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Home My WebLink AboutMiscellaneous - 1005 FOREST STREET 4/30/2018 (3)l i 4 U� Q� rl November 14, 2017 Address: 1005 Forest Street All North Andover Residents with Septic Systems and Garbage Disposals Please note that due to a recent review of a Title 5 Report, your property has been identified as maintaining a working garbage disposal that is being used in conjunction with a septic system. The Health Department is concerned for the longevity of your septic system. Garbage disposals are never recommended where septic systems are used, but if they are installed, the system must be specifically designed to handle the waste from them; your system can not handle the waste as designed. Please note that continued use of this disposal could quickly cause a pre -mature failure of your septic system, resulting in a large expenditure to replace it. The North Andover Health Department recommends that you remove it from your home as soon as possible. Some information regarding regular maintenance of your septic system is attached. Please call the Health Department at 978.688.9540 if you have any questions, or e-mail your questions to: healthdept@northandoverma. goy. Thank you for taking the time to consider the impact that your current setup has on your septic system and the environment. Sincerely, rian LaGrasse, T Director of Public Health 120 Main Street, North Andover, Massachusetts 01845 Phone 978.688.9540 Fax 978.688.9542 Web http://www.northandoverma.gov Commonwealth of Massachusetts Title 5 official Inspection Form RECEn�� Subsurface Sewage Disposal System Form - Not for Voluntary Assessments NOV 14 2017 1005 Forest St Property Address TOWN OF NORTH ANDM Georgia Stewart HEALTH DEPARTMENT Owner Owners Name information is No Andover MA 01845 10-10-17 required for every page. City/Town State Zip Code Date of Inspection ,� L Inspection results must be submitted on this form. Inspection forms may not a alters y way. Please see completeness checklist at the end of the form. �n �O Important: When A. General Information Q filling out forms on the computer, use only the tab 1. Inspector: key to move your cursor - do not John DiVincenzo use the return Name of Inspector key. J and S Development Corp. dba Stewarts Septic Service, Andover Septic my Company Name 58 South Kimball st Company Address Bradford Ma 01835 City/Town State Zip Code 978-372-7471 s113386 Telephone Number License Number B. Certification 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 ❑ Fails by the Local Approving Authority 10-10-17 Date The system inspector shallplbmit 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. ****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. t5ins • 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1005 Forest St Property Address Georgia Stewart Owner Owner's Name information is required for every No Andover MA 01845 10-10-17 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E / always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) 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. Check the box for "yes", "no" or "not determined" (Y, N, ND) 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. ❑ Y ❑ N ❑ ND (Explain below): t5ins • 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 2 of 17 �— Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1005 Forest St Property Address Georgia Stewart Owner's Name No Andover Cityfrown B. Certification (cont.) MA 01845 10-10-17 State Zip Code Date of Inspection ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ 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 ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ 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 ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): 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 t5ins • 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 3 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1005 Forest St _ Property Address Georgia Stewart _ Owner Owner's Name information is No Andover MA 01845 10-10-17 required for every _ page. CityTrown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: ** This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent 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: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or "No" to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/2 day flow t5ins • 3113 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 4 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 10_0_5 Forest St _ Property Address Georgia Stewart Owner Owner's Name quine d fotifo is every eNo Andover MA _01845 10-10-17 quire— age. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No El® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: El® Any portion of the SAS, cesspool or privy is below high ground water elevation. El® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. El® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. 