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HomeMy WebLinkAboutMiscellaneous - 1029 JOHNSON STREET 4/30/2018N r Lb COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENmoNMENTAL PROTECTION ONE WINTER STREET, BOSTON MA 02108 (617) 292-5500 TRUDY COXE Secretary ARGEO PAUL CELLUCCI DAVID B. STRUHS Governor Commissioner SUBSURFACE SEWAGE DISPOSAL SYSTEM MSPECTION FORM V.C. Rajashekar CERTIIflCATION 1029 Johnson Street "'°pe"'' Ate' N. Andover, MA 01845 Ad °—-" Address Dace of hmpection:7/25/00 Name of Inspector: (Please Print) RRIC ..NARDSON 1 am a DEP approved system inspector pursuent to Section 15.340 of Tale 5 (310 CMR 15.000) Company Name: S meWid, Fnvinxunm1al _-- MaiMng Address: P.O. Box 5062 Telephone Number: Groote, RI 02827 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 inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: Passes _ Conditionally Passes Needs Further Evaluation By the Local Approving Authority _ Fails Inspector's Signature: G sem.. Date: J� The System Inspector shall submit a copy of this inspection report to the Approving ority (Board of Health or DEP)within thirty (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 Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. NOTES AND COMMENTS 16 revised 9/2/98 Page 1 of II SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A V.C. Rajashekar CERTIFICATION (continued) Property Adg. 1029 Johnson Street owner: N. Andover MA 01845 Daft of '7/25/00 INSPECTION SUMMARY: Check B, C, or A S STEM PASSES: 1 have not found any information which indicates that any of the failure conditions described in 310 CMR 15.303 exist. Any failure criteria not evaluated are indicated below. OMMENTS: B. SYSTEOLCONDITIONALLY PASSES: One orre system components as described in the "Condihionai Pass" section need to be replaced or repaired. The system, upon completi0 f the replacement or repair, as approved by the Board of Health, will pass. Indicate yes, no, or not ermined (Y. N. or ND). Describe basis of determination in all instances. If "not determined", explain why not. _ The se ' tank is metal, unless the owner or operator has provided the system inspector with a copy of a Certificate of Comptianc (attached) indicating that the tank was installed within twenty (20) Years prior to the date of the inspection; or the septic to ,whether or not metal, is cracked, structurally unsound, shows substantial infiltration or exfiltration, or tank failure is immi t. The system will pass inspection if the existing septic tank is replaced with a complying septic tank as approved by the and of Health. Sewage backup or breako or high static water level observed in the distribution box is due to broken or obstructed pipets) or due to a broken, settled o neven distribution box. The system will pass inspection if (with approval of the Board of Health). broken pipets) a replaced obstruction Is r ved distribution box is le lied or replaced - The system retpmed pumping more than four .mes a year due to broken or obstructed pipets). The system will pass inspection if (with approval of the Board of He ): broken pipets) are replaced obstruction is removed revised 9/2/98 Page 2of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A V. C. Rajashekar CERTIRCATION (continued) ft.p.,,,y A:1029 Johnson Street Owner: N. Andover, MA 01845 Dec` of hwaction7/25/00 C. FURTHER EVA't[ATim LS REQUIRED BY THE BOARD OF HEALTH: Conditions exist hich require further evaluation by the Board of Health in order to determine if the system is fvA ng to protect the public health, safe and the environment. 1) SYSTEM WUl PASS LESS BOARD OF HEALTH DETERMINES IN ACCORDANCE WITH 310 CMR 15.303 (10) THAT THE SYSTEM IS NOT FUNCTIONING A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT'- Cesspool NVIRONMENT: Cesspool or priW ' within 50 feet of surface water Cesspool or privy i 50 feet of a bordering vegetated wetland or a silk marsh. 2) SYSTEM WILL FAB. UNLESS THE BOARD OF (AND PUBLIC WATER SUPPLIER. IF ANY) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE HEALTH AND SAFETY AND THE ENVfRONMENT: The system has aseptic tank and soil absorption ystem (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 soil absorption s\co AS is within a Zone 1 of a public water supply well. _ The system has a septic tank and soil absorption sS is within 50 feet of a private water supply well. The system has a septic tank and soil absorption sAS is less then 100 feet but 50 feet or more from a private water supply well, unless a well water analbacteria and volatile organic compounds indicates that the well is free from pollution from that facd'ity and themonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method used to determine distanceximation not valid). 