.ROX,56,9 NOTEiPROPERTY DESCRIPTION FROM NERD PLAN "8012 � PIA 670f /i_/ n /Ho n 7 86 5 t 3