1:1® 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 fecal coliform bacteria indicates absent 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 and chain of custody must be attached to this form.] i r p ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® 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. For large systems, you must indicate either "yes" or "no" to each of the following, in addition to the questions in Section D. 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 II of a public water supply well ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® 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. For large systems, you must indicate either "yes" or "no" to each of the following, in addition to the questions in Section D. 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 II 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. t5ins • 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 5 of 17 c Commonwealth of Massachusetts - W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °wM 1005 Forest St _ Property Address Georgia Stewart Owner Owner's Name information is No Andover MA 01845 10-10-17 required for every — page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate "yes" or "no" as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner (and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 4 Number of bedrooms (actual): 4 — ---- DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x # of bedrooms): .440 gpd t5ins • 3113 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 6 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1005 Forest St _ M Property Address Georaia Stewart Owner Owner's Name information is required for every No Andover page. City/Town D. System Information Description: MA 01845 10-10-17 State Zip Code Date of Inspection Number of current residents: Does residence have a garbage grinder? Is laundry on a separate sewage system? (Include laundry system inspection information in this report.) Laundry system inspected? Seasonal use? Water meter readings, if available (last 2 years usage (gpd)): Detail: Sump pump? Last date of occupancy: Commercial/Industrial Flow Conditions: Type of Establishment: --- -- Design flow (based on 310 CMR 15.203): - - - ---- Gallons per day (gpd) Basis of design flow (seats/persons/sq.ft., etc.): - - - - --- Grease trap present? Industrial waste holding tank present? Non -sanitary waste discharged to the Title 5 system? Water meter readings, if available: — -- -- ® Yes ❑ No ❑ Yes ® No ❑ Yes ❑ No ❑ Yes ® No ❑ Yes ® No occupied Date ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No t5ins • 3113 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 7 of 17 Commonwealth of Massachusetts - _ W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1_005 Forest St Property Address Georgia Stewart Owner Owner's Name information is required for every No Andover page. City/Town D. System Information (cont.) Last date of occupancy/use: Other (describe below): Pumping Records: Source of information: MA 01845 10-10-17 State Zip Code Date of Inspection Date General Information Was system pumped as part of the inspection? If yes, volume pumped: How was quantity pumped determined? Reason for pumping: 1000 gallons site quage on truck inspect tank Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ® Yes ❑ No ❑ 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) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other (describe): t5ins • 3113 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 8 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 1005 Forest St Property Address Georgia Stewart Owner Owner's Name information is required for every No Andover MA 01845 10-10-17 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: Were sewage odors detected when arriving at the site? 10llll�_ �R Building Sewer (locate on site plan): Depth below grade: e0et Material of construction: ® cast iron ® 40 PVC ❑ other (explain): Distance from private water supply well or suction line: 140_'+feet Comments (on condition of joints, venting, evidence of leakage, etc.) Septic Tank (locate on site plan): Depth below grade: Material of construction: ® concrete ❑ metal BTG feet ❑ fiberglass ❑ polyethylene ❑ other (explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) Dimensions: Sludge depth: ❑ Yes ❑ No t5ins • 3113 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 9 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form - Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1005 Forest St Property Address Georgia Stewart Owner Owner's Name information is required for every No Andover MA 01845 10-10-17 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank (cont.) Distance from top of sludge to bottom of outlet tee or baffle Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle 27" 0 6" 15" How were dimensions determined? Tape measure, sludge jugde Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): both baffle ,good no leakage ,liquid level good Grease