3) OTHER revised 9/2/98 Pagc3ofli SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CE101FICATION Icon*wedl V. C. Rajashekar Property Ams: 1029 Johnson Street' Owner: N. Andover, MA 01845 Date of'"sPe':7/25/00 D. SYSTEM FA . You must indicate 'ther "Yes" or "No" to each of the following: 1 have dot mined that one or more of the following failure conditions exist as described in 310 CMR 15.303. The basis for this determinati is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No Back of sewage into facilitywor system componerfidne'to an overloaded or -Jogged -SAS- or -cesspool. ' Dischar or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. Static liqui evel in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. Liquid depth ) cesspool is less than 6" below invert or available volume is less than 1/2 day flow. Required pumpin more than 4 times in the last year NOT due to clogged or obstructed pipets). Number of times mped Any portion of the S ') Absorption System, cesspool or privy is below the high groundwater elevation. Any portion of a cess or privy Is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool privy is within a Zone 1 of a public well. _ Any portion of a cesspool or vy is within 50 feet of a private water supply well. Any portion of a cesspool or is less -then 100 feet but greater than 50 feet from a private water supply well with no T acceptable water quality analysis. H the well has been analyzed to be acceptable, attach copy of well water analysis for -coliform bacteria, volatile organic pounds, ammonia nitrogen and nitrate nitrogen. E. LARGE SYSTEM FAILS: You must indicate either "Yes" or "No" to each of the folio 'ng: The following criteria apply to targe systems in a ' n to the criteria above: The system serves a facility with a design flow of 10.0 gpd or greater (Large System) and the system is a significant threat to public health and safety and the environment because one or m e of the following conditions exist: Yes No the system is within 400 feet of a surface drinking w\ing _ the system is within 200 feet of a tributary to a surfapplythe system is located in a nitrogensensitive area (intetion Area - IWPAI or a mapped Zone 11 of a public water supply well) The owner or operator of any such system shall upgrade the system in aCMR 15.304(2). Please consult the local regional office of the Department for further information. revised 9/2/98 Page4ofll SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST V.C. Rajashekar Proms Address: 1029 Johnson Street Owner: D,Ae of inspection: N. Andover, MA 01845 7/25/00 Check if the following have been done: You must indicate either "Yes" or "No" as to each of the following: Yes No Pumping information was provided by the owner, occupant, or Board of Health. / ✓ None of the system components haw.been pumped4w-at Jeast two weeks and -the system has been-seceiving Awmai flow r rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. / As built plans have been obtained and examined. Note if they are not available with N/A. The facility or dwelling was inspected for signs of sewage back-up. _ The system does not receive non -sanitary or industrial waste flow. _ The site was inspected for signs of breakout. . _ All system components, excluding the Soil Absorption System, have been located on the site. _ The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum. The size and location of the Soil Absorption S n the site has been determined based on: / KI ✓ Existing information. For example, an at6 O. it Determined in the field (if any of the failure criteria related to Part C is at issue, approximation of distance is unacceptable) [I 5.302(3)(b)) The facility owner land occupants, if differemat from. owner) were provided.with information. on the.fuoper maintenaara-of SubSurface Disposal Systems. revised 9/2/98 Page 5of11 a SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION V.C. Rajashekar Plc Ate: 1029 Johnson Street Owner: Date of kspecsoa:N. Andover, MA 01845 7/25/00 FLOW CONDITIONS RESIDENTIAL: Design flow: i g.p.d./bedroom. Number of bedrooms (design): Number of bedrooms (actual): Total DESIGN flow Number of current residents: Garbage grinder (yes or no)*.6a rno • If yes, separate inspection required Laundry (separate system)Poo Laundry system inspectedr no) Seasonal use (yes or no): Water meter readings, if available (last two year's usage (gpd): Sump Pump (yes or no):40— Last date of occupancy, Type of establishment: N. Design flow: d ( Based on 15.203) Basis of design flow Grease trap present: (yes or no)_, Industrial Waste Holding Tank presem Non -sanitary waste discharged to the Water meter readings, if available:_ Last date of occupancy: OTHER: (Describe) Last date of occupancy: or no)_ system: (yes or no)_ GENERAL INFORMATION PUMPING RECORDS and source of information: System pumped as part of inspection: (yes or If yes, volume pumped: gallons Reason for pumping: TYPE O STEN Septic tank/distribution box/sod absorption system Single cesspool Overflow cesspool Privy Shared system {yes or no) (if yes, attach previous inspection records, if any) I/A Technology etc. Attach copy of up to date operation and maintenance contract Tight Tank Copy of DEP Approval Other APPROXIMATE AGE of all components, date installed known) -and source of information: ZIL-1 Wg IR Sewage odors detected when arriving at the site: (yes or no) 110 revised 9/2/98 Page 6of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM IMSPECTION FORM PART C V.C. Rajashekar SYSTEKINFORMATION4continued) Property Ad*,=: 1029 Johnson Street oma: N. Andover, MA 01845 Date of 7/25/00 BUILMG SEWER: (Locate on site plan) .` Depth below grader Material of construction: cast iron , 40 PVC _ other (explain) Distance from private water supply well or suction line Diameter Comments: icopdition of ioirpts, venting, evidence of leakage, -etc.) (1 , SEPTIC TANK-_L.,- (locate ANK_L/(locate on site plan) Depth below grade Material of constru on: *concrete _metal — Fiberglass ,Polyethylene _other(explain) If tank is metal, list age _ Is.age.confirmed by Certificate of Compliance _ (Yes/No) Dimensions: to C k(AA __ Sludge depth: t- j' 4 i 1 Distance from top`� dge to bottom of outlet tee or baffle: `� -' Scum thickness:_ i I Distance from top of scum to top of outlet tee or baffler Distance from bottom of scum to bottom of utlet tee or baffle:_ How dimensions were determined: -<T-vt Comments: (recommendation for pumping, canditi n ofjroetend outle t s of baffles, depth of liquid level in relation to outlet rove tructural-integrity, evidence of leakage, etc.) i c IGz ` GREASE TRAP: (locate on site pian) Depth below grade: Material of constructi\crete _metal _Fiberglass _Polyethylene _otherfexplain) Dimensions: Scum thickness: Distance from top of scum to top of outlet%baffle:Distance from bottom of scum to bottom offle: Date of last pumping: Comments: frecommendation for pumping, condition otees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) revised 9/2/98 Page 7of11 SUBSURFACE SEWAGE DISPOSAL SYSTum INSPECTION FORM PART C SYSTEM rNFORMATION (conlinred) V.C. Rajashekar Property Address: 1029 Johnson Street 0"mer.N. Andover, MA 01845 Daft of 7/25/00 TIGHT OR HOLD G TANK: (Tank must be pumped prior to, or at time of, inspection) (locate on site pia ) Depth below grade Material of constru ion: _concrete _metal _,Fiberglass _Polyethylene —other(explain) Capacity: gallons Design flow: gallons/day Alarm present Alarm level: larm in working order: Yes _ No Date of previous pumpi Comments: (condition of inlet tee, con 'tion of alarm and float switches, etc.) DISTRIBUTION BOX: \ (locate on site plan) 11 Depth of liquid level above outlet invert: _ Comments: !nte if level and distributionis equal, eviidenee of PUMP CHAMBER:_ (locate on site plan) Pumps in working order: (Yes or No) Alarms in working order (Yes or No) Comments: (note condition of pump chamber, condition e carryover, evidence of leakage into or out of boA. e^ i) and appurtenances, etc.) revised 9/2/98 Page 8of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C V.C. Rajashekar SYSTE INFORMATION (continued) Prepefn► Address: 1029 Johnson Street Owner: N. Andover, MA 01845 D°"a 01 "x°"7/25/00 SOR ABSORPTION SYSTEM (SAS): (locate on site plan, if possible; excavation not required, location may be approximated by non -intrusive methods) If not located, explain: Type: leaching pits, number:_ leaching chambers, number:_ leaching galleries, number: leaching trenches, number, length' �v leaching fields, number, dimensions: overflow cesspool, number:_____ Alternative system: Name of Technology: Comments: (note condition of soil, CESSPOOLS- _ (locate on site plan) of hydraulic failure, levo of Number and configuration: Depth -top of liquid to"inlet inv _ Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater: inflow (cesspool must be Comments: (note condition of soil, signs of hydraulic PRIVY- _ (locate on site plan) as part of inspection) condition of vegetation, etc.) of ponding, condition of vegetation, etc.) Materials of construction: Depth of solids: Comments: (note condition of soil, signs of hydraulic failure, level of condition of vegetation, etc.) revised 9/2/98 Page 9of11 Dimensions: SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM.NFORMATION (covidnued) V.C. Rajashekar Property Address: 1 O29 Johnson Street Owner: N. Andover, MA 01845 Date of Inapectiion. 7/25/00 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent reference landmarks or benchmarks locate all wells within 100' (Locate where public water supply comes into house) e� B ,3t,kV1-SU, ik o - revised 9/2/98 Page 10 of 11 .3 I 4 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C V.C. Rajashekar SYSTEM OFORMATION Icm*wed) ft,ww Ate: 1029 Johnson Street Ownw. N. Andover, MA 01845 Data of Inspection"7/25/00 NRCS Report name — Soil Type_ Typical depth to groundwater USGS Onto website visited Observation Wells checked Groundwater depth: Shallow Moderate Deep SITE EXAM .Slope .,/Surface water eck Cellar ,,�PShallow wells Estimated Depth to Groundwater Feet Please indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record Observed.Site (Abutting property, observation hole, basement sump etc.) determined from local conditions Checked with local Board of health Checked FEMA Maps Checked pumping records Checked local excavators, installers Used USGS Data Describe how you established the High Groundwater Elevation. (Must be completed) revised 9/2/98 Page 11 of 11 �e� c2 NORTH `�_7 O N � PUBLIC HEALTH DEPARTMENT Community Development Division October 22, 2008 Mark and Kristen Federico 1029 Johnson Street North Andover, MA 01845 Re Addition Dear Mr. and Mrs. Federico, This letter is in response to Health Department concerns raised regarding the review of your application for an addition at your residence known as 1029 Johnson Street. On October 21, 2008 I conducted a walk through at your home and we discussed the project. Certain items were discussed and agreed upon. These items are listed below. 