Trap (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal Dimensions: Scum thickness feet - -- - ❑ fiberglass ❑ polyethylene ❑ other (explain): 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: t5ins • 3113 Date -- Title 5 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 10 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1005 Forest St �M Property Address Georgia Stewart Owner Owner's Name information is required for every No Andover MA 01845 10-10-17 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 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 per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: Date of last pumping: Date Comments (condition of alarm and float switches, etc.): ❑ Yes ❑ No Attach copy of current pumping contract (required). Is copy attached? ❑ Yes ❑ No l5ins • 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 11 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 1005 Forest St Property Address Georgia Stewart Owner Owner's Name information is required for every No Andover MA 01845 10-10-17 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0 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.): equal distribution, no leakaqe , no solids carry over Pump Chamber (locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins • 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1005 Forest St Property Address Georgia Stewart Owner Owner's Name information is NO Andover required for every. page. Cityrrown MA 01845 10-10-17 State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 3 ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): No hydraulic failure , no ponding , no damp soils Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth — top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins • 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 13 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1005 Forest St M D. System Information (cont.) MA State r11QAG —F _- 10-10-17 Date of Inspection Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins - 3113 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 14 of 17 Property Address Georgia Stewart Owner Owner's Name information is required for every No Andover page. City/Town D. System Information (cont.) MA State r11QAG —F _- 10-10-17 Date of Inspection Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins - 3113 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1005 Forest St Property Address Georgia Stewart Owner Owner's Name information is required for every No Andover MA 01845 10-10-17 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view 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. Check one of the boxes below: ❑ hand -sketch in the area below ❑ drawing attached separately t5ins • 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 15 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 1005 Forest St Property Address Georgia Stewart Owner Owner's Name information is required for every No Andover MA 01845 10-10-17 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ❑ Surface water ® Check cellar ❑ Shallow wells Estimated depth to high ground water: No water @ 72' feet Please indicate all methods used to determine the high ground water elevation: /1 ocs i Obtained from system design plans on record If checked, date of design plan reviewed: 4-2-77 Date Observed site (abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health - explain: Dulled file Checked with local excavators, installers - (attach documentation) Accessed USGS database - explain: You must describe how you established the high ground water elevation: Take from design plan on record Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins • 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 16 of 17 Commonwealth of Massachusetts ------W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M - 1005 Forest St Property Address Georgia Stewart Owner Owner's Name information is required for every No Andover MA 01845 page. City/Town State Zip Code E. Report Completeness Checklist 10-10-17 Date of Inspection ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information — Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins - 3113 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 17 of 17 ' HOR71/ V U Of OL F .. 