1) The application will remain for a 3 bedroom home by eliminating a wall between 2 existing bedrooms 2) The storage area under the new addition will remain an unfinished area 3) Due to the required connection of the washing machine water to the septic system, per the North Andover Regulations, a second inspection of the subsurface disposal system shall be conducted within 6 months after the change over. Future expansion of the number of habitable rooms or a failure to pass the system inspection in six months will result in the requirement that an upgrade of the system be done in line with the MA DEP regulations. Thank you for your cooperation in this important matter. Sincere f / � / Susan Sawyer, REHS/RS Public Health Director 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com PUBLIC HEALTH DEPARTMENT Community Development Division October 22, 2008 Mark and Kristen Federico 1029 Johnson Street North Andover, MA 01845 Re Addition Dear Mr. and Mrs. Federico, This letter is in response to Health Department concerns raised regarding the review of your application for an addition at your residence known as 1029 Johnson Street. On October 21, 2008 I conducted a walk through at your home and we discussed the project. Certain items were discussed and agreed upon. These items are listed below. 1) The application will remain for a 3 bedroom home by eliminating a wall between 2 existing bedrooms 2) The storage area under the new addition will remain an unfinished area 3) Due to the required connection of the washing machine water to the septic system, per the North Andover Regulations, a second inspection of the subsurface disposal system shall be conducted within 6 months after the change over. Future expansion of the number of habitable rooms or a failure to pass the system inspection in six months will result in the requirement that an upgrade of the system be done in line with the MA DEP regulations. Thank you for your cooperation in this important matter. Sincere /Susan Sawyer, REHS/RS Public Health Director 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com Owner Owner information is required for every page. . Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. I� ICI Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1029 Johnson Street Property Address Mark & Kristen Federico Owners Name No Andover City/ rown MA 01845 2/1/08 State Zip Cod Date of Inspection results must be submitted on this form. Inspection way. A. General Information 1. Inspector: Benjamin C. Osgood Jr. Name of Inspector New England Engineering Services, Inc. Company Name 1600 Osgood Street Suiten-64 Company Address No. Andover City/Town 978-686-1768 Telephone Number B. Certification MA State License Number be altered in any 01845 Zip Code I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000). The system: asses ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority Inspecto ' Signature Date 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. ****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. /0 O / L - :56-F le )4ir�L ►446 t. J� TITLE 5 FORM 2007.DOC • 08/06 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 1 of 15 Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1029 Johnson Street Property Address Mark & Kristen Federico Owner's Name No Andover MA 01845 2/1/08 Cityrrown 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: 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: r! E!S R eco, nn e t DLi•i7DN I f C.L r4';'i74tL 1� B) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass" section need to be replaced or repaired.7he 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 TITLE 5 FORM 2007.DOC • 08/06 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 2 of 15 Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1029 Johnson Street Property Address Mark & Kristen Federico Uwners Name No Andover MA 01845 2/1/08 Citylfown State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ distribution box is leveled or replaced ND Explain: ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if (with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ obstruction is removed ND Explain: 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 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. TITLE 5 FORM 2007.DOC - 08/06 Tide 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 3 of 15 Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments w •.''t 1029 Johnson Street Property Address Mark & Kristen Federico Owner Owner's Name information is required for No Andover MA 01845 2/1/08 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) C) Further Evaluation is Required by the Board of Health (cont.): ❑ 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 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 ❑ 12- Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ a Liquid depth in cesspool is less than 6" below invert or available volume is less than 'h day flow ❑ ❑,. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ 2 Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. TITLE 5 FORM 2007.DOC - 06/06 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 4 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1029 Johnson Street B. Certification (cont.) D) System Failure Criteria Applicable to All Systems (cont.): 2/1/08 Date of Inspection Yes No ❑ 5?^ 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. El 12"*' 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.] ❑ E�r The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ d/ 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 ❑ [I/' the system is within 200 feet of a tributary to a surface drinking water supply ❑ 15111*� 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. TITLE 5 FORM 2007.DOC • 08/06 Title 5 Official Inspection Forth: Subsurface Sewage Disposal System - Page 5 of 15 rroperty Address Mark & Kristen Federico Owner Owner's Name is required for required for No Andover MA 01845 every page. City/Town State Zip Code B. Certification (cont.) D) System Failure Criteria Applicable to All Systems (cont.): 2/1/08 Date of Inspection Yes No ❑ 5?^ 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. El 12"*' 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.] ❑ E�r The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ d/ 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 ❑ [I/' the system is within 200 feet of a tributary to a surface drinking water supply ❑ 15111*� 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. TITLE 5 FORM 2007.DOC • 08/06 Title 5 Official Inspection Forth: Subsurface Sewage Disposal System - Page 5 of 15 N W Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1029 Johnson Street Property Address Mark & Kristen Federico Owner information is Owner's Name required for No Andover NIA 01845 2/1/08 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? d❑ Has the system received normal flows in the previous two week period? ❑ 0/ Have large volumes of water been introduced to the system recently or as part of this inspection? d❑ 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? Le" ❑ Were all system components, excluding the SAS, located on site? Ljl ❑ Were the septic tank manholes uncovered, opened, and the interior of th�tank inspected for the condition of the baffles or tees, material of construction., dimensions, depth of liquid, depth of sludge and depth of scum? L9' ❑ Was the facility owner (and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? TITLE 5 FORM 2007.DOC • 08/06 The size and location of the Soil Absorption System (SAS) on the site has been determined based on: Q/ ❑ 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)] Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 6 of 15 t Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 1029 Johnson Street Property Address Mark & Kristen Federico Owner Owner's Name required for is No Andover required for MA 01845 2/1/08 every page. City/Town State Zip Code Date of Inspection D. System Information Residential Flow Conditions: Number of bedrooms (design): Number of bedrooms (actual): DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x # of bedrooms): Number of current residents: Does residence have a garbage grinder? ❑ Yes jX No Is laundry on a separateewage system? [if yes separ to inspection required] ( Yes ❑ No SCe. %LG6orn eCSK.%C i2 ec Laundry system inspected? ❑ Yes A] No Seasonal use? El Yes INZ NO Water meter readings, if available (last 2 years usage (gpd)): Sump pump? ❑ Yes 5Q No Last date of occupancy: r,r ! —7 -- Date 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? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non -sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Other (describe): Date TITLE 5 FORM 2007.DOC - 08/06 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 7 of 15 Owner information is required for every page. Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1029 Johnson Street Property Address Mark & Kristen Federico Owner's Name No Andover City/Town D. System Information (cont.) Pumping Records: Source of information: \AA 01845 2/1/08 Zip Code Date of Inspection General Information Was system pumped as part of the inspection? If yes, volume pumped: How was quantity pumped determined? Reason for pumping: OL/oy rJc-0— gPt-c R,::� RLV,5 gallons Type of System: Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Yes 0 No ❑ 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: -�pTw�N Were sewage odors detected when arriving at the site? ❑ Yes Q""No TITLE 5 FORM 2007.DOC - 08/06 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 8 of 15 . -, Commonwealth of Massachusetts a Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments wM 1029 Johnson Street Property Address Mark & Kristen Federico Owner information is Owner's Name required for No Andover MA 01845 2/1/08 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Building Sewer (locate on site plan): Zt Depth below grade: feet Material of construction: ® cast iron ❑ 40 PVC ❑ other (explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): l' t7ELL>e, K 5 AIOQ^� e4:L_ I,v 'X +.s i Septic Tank (Incate on site plan): Depth below grade: feet Material of construction: concrete ❑ metal ❑ fiberglass ❑ polyethylene El other (explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No -------------------------------------------------------------------------------------------------------------------------- Dimensions: Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? TITLE 5 FORM 2007 DO / 10042 C%I-L. Lo 3 �E'►4SJ 2C S12L C • 08 — Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 9 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1029 Johnson Street Property Address Mark & Kristen Federico Owner Owner's Name information is required for No Andover MA 01845 2/1/08 every page. Cityrro` n 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.): !!rAV K i Av '0 k c o Aj v .'1 art 11-400 Ilk E QJ_Q � � rr C1 -1-t 6- C "-U 58%��et.E w kic t -L S Gf a u IAC Q�ACE� w Kik r9 - P -o-c- TL c N 1,4 Grease Trap (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass 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 feet ❑ polyethylene ❑ other (explain): Date of last pumping: Date Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): /u IA 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): TITLE 5 FORM 2007.DOC • 08/06 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 10 of 15 Depth of liquid level above outlet invert cJ 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.): a.a.Q Gt7...`}t�o.A %VCS.