9 Town of North Andover HEALTH DEPARTMENT ,SS�CNU�+f't CHECK #: DATE: 7 LOCATION: /n O5 zr'e-S 4 54 H/O NAME: CONTRACTOR NAME: //A D Type of Permit or Li ense: (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 $ xTitle 5 Report -5-Q" s -5-0— ❑ Other. (Indicate) $ Hea gent Initials White - Applicant Yellow - Health Pink - Treasurer 0 0 0, 0 CD w v CL 0 CD cn 0 0 0 z O D CL 0 CD 1 cr 0 a) 1 CL 0 co v 00 Town of North Andover Olt tNORTN OFFICE OF COMMUNITY DEVELOPMENT AND SERVICES 27 Charles Street North Andover, Massachusetts 01845 WILLIAM J. SCOTT SSAcmusE Director (978) 688-9531 November 8, 1999 Mr. and Mrs. Leyne 1005 Forest Street North Andover, MA 01845 VIA Certified Mail # Z 3,--"y 6� 7 41V&I, Fax (978) 688-9542 RE: Violation of the Massachusetts Wetland Protection Act (M.G.L. C.131 S.40) and The North Andover Wetlands Protection Bylaw (C. 178 of the Code of North Andover). Dear Mr. and Mrs. Leyne: On November 5, 1999, this Department visually observed an "alteration" that took place at the above referenced property. The term "alteration" includes but is not limited to, the placement of fill, excavation, or regrading (Section III. (d)(3) of the North Andover Wetlands Protection Bylaw and Regulations. The subject violation consists of regrading within the 100.' Buffer Zone of a Bordering Vegetated Wetland (BVW). Any work proposed within 100' of a BVW is subject to a Request for Determination of Applicability (RDA) or Notice of Intent (NOI) filing with the North Andover Conservation Commission (NACC) (Sections V and VI of the North Andover Regulations). Please be aware that you are in violation of the Massachusetts Wetland Protection Act and The North Andover Wetlands Protection Bylaw (Chapter 178 of the Code of North Andover). This Department mandates the installation of erosion control (trenched silt fence with double -staked hay bales) along the entire limit of work and temporary stabilization of exposed soils with winter rye seed and hay mulch by no later than November 19, 1999. The subject area must be completely stabilized (i.e. Seeded and reached its full potential growth) by no later than June 1, 2000. Failure to comply with the above mentioned deadline will result in additional penalties and / or fines. Please refer to the attached Enforcement Order. If you have any comments, questions, or concerns, feel free to contact me at (978) 688-9530. Thank you for your anticipated cooperation. BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 V M2� Conservation Associate cc: Richelle Martin, Conservation Administrator NACC members DEP-NERD `Y File iWassachuse.Us Departimnt of-Eavironmental Protection Bureau of Resource Protection - Wetlands WRA Form SA: - Enforcement Order and North Andover Wetland Massachusetts. Wetlands"Protection Act M.G.L. c.- 131, §40 Protection Bylaw. Order The Issuing Authority hereby ordersthe. following (check all The property owner shall take the following action to that a i PP y): prevent further violations of the Act: ❑ The propertyowner,'hts agents, permittees, and all - ` =i`S+" �! t/VS1,JA) COn"�rd� Y S eed -..,-,others shall immediately cease`atidAesist;.fromihe further, ._ activity affecting the Buffer Zone'andld'Vweilind resource KI M�� " MO 16Je f - ro areas on this pperty.. - ._ =fes -- -= Wetland 'alterations resultihgfrorrsail activity shall.be El- '7- _ - corrected and the site returned to its original condition :- d �.�'e �N 5U� e .�, 2000 ❑ ' Complete the attached Notice of Intent. The completed = . - _- -application and plans for all proposed work as required by-- -° T " the•Act.and regulations.shalfbe:filed with.the Issuing.;'" " Authority on or before - (date).-: No further work shall be performed until a public hearing -•- :-Failure to comply with this Order. may constitute:.grourids `has been held and an Order of Conditions has4rbeen issued:` -'--.for additional legal action. Massachusetts General Laws = to regulate. said work ..- - - Chapter 131, Section 40 provides: "Whoever violates any provisions of this section shall be punished by a fine of not more than twenty-five thousand dollars or by imprisonment -- -- — : for not more than two years or both. Each day or portion - - thereof of continuing violation shall constitute a separate offense." - Appeals/Signatures - - _ An Enforcement Order issued by a conservation commission,_ "cannot be appealed to the.Department.of Environmenial " -`' -,.:.Signatures:- Protection, but may be filed in Superior Court = , - t � is Questions regarding this Enforcement Order should be ` directed to: T • l9 fZSSF /4GCnlfi� Ma5sach4setts Department of Environmental Protection DEP File number ` Bureau of Resource Protection — Wetlands US A Form 9A " Enforcement Order for DEP use only Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 and North Andover Wetland Protection'Bylaw. Violation information This Enforcement Order is issued by: Extent and type of activity: R-e(46CIIJAIAiN ,- Cow arimCommission(&wingAurhaq) _ r j r JC�tf OAIC 'cictiS�' I�" L-C,IA'r% Ley S N Z - ._._-:.NameotVloiarorr•=.t,:�= _. _.__ _ . Location of Violation: RIW A d-ress _A Ciry/fown - — 2t0 DOSS Azessois Maolat ' < - -". A. "f::' Fercaf Ca t Date. of Issuance:-.-:,- -' _ Date Findings _ The Issuing Authority has determined that the activity Other (specify): described above is in.violaiion of.tiie Wetlands Protection A_ ct f( O (M.G.L. c.131, §40) and its -regulations (310 CMR 10.00), because: _.. ___e r-• ^ the activity has been/is being conducted without tvalid rderof Conditions. ❑ the activity has beerdis being conducted in violation of the Order of Conditions issued to:.:::._ Name. -=� . <:::.: •_• _ , _ _.. _ _ - .. _ . . Dated .. _, meNumba condbon wmber(s)