— Ca.ie.2c9c� �v L X=AV, ctv . C" r-_7 O✓fit.. tl)k Pump Chamber (locate on site plan): Pumps in working order: Alarms in working order: ❑ Yes ❑ Commonwealth of Massachusetts W W Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1029 Johnson Street Property Address Mark & Kristen Federico Owner Owner's Name information is required for No Andover MA 01845 2/1/08 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) A)VTight or Holding Tank (cont.) Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float swit=II jes, ritC.): Attach copy of current pumping contract (required). Is copy attached? ❑ Yes ❑ No Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert cJ 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.): a.a.Q Gt7...`}t�o.A %VCS.— Ca.ie.2c9c� �v L X=AV, ctv . C" r-_7 O✓fit.. tl)k Pump Chamber (locate on site plan): Pumps in working order: Alarms in working order: ❑ Yes ❑ No ❑ Yes ❑ No TITLE 5 FORM 2007.DOC - 06/06 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 11 of 15 Commonwealth of Massachusetts D.- Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1029 Johnson Street Property Address Mark & Kristen Federico Owner Owner's Name information is required for No Andover MA 01845 2/1/08 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: 112 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.): E�4 c� F �t Ec-P �.ao u.� .vo Q/vtAL, stip rte, pa2c E c.'2F::- P9NP(t!!q DAMP Sart.-rte j,JQ.✓r,— UF-&-eT-A-)bAJ. TITLE 5 FORM 2007.DOC • 08/06 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 12 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1029 Johnson Street Property Address Mark & Kristen Federico Owner Owner's Name informationis No Andover required wirfor for MA 01845 2/1/08 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Nlk 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 F� v^_ M 1111 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.)-. TITLE 5 FORM 2007.DOC • 08/06 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 13 of 15 Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1029 Johnson Street Property Address Mark & Kristen Federico Owner Owner's Name information is required for No Andover MA 01845 2/1/08 every page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) 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. �a.�•.e9c� � ry we u AW TITLE 5 FORM 2007.00C - 08/06 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 14 of 15 Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1029 Johnson Street Property Address Mark & Kristen Federico Owner's Name No Andover Cityrrown D. System Information (cont.) Site Exam: [Check Slope Surface water ❑ Check cellar 2—Shallow wells,vo,.�c% Estimated depth to ground water: MA 01845 State Zip Code feet 2/1/08, Date of Inspection Please indicate all methods used to determine the high ground water elevation: X F4 F. Obtained from system design plans on record If checked, date of design plan reviewed: Date 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) R1 Accessed USGS database - explain: You must describe how you established the high ground water elevation: LptGS *-4Aj?A L-1-01 C01� L&jAIIRA —i—"Li-7 � �• Sew LQ SeeQ olc0..J. a� �Qpw..ln s: oc_ TITLE 5 FORM 2007.DOC • 08/06 Title 5 Official Inspection Forth: Subsurface Sewage Disposal System • Page 15 of 15 NEw ENGLAND Erie MG SERVICES, INC, 1600 Osgood Street Building 20 Suite 2-64 North Andover, MA 01845 7b1: (978) 686-1768 9 Fax: (978) 327-6138 www neengineeringinc-com May 1, 2008 Susan Sawyer North Andover Board of Health 1600 Osgood Street North Andover, MA 01845 Re: 1029 Johnson Street, North Andover Dear Susan: Enclosed is a passing Title 5 report for the above referenced property. There is however a laundry dry well which was not inspected because the owner is in the process of applying to the building department to construct an addition which would require the removal of the laundry dry well. It is my recommendation that the laundry dry well be removed and the laundry piping be connected to the existing septic system during the construction of the addition. There is no evidence that this system can not handle the additional flow however the Board of Health may want to make it a condition that the system be inspected again a few months after all of the construction is done to verify that the system can handle the new flow. If you have any questions, or need additional information, please do not hesitate to contact this office. Sincerely, 9 r-- 6? . Benjamin C. Osgood, Jr., P.E. President V Th OHO COLMIC lWKN .7/ PUBLIC HEALTH DEPARTMENT Community Development Division Date: October 7, 2008 Address: 1029 Johnson Street Re: Application for home addition Dear: Mr. and Mrs. Federico, Your application received for review on October 6, 2008 has been fully reviewed by the Health Department. The application was unfortunately denied on, October 7, 2008, for the following reason as shown in red: 1. ❑ Missing information 2. ❑ Passing Title 5 inspection of septic system required per local N. Andover regulations 3. ❑ Location of structure not acceptable 4. X Undersized septic system (see attached section of the MA DEP regulations section 15.204) To address the problem(s): If #4 is checked: Options Septic systems are designed for a certain size home. The Feb. 2008 Title V report indicates it passed a test on the function of the system, however the information provided regarding the home shows the system is too small. The floor plan review has shown that the house with the addition will increase to an eight or nine -room house. At minimum there are; 3 bedrooms, I study, 2 family like type rooms, a kitchen and a dining room. (the ninth room is the undetermined unfinished room in the basement) If this is incorrect, an onsite visit may be arranged by the health staff. 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com The town assessor file shows your house as a three bedroom home. The Health files have no information regarding the size of the system. The title five indicates a 3 - bedroom home. The conclusion is that the system is designed for a 3 -bedroom or maximum 7 -room home. It is incumbent upon you to do one of the following prior to receiving approval on this application. a. Provide additional information proving that the existing septic system meets current capacity requirements. Please consult a professional engineer or registered sanitarian to determine the flow capacity of the septic system. b. Hire a professional engineer to design a new septic system that meets State Regulations c. Request approval of a variance to place a deed restriction as detailed in 15.414 (see attached) Please feel free to call the Health Office at 978-688-9540 with any questions you may have. Sincerely, Susan Sawyer, Pub ' Health Dir for Cc: Building Department File 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 978.688.9540 fax 978.688.8476 Web www.townofnorthandover.com 310 CMR: DEPARTMENT OF ENVIRONMENTAL PROTECTION 15.204: Increases in Design Flow to System No person shall increase the actual or design flow to any cesspool or to any other system above the existing approved capacity, or change the type of establishment of a facility served by a cesspool, unless the cesspool or system is upgraded first. Upgrades to accept increased design flow shall be performed in full compliance with the requirements applicable to new construction unless a variance is allowed pursuant to 310 CMR 15.414. For purposes of 310 CMR 15.204, the approved design flow shall be the flow listed in the most recent Disposal Works Construction Permit. 15.211: Minimum Setback Distances (1) All systems must conform to the minimum setback distance for septic tanks, holding tanks, pump chambers, treatment units and soil absorption systems, including reserve area, measured in feet and as set forth below. Where more than one setback applies, all setback requirements shall be satisfied. • [1] Disposal facilities shall be at least 18 inches below water supply lines. Wherever sewer lines must cross water supply lines, both pipes shall be constructed of class 150 pressure pipe and shall be pressure tested to assure watertightness. [2] The required setback shall be 50 feet where the applicant has provided hydrogeologic data acceptable to the Approving Authority demonstrating that the location of the soil absorption system is hydraulically downgradient of the vernal pool. Surface topographyalone is not determinative. 4/21/06 310 CMR - 512 Septic Tank Soil Absorption System Holding Tank Pump Chamber Treatment Unit Grease Traps Property Line 10[5] 10[5] Cellar or Crawl Space Wall, Swimming Pool (inground), foundation drain 10 20 Slab Foundation 10 10 Water Supply Line (pressure) 10[l] 10[1] Surface Waters (except wetlands) 25 50 Bordering Vegetated Wetland (BVW), Salt Marshes, Inland and Coastal Banks 25 50 Surface Water Supply - Reservoirs and Impoundments 400 400 Tributaries to Surface Water Supplies 200 200 Wetlands bordering Surface Water Supply or Tributary thereto 100 100 Certified Vernal Pools 50 100[2] Private Water Supply Well or Suction Line 50 100 Public Water Supply Well (2) (2) Irrigation Well 10 25 Open, Surface or Subsurface Drains which discharge to Surface Water Supplies or tributaries thereto 50 100 Other Open, Surface or Subsurface Drains (excluding foundation drains) which intercept seasonal high groundwater table [3] 25 50 Other Open, Surface or Subsurface Drains (excluding foundation drains) 5 10 Leaching Catch Basins & Dry Wells 10 25 Downhill Slope not applicable 15[4] [1] Disposal facilities shall be at least 18 inches below water supply lines. Wherever sewer lines must cross water supply lines, both pipes shall be constructed of class 150 pressure pipe and shall be pressure tested to assure watertightness. [2] The required setback shall be 50 feet where the applicant has provided hydrogeologic data acceptable to the Approving Authority demonstrating that the location of the soil absorption system is hydraulically downgradient of the vernal pool. Surface topographyalone is not determinative. 4/21/06 310 CMR - 512 310 CMR: DEPARTMENT OF ENVIRONMENTAL PROTECTION 15.412: continued (c) With the exception of those watersheds (Ware, Quabbin and Wachusett) to which the provisions of 350 CMR 11.00 (MDC Watershed Protection regulations) apply, local Approving Authorities may, after consultation with the local water supplier, issue variances for the siting of systems within the setbacks to surface water supplies or to tributaries to surface water supplies and may exempt tributaries consistent with the standards and procedures of 350 CMR 11.00 without Department approval provided that no such variance or exemption shall result in the siting of a septic tank or soil absorption system within 200 feet of said surface water supplies or 100 feet of said tributaries, or siting of a septic tank within 25 feet or a soil absorption system within 50 feet of any surface water. Copies of all such variances for uses and exemptions of tributaries shall be submitted to the Department by the local Approving Authority within 30 days of issuance. 15.413: Conditioning of Variances (1) The local Approving Authority or the Department may issue variances subject to such conditions, including, but not limited to, monitoring and reporting requirements, deed recordation requirements, financial assurances or other qualifications on the use of the system, as it deems necessary to protect public health, safety, welfare and the environment. Any conditions shall be expressed in writing in allowing the variance. (2) Any denial of a variance by the local Approving Authority or the Department may direct the applicant to upgrade an existing system consistent with the requirements and standards of 310 CMR 15.404 and 15.405. Failure to do so may be the subject of enforcement action by the local Approving Authority or the Department. 15.414: Variances for increased Flow to Existing System Local approving authorities and the Department may vary the application of any provisions of 310 CMR 15.000 with respect to any particular case involving increased flow to an existing system only when in the opinion of both the Department (except as provided in 310 CMR 15.412(4)) and the local Approving Authority all of the following conditions are met. A showing by the person requesting a variance that the proposed variance would satisfy the maximum feasible compliance provisions as set forth in 310 CMR 15.404 and 15.405 shall not presumptively entitle such person to a variance. (1) The person requesting a variance has established that strict enforcement of the provision of 310 CMR 15.000 from which a variance is sought would be manifestly unjust, considering all the relevant facts and circumstances of the individual case including, at a minimum, the following.- (a) ollowing:(a) the owners of any such system for which permit applications were filed after March 31, 1995 shall be deemed to have had knowledge that full compliance with the requirements applicable to new construction is preferred; (b) the costs of full compliance with the requirements applicable to new construction shall be compared to the costs of compliance with a variance; and (c) whether an upgrade in full compliance with 310 CMR 15.000 is feasible without increased flow. (2) The system cannot be brought into full compliance through any of the following: (a) an upgraded system which is in full compliance with 310 CMR 15.100 through 15.293; (b) an alternative system which has been approved for such use pursuant to 310 CMR 15.284 (remedial use), 15.285 (piloting), 15.286 (provisional approval), or 15.288 (certification for general use); (c) a shared system which has been approved for such use pursuant to 310 CMR 15.290 and 15.291; or (d) connection to a sewer system (3) The upgraded system with the increased flow provides better protection of public health and safety and the environment than the existing system with no increase in flow. Increased flows not incompliance with 310 CMR 15.000 will rarely provide better protection than existing flows to a system designed and constructed in compliance with the 1978 Code or 310 CMR 15.000, but are more likely to constitute improvements over nonconforming or failed systems. 9/22/06 (Effective 4/21/06) - corrected 310 CMR - 566 Commonwealth of Massachusetts �, 4A-��� , Massachusetts System Pumping Record System Owner Date of Pumping: � ,3!;�; Cesspool: No -m] Yes [ ] System Pumped by: 64&44at System Location C4- Date + Quantity Pumped: /�Jgallons Septic Tank: No [ ] License # Contents transferred to: Greater Lawrence Sanitary District Date: Inspector: Yes [4--" 5 Syale11S�VS Conu»onwealtfl of Massaciwsells ,Massachusetts 6 Sten pure ngReoord System Localion 'r1D Dale of 1'uillping: r2,22,2- O Ouai►lily Pumped: gallons Cesspool: No rV Yes L I Septic Tank: No I] Yes 41""— System I'ui»ped by: $at'eQoff Fie4n,64ijed License #—_—__-- Canlenls lransferrred to : ca[ea:er f awfence sanllary plsklcI Dale: _____ lnspeclor: WN�?F'NO$.TH ANI?C K �- SYSTEM�Pt1 OrNTC3 RECO. DATE SYSTEM OWNER & ADDRESS F�erl CIO 1o�g �ahnsz�t A) - QJu.6aye-e-, ma . SYSTEM LOCATI DATE OF PuMPAig_ gUA.NUTY'PUWED_ .�. DD a CESSPOOL NO YOB; UPTIC TANK NO �w YES NATURE OF SERVICR,; YRQ�tlIFNE EMMR©ENGY OBSERVATIONS: GOOD CONDITION' FULL TO COVER H$AVY GREASE ; : BAFFLES IN LACE ROOT'S : ;LBACHFIELD RUNBACK EXCESSIVE SOLID' FLOODED SOLII) CARRSYOVEF,- OTHER EXPLAIN r , SYSTEM PUMPED BY , COMMENTS; CONTENTS TRANSFERREDTO;;;__��� • ��;�.1wro �k.>'� :.� t 3unj� �:t���;';F'�, ' :+1�'�, wY t. � .. ,1� � Y t ?' _: .. .. v WN�?F'NO$.TH ANI?C K �- SYSTEM�Pt1 OrNTC3 RECO. DATE SYSTEM OWNER & ADDRESS F�erl CIO 1o�g �ahnsz�t A) - QJu.6aye-e-, ma . SYSTEM LOCATI DATE OF PuMPAig_ gUA.NUTY'PUWED_ .�. DD a CESSPOOL NO YOB; UPTIC TANK NO �w YES NATURE OF SERVICR,; YRQ�tlIFNE EMMR©ENGY OBSERVATIONS: GOOD CONDITION' FULL TO COVER H$AVY GREASE ; : BAFFLES IN LACE ROOT'S : ;LBACHFIELD RUNBACK EXCESSIVE SOLID' FLOODED SOLII) CARRSYOVEF,- OTHER EXPLAIN r , SYSTEM PUMPED BY , COMMENTS; CONTENTS TRANSFERREDTO;;;__��� Commonwealth of Massachusetts Massachusetts System Pumping Record System Owner �^ �e �� P- � 00 System Location Date of Pumping:. "l' C Quantity Pumped: PZ-i� gallons Cesspool: No Yes ❑ Septic Tank: No ❑ Yes T System Pumped by: 644dow 460&0uda License # Contents transferrred to : Greater Lawrence Sanitary District Date: Inspector: