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HomeMy WebLinkAboutMiscellaneous - 1080 TURNPIKE STREET 4/30/2018 (3)Q v r� i U v O o v O n � U C Z Cj (A 'V O T. G rtI O Cl) O --q G i 1 WATER SUOPLY: TOWN WELL WELL PERMIT DRILLER._...__._.. ...... WELL TESTS: CHEMICAL DAZE APPROVED-- . .......... BA 'ERIA I BACTERI II COMMENTS: - DA I E (WIPRUVED DATE APPRUVED FORM U APPROVAL: APPROVAL TO ISSUEYES NO DATE rSSUED-Z% Z- BY -.zl CONDITIONS: FINAL APPROVAL.-. ALL PERMITS PAID YES NO WELL CONSTRUCTION APPROVAL YES NO SEPTIC SYSTEM CONSTRUCTION APPROVAL YES NO OTHER YES NO ANY VARIANCE NEEDED YES NO FINAL BOARD OF HEALTH APPROVAL: DR I'E: ...... DY y 7 w + ,B- 'U :.. ' .. '�r ' •'1 i'- 1 `• f _ t \.t.:}]. ! 9 `.. . .I 'A P� Yr \..t� i Lti �• e•C �.. ,^i-•l. x� IS THE LICENSED? - } . INSTALLER +� YES NO f Vit•,- ` , + _ • � • ` ' .- ' - { Jr • .TYPE OF- CONSTRUCTION: ; _ r' .. g-EW REPAIR' ...."NEW CONSTRUCTION:::., CERTIFIED PLOT-PLAN REVIEWYES NO CONDITIONS OF..APPROVAL ES NO -., .. (FROM FORM U) •`•' I:. '� li \, . ;•: .',; l'.•°' r1-, .,: .! '. 1 _ In ,ISSUANCE •OF DWC PERMIT f„'_ _ t YE NO =YDWC :PERMIT N0. 1. ., ` y INSTALLER: AL? T6/(�GX BEGIN INSPECTION • YES N0: • _ .;EXCAVATION . INSPECTION: :NEEDED: PASSED ,BY :-;CONSTRUCTION INSPECTIONS NEEDED( AS BUILT PLAN SATISFACTORY: YESs 1 �?iA4 1�4 - TO BACKFILL: DATE: BY_ _APPROVAL AFINAL.GRADING APPROVAL: DATE /� BY 7 : vZZ/q B Y I '.,`; .•FINAL CONSTRUCTION APPROVAL.: � DATE. PUBLIC HEALTH DEPARTMENT Town of North Andover Community Development Division CERTIFICATE OF COMPLIANCE As of: 8/11/16 This is to certify that the individual subsurface disposal system received a SATISFACTORY INSPECTION of the: Repair of D -box and pump cover By: Todd Bateson At: 1060 Turnpike Street Map 107.0 Lot 0008 North Andover, MA 01845 of this ce if�e shall not be construed as a guarantee that the system will function satisfactorily. Michele Grant Public Health Agent 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 978.688.9540 Fox 978.688.8476 Web www.townofnorthandover.com North Andover Health Department (ommunity and Economic Development Division ONSITE WASTEWATER SYSTEM CONSTRUCTION NOTES LOCATION INFORMATION ADDRESS: 1060 Turnpike St. MAP: 107.0 LOT: 0008 INSTALLER: Todd Bateson DESIGNER: PLAN DATE: BOH APPROVAL DATE ON PLAN: INSPECTIONS Replace D -box and pump cover INSPECTION: AIIN DATE OF BED BOTTOM INSPECTION: DATE OF FINAL CONSTRUCTION INSPECTION: DATE OF FINAL GRADE INSPECTION: SITE CONDITIONS ❑ Contractor reports any changes to design plan ❑ Existing septic tank properly abandoned ❑ Internal plumbing all to one building sewer ❑ Topography not appreciably altered �_,�c.r�� v-e—.zo4 Ai -L j kcv-A `p-3ai. -Fwd- 5 Comments: � �i,nC���d� ,a.C.t' SEPTIC TANK ❑ Building sewer in continuous grade, on compacted firm base ❑ Cleanouts per plan ❑ Bottom of tank hole has 6" stone base ❑ Weep hole plugged ❑ 1500 gallon tank has been installed H-10 loading ❑ Monolithic tank construction ❑ Water tightness of tank has been achieved by visual testing ❑ Inlet tee installed, centered under access port ❑ Outlet tee installed, centered under access port (gas baffle/effluent filter) ❑ inch cover to within 6" of finish grade installed over one access port ❑ Hydraulic cement around inlet & outlet Comments: PUMP CHAMBER ❑ Bottom of tank hole has 6" stone base ❑ Weep hole plugged ❑ 1500 gallon Pump Chamber installed ❑ H-10 loading ❑ Monolithic tank construction ❑ Inlet tee installed, centered under access port ❑ Pump(s) installed on stable base ❑ Alarm float working ❑ Pump On/Off floats working ❑ Separate on/off floats ❑ Drain hole in pressure line ❑ cover at final grade installed over pump access port ❑ Water tightness of tank has been achieved by testing ❑ Hydraulic cement around inlet & outlet Comments: CONTROL PANEL ❑ Alarm & Pump are on separate circuits ❑ Alarm sounds when float is tripped ❑ Location of control panel: basement ❑ Alarm signal located inside: basement Comments: DISTRIBUTION -BOX Installed on stable stone base H-20 D -Box Inlet tee (if pumped or >0.08'/foot) Hydraulic cement around inlet & outlets / Observed even distribution Speed levelers provided (not required) Schedule 40 PVC Pipe Comments: 8/12/2016 IMG_1454.JPG -- https:/Imail.google.com/mail/ca/u/O/ffinbox/l 567c3830ab512cc?projector=1 1/1 M� s slip �. r i e y� l • or fit 400 it Ai . i 10 1 rm AM, ! �'�s� ;dc ���1�'� .' y x� rig �t �+ +'a[ y' x � .c .*t+.sx��,p�v. �`` •. sr_}, r�'d •• '. ;5 167t !!1,t•►� I4# k'1,� 7� � ci � -UN yrs *" a!4G�'� ^ylrt 4'fl►'''r#i''�a!� £ RidArt- INN aa.`,x, 3�. $*1 tats �t I{ N +L. 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Map -Block -Lot 107.00008 ---------------------- Permit No BHP -2016-0251 ----------------------- FEE DISPOSAL WORKS CONSTRUCTION PERMIT Permission is hereby granted Todd -Bate -son --------------------------------------------------------------------------- $175.00 to (Repair) an Individual Sewage Disposal System. at No 1060 TURNPIKE STREET �' U� �' - c -------------------------.--- ---- � - -b ---- I --------------------- as shown on the application for Disposal Works Construction Permit No. BHP -2016-025 Dated August -0-8,-2-0-1-6 -------------------------------------------------- Issued On: Aug -08-2016 BOARD OF 14RA1714 ill . C'P N e °`�. � i 1. • • 1 la 1 • • Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. ILS Construct a new on-site sewage disposal system* TODAY'S DATE $ 0—Full Repair j$9M - Component ❑ Repair or replace an existing. on-site sewage disposal' system* (,Repair or replace an existing system component — What? P --e p��y ce 0,L—_ j fS 'du A. Facility Information 54. Address or Lot # CityfTown --may V,J V AUG Qg 2 tiqLJL 2: *TYPE SEPTIC SYSTEW: 16 ump ❑ Gravity (choose one) 10WN OF NORTH ANDO ***If pump sys attach copy of electrical permit to application HEALTH DEPARTMENTER ➢ onventional System (pipe and stone system) ➢ ❑ Infiltrator or Biodiffuser (Gravel -Less) (Attach a copy of your cerfifrcation to install this type of system.) ➢ ❑ Pressure Distribution S.A.S. (No D -Box) ➢ ❑ Pressure Dosed (D -Box Present) S.A.S. ➢ ❑ Does the system require an effluent filter? Yes No If yes, does plan specify make and model of filter? YES = (no further info. needed) NO = (installer must specify brand of filter before DWC issuance) 2. 9 What is the Make? what is the Moder- LLM ?dame 5 I Address (if different from above) ' City/Town ke State Zip Code Installer Information Name Address City/rown 4. Designer Information Name Address City/Town Telephone Number Name of Company i 111 ARGILLA ROAD i"IA State ®las/0 Zip Code Telephone Number (Cell Phone # if possible please) Name of Company State Zip Code Telephone Number (Best # to Reach) Application for Disposal System Construction Permit - Page 1 of 2 TODAY' DATE $:250.00 *-Pull Repair 5125.00: -Component PAGE 2 OF 2 A. Facility. nformation continued.... 5. Type,of Buffding: 2 esidential Dwelling or []Commercial B. Agreement The unders/gned agrees to ensure the construction and maintenance of the afore -described on-site sewage disposal systemin accordance with the provisions of Titles of the Environmental Code, as well as the Local Subsurface Disposal Regulat/ons for the Town of North Andover, and not to place the system In operation until a Certificate of Compliance has been issued y this Board of Health. Name Date Application Disapproved. for the following reasons: For Office Use Only: 1 " Pee AttacbedpYes No 2.- PtojectArt iager Obligation Form 3.; mp SVS ? Ifsoi Attach co�� 4. Fvuadadd*As Bu&z thew construction-ronly): (Same scale as apptoyed plan) 5. FloorRws? thew construction' only): No, - No No No 4P!6t(On'for,00Q5al 4stdit:061tstMC00ri Permh'- Rsae 2 rit 7 SEP�k`IC�"S�'3'�F�+L•�'�•��RO,�C'T' 34[�1N�1,��.�•�p�I,iGA'�IUNS As 9W N99h Aadove0mmetil3i ono ft 46J4tMWft=d-f6 lhezTdc "stop farther apettyat; laloo {Ads ofsq* uo* s All #: m III Restive tD dW4pp md= of A T�So (itae s rinse Aad dOad Dstrd o : A Whit mvidof I uadttaiaad the foDowlpg ObUgatiom for m magemeat of Chia protect: i. 1ls the �asmJkr, I aas.oblig ttnd to obbdas�llpeaeib mdBose of�Iesrldt apptovaci plma;ft to �petbom:iug aap.'Wa�c vier c sdte. 3. As dte i Ire .I. t It s�aei ifl*mpwdbm Mood= not con ptgcamsnage; or nap a�haput= tlots4oc b ted with my c=T mp -L-1'-1-•na iVect = and du spsteta is notmcdy, thcg to T�svcdre9c:PIMPIts oft . '� ;: •.� •�=�f � th�.�l"�'�p-:�hrsc is crnctn't�tg moi, a�h%Ir etstflispado9 fat40tIlotleo m hepMbtit• . 6. —atp for �3fevionsti�, ct+G a �nebld OIC'(Or a tIX rwu wu from thea& must ' ba tubmittird•to �#te.8oxrcd"ofH�, amt: .` �x•m ect�pa vitae, 'Iasmllis iriust ZC* slut 6apzeusitferr ti,iaspmdoa, tts� pst�tavQtltgat lienbie c8 • 'eonsep�p.tti s�id�o .. :. • - .. . • • • ,• a ���tailert�at�earoaahe�i�ll�dirt��sentapltte:• iei�ocanot • have #o be arts.. ;'. .. .. . . , 4 Aslte ksWIe;'I =*iomd that ady I $u 1c'(ot�ir'tbas► �),pnd m; teq,,iired io Too •tha n of tie syst�egi idem # .i ed atioa j . 5,. A1r th`etet;�i n�der�tnaii . Iumkv s coaston . A; De archer dwf.drop iv& dmdi a ofdW Ck drVAdoA 14•,bCM Amcbea ' . k I�n�petdo� a�tlie"sFad readatp�ae�b �e s� - . . a ' Pmslfaapraxfavrby8or�to1.�YeAlthat�atraaastiibut� � .. . • • - . A Ia4ls ribAdfmak, D-. ang r, ataat, neat, fiber, ssi� aagnif other . 6. Uadet d Utetued Sepda.0 RECEIVED. Commonwealth of Massachusetts^ 20 13 City/Town of T0M, OFN AM)OVER System Pumping Record N1�� Form 4 DEP has provided this form for use -by local Boards of Health. Other forms may be used, but the information must be substantially the same as that provided here. Before using.this form, check with your local Board of Health to determine the form they use. The System Pumping Record must be submitted to the local Board of Health or other approving authority. A. Facility Information 1. System Location: Q/ Rig r eft /Right rear of house, Left/ right side of house, Left/ Right side of building, Left / Right front of building, Left / Right rear of building, Under deck Address 0 E0 ! 0 'v\ SF�- d Q,9 Citylrown State Zip Code 2. System Owner. Name Address (if different from location) City!Town state ' ��-y Q �Z Telephone Number B. Pumping Record _ 1. Date of Pumping Date 2. Quantity Pumped: Gallons 3. Type of system: ❑ Cesspool(s)Septic Tank ❑ Tight Tank CI ❑ Other (describe): Effluent Tee Filter present? ❑ Yes No /st 6. System Pumped By: If yes, was it cleaned? ❑ Yes ❑ No Neil Bateson F5821 Name Vehicle License Number Bateson Enterprises Inc- Company ncCompany 7. Locag2awhere contents were disposed: Lowell Waste Water -- - �3 luled I Date t5form4.doc• 06t03 System Pumping Record • Page 1 of 1 I Orn bcaUon) T"T —4' 17 5776, t, - - - - - - - - - - - - - - - 'Pumping. egord: oa'4�� Q! Pvmpin9 m (? I ., .. I Typq 91 oya(OM: ❑Co 5 5POOI(5) $00C Tens L) (do x0o�:' EM�om To ) 4 Fl."...." . .. .... Nou(mnr? ❑ Yo5 ❑No lk j;j •.0 Qn "-.k J" Pvm' on whore D r v 4 (fl , m a 4.90 y I ww.a We /)0- .7 T19"ll Tan" lf Yes. --63 i: voanoo? C yes — 1. 7D EP-helPfQvldod jhJ4 tQfrl NOV 3 2008 t,�t D 0 b fr. I; 1 0 a C f H 0 8!::� ?^o SY3:0.'n ilQdim or c(flo %" Alft Faclljty lnforrl 'aftn HEALTH DEPARTMF-,,4,[- �Ys Am location: • 7.4 ,^.4 L" 9 &L') U.� W eoo�lol �44 V4 v ql Town 7 Orn bcaUon) T"T —4' 17 5776, t, - - - - - - - - - - - - - - - 'Pumping. egord: oa'4�� Q! Pvmpin9 m (? I ., .. I Typq 91 oya(OM: ❑Co 5 5POOI(5) $00C Tens L) (do x0o�:' EM�om To ) 4 Fl."...." . .. .... Nou(mnr? ❑ Yo5 ❑No lk j;j •.0 Qn "-.k J" Pvm' on whore D r v 4 (fl , m a 4.90 y I ww.a We /)0- .7 T19"ll Tan" lf Yes. --63 i: voanoo? C yes — Town of North Andover Office of the Health Department f Community Development and Services Division e 27 Charles Street 4 •� North Andover, Massachusetts 01845 RSSAcµusEt Sandra Starr Telephone (978) 688-9540 Public Health Director Fax (978) 688-9542 March 4, 2002 Mr. and Mrs. Michael Putnam 1080 Turnpike Street North Andover, MA 01845 RE: Proximity of proposed addition to existing septic system components. Dear Mr. and Mrs. Putnam: The site plan dated 9/13/01 REV 2/21/02 submitted to the Health Department has been reviewed and has raised an additional concern. The Health Department has been working with you and your consulting engineer in an attempt to design a project that meets state and local regulations for some time and anticipate this will be the last revision needed. The following items are cited to prevent possible damage to your septic system, as well as to your residence, both of which could be very costly. The addition must be scaled down to meet the mandated setback requirements of the septic system and its components. Please address the following: • The proposed deck does not meet the 5' local setback requirement to the septic tank. The stairs are depicted approximately 3' from the septic tank. • The concrete slab for the addition is proposed approximately 2' from the septic line connecting the house and the septic tank. This line is a vital septic system component that could cause an imminent health hazard if damaged. Any damage to this line could cause sewage backup into the dwelling, soil and groundwater. The concrete slab must be proposed 5' from this line. Note: The system and its components may be seriously damaged if any machinery drives over any part of the system. Access by heavy machinery must be restricted to the rear of the dwelling. The contractor must be aware of the septic system component locations and advise all the subcontractors working on site to exercise extreme care when operating near them. Please contact me at (978) 688-9540 if you have any questions, comments or concerns. Sincerely Bran J. LaGrasse Health Inspector cc: Building Department File Hancock Engineering Associates, 235 Newbury Street, Danvers, MA 01923 BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 Town of North Andover Office of the Health Department or Community Development and Services Division 27 Charles Street North Andover, Massachusetts 01845 "SSgCHU Sandra Starr Health Director March 4, 2002 Mr. and Mrs. Michael Putman 1080 Turnpike Street North Andover, MA 01845 Re: Application for an addition to an existing home Dear Mr. Michael Putman: Telephone (978) 688-9540 Fax (978) 688-9542 Your application for an addition at 1080 Turnpike Street has been reviewed by the Health Department. The application was denied on March 4, 2002 for the following reasons: 1. Missing information 2. Passing Title 5 inspection of septic system may be required 3. X Location of structure not acceptable To address the problem(s): If #1 is checked, please supply: a. Floor plan of the existing dwelling and the proposed addition; b. Certified plot plan showing house, septic system and proposed project in scale, including any associate grading. If #2 is checked: a. Have the septic system inspected by a certified Title 5 inspector to determine the size of the system and whether it is operating properly: OR b. Tie-in to municipal sewer. If #3 is checked: a. Relocate the project. Please see attached correspondence. Please feel free to call the Health Office at 978-688-9540 with any questions you may have. Since r ly, -z ian J. LaGrasse, Health Inspector Cc: Building Department ,/File BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 NURSE 688-9543 PLANNING 688-9535 -0% TOWN OF NORTH ANDOVER HEALTH DEPARTMENT 1 27 CHARLES STREET NORTH ANDOVER, MASSACHUSETTS 01845 Sandra Starr Public Health Director DATE: January 9, 2002 TO: Heidi Griffin, Dir. CD&S RE FROM: 1080 Turnpike Street S. Starr MEMO The following is a chronology of 1080 Turnpike Street — Michael Putnam. Telephone (978) 688-9540 FAX (978) 688-9542 On or about August 8, 20011 received a letter and fax from a Michael Putnam asking for possible health issues if he changed his floor plan and put on an addition. This was out of the blue and I called and talked to him about his plans and what might be of interest to the BOH. I don't believe I knew the address or anything specific. Sometime around the end of October or the beginning of November, I received a call from Julie Parino about a project she was about to file, or had just filed with Conservation. I tried to explain the permitting process to her but felt that my message was not taken in. On or about November 21, 20011 received a letter from a Jim Scanlon of Hancock Engineering along with a Local Upgrade Approval form requesting variances from Title 5, a rough sketch that looked a little familiar, and construction plans for an addition. I was very confused about this and tried to find out what it was for since there was no Form U attached. I started to write notes as I reviewed the plans in reference to the variances they requested. There were many calls back and forth to and from Hancock and to Mr. Putnam. I had already determined that: the variances could not be granted without causing the septic system to become non -conforming relative to setbacks; a Local Upgrade Approval form should n6t have been submitted because nothing was being done to the septic system (The addition was proposed too close to the system.); the site had been evaluated prior to the current Title 5 and for new construction, (the addition), everything must be in -compliance. (This would include soil evaluation.); a deed restriction was not appropriate since they are used for septic system repairs for existing homes that are larger than the largest septic system that can be built on the site; and a number of other technical nitpicks. In the meantime I had spoken to the homeowner several times. At one point he stated that he had backhoes and other machinery in his yard and that he had a hole in the side of his house. I was taken aback and asked if he had obtained his demolition permit and whether he had a building permit. He did not respond. I believe at that time I promised that he would have a letter from me detailing the problems by December 28, 2001 or by Friday of the following week. After the call I talked to Mike Maguire asking if he had an application and an issued permit for 1080 Turnpike Street. He had neither. The Building Inspector visited the site a day or so after our discussion to issue a "cease and desist order". He told me that a new garage was proposed for the site, and asked if I had a problem with it; it was on the opposite side of the house from the septic system. I told him that it was OK with me that they continue with the garage. I was relieved that work could move ahead. At this point I called the state DEP to get an opinion on my take of the situation. I was told that a fully- complying system was required for the addition. On or about December 21, 20011 had finished my notes on the review and gave them to my secretary to type up. Jim Scanlon also came to the office and I suggested we try to do limited soil/site evaluation as soon as possible; I had already checked with the Board to ascertain whether they had any problems with out -of -season testing for this particular site. They did not. On December 27, 20011 received the first draft of the letter and began editing it. I believed that I finished it and gave it back to my secretary to change and send out. In this I was incorrect; I had not finished the editing process so Mr. Putnam never received a letter from me. I feel very badly about this because I had promised and I had broken my word. This was totally my fault. Being on vacation didn't help anything either! Apparently during the time that I was ofl� an appointment for a meeting was made with poor Mr. Putnam, who I understand took the day off from work so we could talk. The meeting was made for 9:00 AM on Monday morning, January 7, 2002. I was not notified about this meeting, a departmental problem that I shall address immediately. Unfortunately I woke very late that day because of a particularly restless night and missed the appointment I didn't know I had — ultimately my fault, regardless. I looked at the plans again today from a different perspective and called Jim Scanlon to recommend that he suggest to his client that the addition be downsized somewhat from a room 20' by 22' feet, to one either 16.4' by 22' or one 20' by 15'. If this is done then they're through with the Health Department. 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. Vf�I lean, Commdhwealth of Massachusetts A Title 5 Official Inspection Fc Subsurface Sewage Disposal System Form - Not for Voluntary 1080 Turnpike Street Property Address Michael Putnam Owner's Name North Andover Cityrrown -MA 01845 State Zip Code 1AY 2 6 20jo 6P NORTH ANDOVER I.TW DEPARTMENT 5/25/2010 Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. , A. General Information 1. Inspector: Neil J. Bateson Name of Inspector ®` Bateson Enterprises Inc. { Company Name 111 Argilla Road Company Address Andover Cityrrown 978-475-4786 Telephone Number B. Certification Ma State SI15 License Number 01810 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: ® Passes ❑ Conditionally Passes ❑ Fails ❑ N Furth r Ev uation by the Local Approving Authority 5/25/201 C Inspe or' 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. t5ins •(X9/08 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 1 of 17 E Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1080 Turnpike Street Property Address Michael Putnam Owner's Name North Andover MA 01845 5/25/2010 Cityfrown 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 - 09/08 idle 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 1080 Turnpike Street Property Address Michael Putnam Owner's Name North Andover MA Cityrrown State B. Certification (cont.) B) System Conditionally Passes (cont.): 01845 5/25/2010 Zip Code Date of Inspection ❑ 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 ❑ Y ❑ N ❑ ND (Explain below): ❑ 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 - 09/08 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 3 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 1080 Turnpike Street Property Address Michael Putnam Owner's Name North Andover MA 01845 5/25/2010 City/Town 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 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 % day flow t5ins • 09/08 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ;M 1080 Turnpike Street Property Address Michael Putnam Owner Owner's Name information is required for North Andover MA 01845 5/25/2010 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or the system is within 200 feet of a tributary to a surface drinking water supply tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply Area — IWPA) or a mapped Zone II of a public water supply well well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory, for 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.] ❑ ® 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 - 09108 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 5 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 1080 Turnpike Street Property Address Michael Putnam Owners Name North Andover Cityfrown C. Checklist MA 01845 5/25/2010 State Zip Code Date of Inspection 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): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x # of bedrooms): 660 t5ins • 09/08 Title 5 Official Inspection Forth: Subsurface Sewage Disposal System • Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments wM 1080 Turnpike Street Property Address Michael Putnam Owner Owner's Name information is required for North Andover MA 01845 5/25/2010 every page. Cityrrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: 3 Does residence have a garbage grinder? ® Yes ❑ No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage 9 ( Y 9 (gPd))� Yes Detail: Sump pump? ❑ Yes ® No Last date of occupancy: Current 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: t5ins • 09/08 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �., 1080 Turnpike Street Property Address Michael Putnam Owner information is required for every page. Owner's Name North Andover MA Cityrrown State D. System Information (cont.) Last date of occupancy/use: Other (describe below): Pumping Records: Source of information: 01845 5/25/2010 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: Type of System: Pumped 2009, owner 1500 gallons Measured tank Inspect tank & tees ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ® Yes ❑ 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) 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 • 09/08 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1080 Turnpike Street Property Address Michael Putnam Owner information is required for every page. Owner's Name North Andover City/Town D. System Information (cont.) MA 01845 State Zip Code 5/25/2010 Date of Inspection Approximate age of all components, date installed (if known) and source of information: 15 years old, 12/5/1995, as built plan Were sewage odors detected when arriving at the site? Building Sewer (locate on site plan): Depth below grade: 2 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.): 4" PVC out to seotic tank Septic Tank (locate on site plan): Depth below grade: Material of construction: ® concrete ❑ metal 1 feet ❑ Yes ® No ❑ 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: 10'x 5'x 4' Sludge depth: 4" ❑ Yes ❑ No t5ins • 09108 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1080 Turnpike Street Property Address Michael Putnam Owner Owner's Name information is required for North Andover MA 01845 5/25/2010 every page. Cityrrown 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 25" Scum thickness 6" Distance from top of scum to top of outlet tee or baffle 8" Distance from bottom of scum to bottom of outlet tee or baffle 12" How were dimensions determined? Tape Measure Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Pumped septic tank. Inlet tee ok. Outlet tee ok. Depth of liquid at outlet invert. No evidence of 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 • 09108 Date Title 5 Cnficial Inspection Form: Subsurface Sewage Disposal System • Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1080 Turnpike Street Property Address Michael Putnam Owner information is required for every page. Owner's Name North Andover MA 01845 5/25/2010 City/Town 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 Dimensions: Capacity: Design Flow: Alarm present: Alarm level: ❑ fiberglass ❑ polyethylene ❑ other (explain): gallons gallons per day ❑ Yes ❑ No Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): * Attach copy of current pumping contract (required). Is copy attached? ❑ Yes ❑ No t5ins • 09/08 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 11 of 17 IN Owner information is required for every page. t5ins • 09/08 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1080 Turnpike Street Property Address Michael Putnam Owner's Name North Andover MA Citylrown State D. System Information (cont.) 01845 5/25/2010 Zip Code Date of Inspection 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.): D -box level & distribution equal, has flow leveler in one pipe. D -box cover broken, replaced it. Evidence of carryover, pumped d -box to clean. No evidence of leakage. 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.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: 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 1080 Turnpike Street Property Address Michael Putnam Owner information is required for every page. t5ins • 09/08 Owners Name North Andover MA Cityfrown State D. System Information (cont.) Type: El El El leaching pits leaching chambers leaching galleries leaching trenches leaching fields overflow cesspool 01845 Zip Code 5/25/2010 Date of Inspection number: number: number: number, length: number, dimensions: number: 2 trenches 60' long ❑ 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.): Soil ok. Vegetation ok. No sign of ponding to surface 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 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 13 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 1080 Turnpike Street Property Address Michael Putnam Owner's Name North Andover MA 01845 5/25/2010 Citylrown State Zip Code Date of Inspection D. System Information (cont.) 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 • 09108 Title 5 Official Inspection Forth: Subsurface Sewage Disposal System - Page 14 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 1080 Tumpike Street Property Address Michael Putnam Owner's Name North Andover Cityrrown MA 01845 State Zip Code 5/25/2010 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 o t - o i t5ins • 09/08 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 15 of 17 Owner information is required for every page. t5ins - 09/08 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1080 Turnpike Street Property Address Michael Putnam Owner's Name North Andover MA 01845 5/25/2010 Cityrrown 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: 4 feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: 8/12/1993 Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health - explain: Original plans ❑ Checked with local excavators, installers - (attach documentation) ❑ Accessed USGS database - explain: You must describe how you established the high ground water elevation: Test pit data on design plan Before filing this Inspection Report, please see Report Completeness Checklist on next page. Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1080 Turnpike Street Property Address Michael Putnam Owner information is required for every page. Owner's Name North Andover Cityrrown MA 01845 State Zip Code 5/25/2010 Date of Inspection E. Report Completeness Checklist ® 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 • 09108 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 17 of 17 1 t5form4.doc• 06/03 Commonwealth of Massachusetts City/Town of System Pumping Record Form 4 DEP has provided this form for use by local Boards of Health. Other forms may be used, but the information must be, substantially the same as that provided here. Before using this form, check with your local Board of Health tQ determine the form they use. The System Pumping Record must be submitted to the local Board of Health of--ottx6r.approving authority. A. Facility Information 1. System Location: Left side of house, Right side of house"eft front of house ight front of house, Left rear of house, Right rear of house. Left rear of building. Rig rear o building. fi4O(eSS 10 250 Citylrown State 2. System Owner: vame —ress tir anrerent from location) City/Town B. Pumping Record 1. Date of Pumping 3. Type of system: ❑ ❑ Other (describe): pv�- maw. 5-O.S- -1 o — 2. Quantity Pumped: Date Cesspool(s) Zip Code State Zi ode Telephone Number is—oc) Gallons eptic Tank ❑ Tight Tank 4. Effluent Tee Filter present? ❑ Yes to If yes, was it cleaned? ❑ Yes ❑ No 5. Condition of System: 6. System Pumped By: Neil Bateson Name Bateson Enterprises Inc Company 7. Location where contents were disposed: L.S.D Lowell Waste Water Signature of Hauler F5821 Vehicle License Number uate System Pumping Record • Page 1 of 1 TOWN OF NORTH ANDOVER HEALTH DEPARTMENT 27 CHARLES STREET NORTH ANDOVER, MASSACHUSETTS 01845 Sandra Stan Public Health Director January 14, 2002 Michael Putnam 1080 Turnpike Street North Andover, MA 01845 Re: Building permit application Dear Mr. Putnam: Telephone (978) 688-9540 FAX (978) 688-9542 This letter comes as a follow-up to our telephone conversation on January 9, 2002 in reference to your building permit application for an addition to your home at 1080 Turnpike Street. After investigating all other possibilities to allow a 20 -foot by 22 -foot addition to your house, it appears that the most cost-effective and timely solution is to change the size of your proposed addition. Instead of the original size of 20' X 22', the addition can be either 16.4' X 22' or 20' X 15'. We also discussed the possibility of maximizing the size of the room by adding a jog to the western side of the room nearest the septic tank. I agreed that was possible as long as the ten- foot setback to the septic tank was maintained. I also passed along the message from Building that a new building permit application was required. As I understand it, you were intending to request your architect to redesign the room. If I have left out anything of note that we discussed, please let me know. I do hope that the remaining portion of your project goes smoothly. Sincerely, Sandra Starr, R.S., C.H.O. Health Director Cc: H. Griffen, Dir. CD&S M. Maguire, Bldg. Insp. File NOTE TO FILE JANUARY 9, 2002 3:10 PM — Mr. Putnam returned my call and we discussed changing the size of the addition. He asked whether there was any way in which to maximize the size of the room by having a jog. I told him that was quite possible as long as the minimum 10' to the septic tank was maintained. I also passed along what Mike Maguire had told me earlier in the day, that a new application would have to be applied for. S. Starr XGA? Page 1 of 5 9A - APPLICATION FOR LOCAL UPGRADE APPROVAL Commonwealth of Massachusetts North Andover, Massachusetts Application for Local Upgrade Approval Title 5,310 CMR 15.000 DEP approved form required by 310 CMR 15.403(1) To be submitted to Local Approving Authori!yMoard of Health: For the upgrade of a failed or non -conforming system with a design flow of <10,000 gpd, where full compliance, as defined in 310•CMR 15.404(1), is not feasible. To be submitted to DEP: For the upgrade of a failed or non -conforming system with a design flow of 10,000 up to 15,000 gpd and/or for upgrade of state of federal facility, where full compliance, as defined in 310 CMF 15.404(1), is not feasible. NOTE: Local upgrade approval shall not be granted for an upgrade proposal that includes the addition of new design flow to a cesspool or privy or the addition of new design flow above the existing approved capacity of a system constructed in accordance with either the 1978 Code or 310 CMR 15/000. 1) Facility/System Owner: Name: m1eHA-EL P,>TI,14tj Address: logo 7-u1ziUo) KC 5T /ll. �4N1,b1/t�Z Phone #: Address of facility: 1080 Tu,e,uP1,LE 5T /l/. XIDOVEl2 2) Applicant (if different from above) Name: Address: - 5AME - Phone #: 3) Type of Facility: Residential Commercial School Institutional (Specify) t To be submitted to Local Approving Authori!yMoard of Health: For the upgrade of a failed or non -conforming system with a design flow of <10,000 gpd, where full compliance, as defined in 310•CMR 15.404(1), is not feasible. To be submitted to DEP: For the upgrade of a failed or non -conforming system with a design flow of 10,000 up to 15,000 gpd and/or for upgrade of state of federal facility, where full compliance, as defined in 310 CMF 15.404(1), is not feasible. NOTE: Local upgrade approval shall not be granted for an upgrade proposal that includes the addition of new design flow to a cesspool or privy or the addition of new design flow above the existing approved capacity of a system constructed in accordance with either the 1978 Code or 310 CMR 15/000. 1) Facility/System Owner: Name: m1eHA-EL P,>TI,14tj Address: logo 7-u1ziUo) KC 5T /ll. �4N1,b1/t�Z Phone #: Address of facility: 1080 Tu,e,uP1,LE 5T /l/. XIDOVEl2 2) Applicant (if different from above) Name: Address: - 5AME - Phone #: 3) Type of Facility: Residential Commercial School Institutional (Specify) Page 2 of 5 \ 4) Type of Existing System: _privy cesspools) conventional system other(describe) Type of soil absorption system (trenches, chambers, pits, etc.) 5) Design Flow Based on 310 CMR 15.203: a) Design flow of existing system tJgQ gpd Approved: _yes Approval date* qg 5 t no Why: . (A S gw, l+ = 10; S, b) Design flow of proposed upgraded system ____pd Why c) Design flow of facility d 6) Proposed upgrade of existing system is: No (> � vore, a) Voluntary required by order, letter, etc. (attach copy) Required following inspection required by 31 CMR 15.301 (provide date inspection form was submitted to the approving authority) (date) b) Describe the proposed upgrade to the system: c) Which of the following are applicable to the proposed upgrade? _X Reduction of setback(s) (list setbacks to be reduced with proposed setback distances9310CM2, 15 .7-11 SEPAQ4crnoN 2c-iWt:z-::7N sL4a AND s(EPnc TANK- o.^nlatinn rata nfZl1 �n »,; REc2019-EI.,,�L ��7PECr MOVIDi b 5 iirnuiE�t-ti111 -fta-1 Q �cU70im 5-02 - 5�0-4,0�o a) 13�� yw I -�,IC et ��G T-4 �e Up to 25% reduction in subsurface dis� 1 area design requ�m D t�stat`e � required & proposed size) Relocation of water supply well (identify well, describe relocation) Reduction of required separation between bottom of SAS & high groundwater (specify proposed reduction & perc rate) Page 3 of 5 `\ Other requirements of 310 CMR 15.000 that cannot be met (specify sections of the code) System upgrades that cannot be performed in accordance with 31 CMR 15.404 & 15.405, or in full compliance with the requirements of 310 CMR 15.000, require a variance pursuant to 310 CMR 15.410-15.417. 7) If the proposed upgrade involves a reduction in the required separation between the bottom of the soil absorption system and the high groundwater elevation, an Approved Soil Evaluator must determine the high ground water elevation pursuant to 310 CMR 15.405(1)(1)(1). The evaluator must be a member or agent of the local approving authority: Distance from soil absorption system to high groundwater feet As determined by: Evaluator's name: Evaluator's Signature: Date of evaluation: 8) Notice to Abutters: No application for upgrade approval in which the setback from property lines or a private water supply well is reduced shall be complete until the applicant has notified all abutters whose property 9or well is affected by certified at least ten days before the Board of Health meeting at which the upgrade approval will be on the agenda. Such notice shall include the date, time and place where the upgrade approval will be discussed. If the department is the approving authority, then such notice to abutters must be completed prior to the date of submission of the application to the department. The notices to abutters shall include a copy of the completed application form and shall reference the standards set forth in 310 CMR 15.402 through 15.405. List of affected abutters: Abutter Name Date notified Address Abutter Name Date notified Address Abutter Name Address Abutter Name Address Date notified Date notified Page 4 of 5 9) Explain why full compliance, as defined in 310 CMR 15.404(1), is not feasible (each section must be completed): a) An upgraded system in full compliance with 310 CMR 15.000 is not feasible: b) An alternative system approved pursuant to 310 CMR 15.283-15.288 is not feasible. c) A shared system is not feasible. /V,O/ 'KP.6(11re61 d) Connection to a sewer is not feasible. 10) An application for a disposal system construction permit, including all required attachments (e.g. plans & specifications, site evaluation forms), must accompany this application. Is the DSCP application attached? yes _�— no �Ale, 6,q, "(MA�✓ iC ��5 iS Qi'O QSC�f" g - 11) Certification "I, the facility owner, certify under penalty of law that this document and all attachments, to the best of my knowledge and belief, are true, accurate, and complete. I am aware that there may be significant consequences for submitting false information, including, but not limited to, penalties or fine and/or imprisonment for knowing violations." Facility Owner's Signature Print Name ame of Preparer Telephone No. & Address of Preparer NOTE: Title 5,310 CMR 15.403(4) requires the system owner or operator to submit to the Department a copy of the local upgrade approval upon issuance by the Board of Health and prior to commencement of construction. ,HAIACCK Engineering Associates 235 Newbury Street, Danvers, MA 01923 (978) 777-3050 Fax (978) 774-7816 ❑ 12 Farnsworth Street ❑ 626 Main Street Boston, MA 02210 Bolton, MA 01740 (617) 350-7906 (978) 779-6767 TO WE ARE SENDING YOU ❑ Attached ❑ Under separate cover via ❑ Shop drawings ❑ Prints ❑ Plans ❑ Copy of letter ❑ Change order ❑ Q 04(/0i/-- following items: ❑ Samples ❑ Specifications COPIES DATE N0. DESCRIP_TION ( THESE ARE TRANSMITTED as checked below: ❑ For approval ❑ Approved as submitted ❑ For your use ❑ Approved as noted ❑ As requested ❑ , W&RAWmA.01�421/ ( THESE ARE TRANSMITTED as checked below: ❑ For approval ❑ Approved as submitted ❑ For your use ❑ Approved as noted ❑ As requested ❑ Returned for corrections ❑ For review and comment ❑ ❑ FORBIDS DUE REMARKS El ❑■ TC r'tf �? ()F Resubmit copies for approval I Submitcopies;for distribution t Return corrected prints ❑ PRINTS RETURNED—AFTER LOAN TO US 1! j Ra�OVED 51/; — If enclosures are not as noted, kindly notify us at once. SzO n HANCOCK Engineering Associates December 21, 2001 North Andover Board of Health 27 Charles Street North Andover, MA 01845 Att: Mrs. Sandra Starr RE: 1080 Turnpike Street Dear Sandy: #9166 235 Newbury Street Danvers, MA 01923 (978)777-3050 Fax (978)774-7816 Bolton, MA (978)779-6767 Boston, MA (617)350-7906 Hancock Engineering Associates (HEA), on behalf of Michael Putnam, would like to schedule an in-house meeting to discuss the material filed with the Board of Health on 11/21/01. Mr. Putnam, of 1080 Turnpike Street, is seeking to construct an addition to his existing dwelling. Construction of the addition will require a variance from 310 CMR 15.211 (separation between Septic Tank and dwelling). A Form 9A -Local upgrade approval application has been submitted. After a conversation with yourself, it appears there is some confusion as to whether a septic system upgrade is necessary. Plans are attached which highlight the existing and the proposed number of rooms. HEA is of the opinion that the proposed project will not require an upgrade, as the existing number of rooms totals eight, and the proposed number of rooms will total eight. The proposed game room will replace the three season porch, which has recently been demolished. The septic system is designed for a four bedroom system. Please let me know when we can meet to discuss the project. Thank you. Sincerely, Hancock Engineering Associates a es B. Scanlan, Project Engineer cc: Michael Putnam Board of Health 200 I'D OF P: e 00 212001 t Division of Hancock Survey Associates, Inc. HANCOCK Engineering Associates 235 Newbury Street, Danvers, MA 01923 (978) 777-3050 Fax (978) 7747816 626 Main Street Bolton, MA 01740 TO (978) 9-6767 Z7 LEARM EFZ OF TRANS-MiI=7TRA WE ARE SENDING YOU ❑ Attached ❑ Under separate cover via the following items: ❑ Shop drawings ❑ Prints ©dans ❑ Samples ❑ Specifications ❑ Copy of letter ❑ Change order THESE ARE TRANSMITTED as checked below: For approval ❑ Approved as submitted ❑ Resubmit copies for approval ❑ For your use ❑ Approved as noted ❑ Submit copies for distribution ❑ As requested ❑ Returned for corrections ❑ Return corrected prints ❑ For review and comment ❑ ❑ FORBIDS DUE ❑ PRINTS RETURNED AFTER LOAN TO US REMARKS T;. VN OF NOR; H A11Dii � CLIA11L) Ur ML"L; r, r____ LNOV 2 1 2om COPY TO SIGNED: If enclosures are not as noted, kindly noti us at once. HANG K Engineering Associates November 21, 2001 North Andover Board of Health 27 Charles Street North Andover, MA 01845 Attn: Ms Sandy Starr Re: 1080 Turnpike Street, North Andover Dear Sandy: #9166 235 Newbury Street Danvers, MA 01923 (978)777-3050 Fax (978)774-7816 Bolton, MA (978)779-6767 Boston, MA (617)350-7906 This letter is written on behalf of our client, Mr. Michael Putnum, who is seeking to construct an addition onto the existing dwelling at 1080 Turnpike St., North Andover. As part of the project, he needs to request a variance from 310 CMR 15.211 (separation between Septic Tank and Dwelling). The proposed addition will be constructed on a slab foundation, 5 feet from the existing septic tank. He also needs to seek a variance from local regulation Section 5.02 (separation between septic tank and deck) as the septic tank is 4'+/- from the proposed deck. Because this is an existing dwelling with no increase in flow, we have filed a Form 9A — Local Upgrade Approval. The existing structure has eight (8) rooms, of which only three (3) are bedrooms. The North Andover Assessors office confirms the total room count, however they list the number of bedrooms as four (4). This is not an issue, as the septic system was designed to handle a four (4) bedroom dwelling. On the first floor there is an eat-in- kitchen/breakfast area/family room, a dining room, an office, a living room, and the 3 -season porch. On the second floor there are three (3) bedrooms (see Existing First Floor Plan and Second Floor Plan). The proposed addition consists of removing the 3 -Season Porch and constructing a Game Room. On the second floor they are enlarging the master bedroom, moving the master bathroom and one closet, and adding a second closet that has an area of 110 S.F.(see Proposed First Floor Plan and Second Floor Plan) The closet is an "unheated storage area" and thus does not increase the bedroom count per Title V, 310 CMR 15.002 (Definitions — Bedrooms). The total number of proposed rooms will be eight (8), five (5) on the first floor and three (3) on the second. This is the same as the existing room count, thus there is no increase in flow. Even if the closet were considered a room, then the total count would be nine (9) rooms, which also equates to a four (4) bedroom dwelling under Title V. Please let me know when this application might be discussed, as we would like to be present to answer any questions that might arise. Thank you for your review of the Form 9A Application and the enclosed plans. Sincerely 7an'les CO ENGINEE ASS ATES _ Scanlan Project Engineer 1 Cc: File #9166 NOY 2 1 2001 Division of Hancock Survey Associates, Inc. COCK Engineering Associates November 21, 2001 North Andover Board of Health 27 Charles Street North Andover, MA 01845 Attn: Ms Sandy Starr Re: 1080 Turnpike Street, North Andover Dear Sandy: 'L 99166 235 Newbury street D.,rs, MA 01923 (978)777-3050 Fax (978)774-7816 Bolton, MA (978)779-6767 Boston, MA (617)350-7906 This letter is written on behalf of our client, Mr. Michael Putnum, who is seeking to construct an addition onto the existing dwelling at 1080 Turnpike St., North Andover. As part of the project, he needs to request a variance from 310 CMR 15.211 (separation between Septic Tank and Dwelling). The proposed addition will be constructed on a slab foundation, 5 feet from the existing septic tank. He also needs to seek a variance from local regulation Section 5.02 (separation between septic tank and deck) as the septic tank is 4'+/- from the proposed deck. Because this is an existing dwelling with no increase in flow, we have filed a Form 9A — Local Upgrade Approval. The existing structure has eight (8) rooms, of which only three (3) are bedrooms. The North Andover Assessors office confirms the total room count, however they list the number of bedrooms as four (4). This is not an issue, as the septic system was designed to handle a four (4) bedroom dwelling. On the first floor there is an eat-in- kitchen/breakfast area/family room, a dining room, an office, a living room, and the 3 -season porch. On the second floor there are three (3) bedrooms (see Existing First Floor Plan and Second Floor Plan). The proposed addition consists of removing the 3 -Season Porch and constructing a Game Room. On the second floor they are enlarging the master bedroom, moving the master bathroom and one closet, and adding a second closet that has an area of 110 S.F.(see Proposed First Floor Plan and Second Floor Plan) The closet is an "unheated storage area" and thus does not increase the bedroom count per Title V, 310 CMR 15.002 (Definitions Bedrooms). The total number of proposed rooms will be eight (8), five (5) on the first floor and three (3) on the second. This is the same as the existing room count, thus there is no increase in flow. Even if the closet were considered a room, then the total count would be nine (9) rooms, which also equates to a four (4) bedroom dwelling under Title V. Please let me know when this application might be discussed, as we would like to be present to answer any questions that might arise. Thank you for your review of the Form 9A Application and the enclosed plans. Sincerely HANCOCK ENGINE ASS90ATES -dames Scanlan -Project Engineer Cc: File 99166 i'G4N OF NORFH A,:OO'.' . J BOARD OF t•'EALTH 21 2001 Division of Hancock Survey Associates, Inc. Pagel of 5 9A - APPLICATION FOR LOCAL UPGRADE APPROVAL Commonwealth of Massachusetts North Andover, Massachusetts Application for Local Upgrade Approval Title 5,310 CMR 15.000 DEP approved form required by 310 CMR 15.403(1) To be submitted to Local Approving Authority/Board of Health: For the upgrade of a failed or non -conforming system with a design flow of <10,000 gpd, where full compliance, as defined in 310 -CMR 15.404(1), is not feasible. To be submitted to DEP: For the upgrade of a failed or non -conforming system with a design flow of 10,000 up to 15,000 gpd and/or for upgrade of state of federal facility, where full compliance, as defined in 310 CMF 15.404(1), is not feasible. NOTE: Local upgrade approval shall not be granted for an upgrade proposal that includes the addition of new design flow to a cesspool or privy or the addition of new design flow above the existing approved capacity of a system constructed in accordance with either the 1978 Code or 310 CMR 15/000. 1) Facility/System Owner: Name: i'jcHA_EL pL rTX14M Address: logo 7-,,1zjUpi Kc_ ST- Al. A1vlx>jic iZ Phone k X38, 686-16DO Address of facility: 10'80 'Tur—UP1 KC ST /V. 14"DOVE2 2) Applicant (if different from above) Name: Address: - SA MF - Phone #: 3) Type of Facility: Residential Commercial School Institutional (Specify) Page 2 of 5 4) Type of Existing System: _privy cesspools) _Lconventional system other(describe) Type of soil absorption system (trenches, chambers, pits, etc.) 5) Design Flow Based on 310 CMR 15.203: a) Design flow of existing system r(� gpd Approved: __yes Approval date - no Why: /Iv s gam, l iz 5 q S� b) Design flow of proposed upgraded system ___gpd Why C) Design flow of facility _ Ii d 6) Proposed upgrade of existing system is: No upcr racL (+UP -0:58 a) Voluntary required by order, letter, etc. (attach copy) Required following inspection required by 31 CMR 15.301 (provide date inspection form was submitted to the approving authority) (date) b) Describe the proposed upgrade to the system: c) Which of the following are applicable to the proposed upgrade? Reduction of setback(s) (list setbacks to be reduced with proposed setback dlstanCeS9310CMR 15.211 sEPA2r�TtON 8ciWaj-=N �V� p SEPi1G lAfjr REGLV e-E.D �p P Er T- DED 5.5 FL-�ET- z QS•cGrloiu 5.oz - SEn 2fa•-naN{� i��'tw ►k--�,� �i ��Pi1G 'T.q,v�. Up to 25% reduction in subsurface disposalosare deign requirements stat`e � .i required & proposed size) Relocation of water supply well (identify well, describe relocation) Reduction of required separation between bottom of SAS & high groundwater (specify proposed reduction & perc rate) Page 3 of 5 Other requirements of 310 CMR 15.000 that cannot be met (specify sections of the code) System- upgrades that cannot be performed in accordance with 31 CMR 15.404 & 15.405, or in full compliance with the requirements of 310 CMR 15.000, require a variance pursuant to 310 CMR 15.410-15.417. 7) If the proposed upgrade involves a reduction in the required separation between the bottom of the soil absorption system and the high groundwater elevation, an Approved Soil Evaluator must determine the high ground water elevation pursuant to 310 CMR 15.405(1)(1)(1). The evaluator must be a member or agent of the local approving authority: Distance from soil absorption system to high groundwater feet As determined by: Evaluator's name: . Evaluator's Signature: Date of evaluation: 8) Notice to Abutters: No application for upgrade approval in which the setback from property lines or a private water supply well is reduced shall be complete until the applicant has notified all abutters whose property 9or well is affected by certified at least ten days before the Board of Health meeting at which the upgrade approval will be on the agenda. Such notice shall include the date, time and place where the upgrade approval will be discussed. If the department is the approving authority, then such notice to abutters must be completed prior to the date of submission of the application to the department. The notices to abutters shall include a copy of the completed application form and shall reference the standards set forth in 310 CMR 15.402 through 15.405. Page 4 of 5 List of affected abutters: Abutter Name Date notified Address Abutter Name Date notified Address Abutter Name Date notified Address Abutter Name Date notified Address 9) Explain why full compliance, as defined in 310 CMR 15.404(1), is not feasible (each section must be completed): a) An upgraded system in full compliance with 310 CMR 15.000 is not feasible: b) An altemative system approved pursuant to 310 CMR 15.283-15.288 is not feasible. Mo / ayl e c) A shared system is not feasible. d) Connection to a sewer is not feasible. All) feu t in rilxl. 10) An application for a disposal system construction permit, including all required attachments (e.g. plans & specifications, site evaluation forms), must accompany this application. Is the DSCP application attached? yes no (No C'GHS�I �c�ian�/�i/✓ jC rs pro pS�G Page 5 of 5 11) Certification "I, the facility owner, certify under penalty of law that this document and all attachments, to the best of my knowledge and belief, are true, accurate, and complete. I am aware that there may be significant consequences for submitting false information, including, but not limited to, penalties or fine and/or imprisonment for knowing violations." Facility Owner's Signature Print Name ame of Preparer I -Id - / / /'JU2J /.S 5 JA Telephone No. & Address of Preparer NOTE: Title 5,310 CMR 15.403(4) requires the system owner or operator to submit to the Department a copy of the local upgrade approval upon issuance by the Board of Health and prior to commencement of construction. .,PART A: GENERAL CONSIDERATIONS AND•PROVISIONS SECTION 1..00: DEFINITIONS The words, -terms or phrases, listed below for the purpose of these Regulations shall be defined and interpreted .as*follows: 1.01 Alterations: Any change or modification of an existing subsurface disposal system that would change -its physical make-up, components, capacity .or location' from that initially constructed or designed. 1.02 Annual Mean High Water Line: With respect to surface water, the line that is apparent from visible markings or changes . in the character of soils or vegetation due to the prolonged presence of water which distinguishes between predominantly aquatic and terrestrial land. 1.03 As -built Plan.- Final: A planshowing the actual lot boundaries,. house. foundation location and . elevation, wells within 150 feet, - utility lines, .and -the location -and elevations of all components • of the completed cbsurface sewage disposal system. See Section 8.05 1.04 As -built Plan - Foundation A plan showing the actual lot boundaries, house foundation location and elevation of the -top of foundation in the scale .of the original approved plan. 1.05 Bedroom: Single family dwellings, shall be presumed to have . •at least four bedrooms. When there are more than nine rooms in a dwelling, the total number of rooms shall be added and divided by -two to determine the total number of bedrooms. Deed restriction variances for existing dwellings with fewer than four bedrooms may be granted by the Board of Health when a larger disposal system cannot be installed on the site. The higher number of bedrooms shall prevail for design purposes for new construction 1.06 Cellar wall: That portion of the outside surface of the foundation wall enclosing a full basement which is above the cellar floor and below the ground surface. Page 4 ,etas 2 1 r"� VO/ V t i 6VV.L 10--r, j 14.•3,) rAA 1JU011 I 1 0 1 bU AV�LrIIVO INWV OLADLIAI WJ UUI/ UU.0 Tcvvd0-F-,',-lORTH BOARD OF I ]AIM: �C AUtj —8 2 1 As J I A lid— LAJ k 0, no -AW ACI r oroo t IN mo- i Q� i a l I� v*3 HA 0 a I 'ate uC vv V I i Lvvl IVli 1•t. —It IrAA 1JVv'! 1 l 01 LV AGVLI I AVIV OW1 arADUAI tib 0 v \ i kesa !1�- AS AAAoac�d; �. 376 Pj7-z , -T 0%A AM � UAAL t j A i I CADIA c..t J k i En i 0 0 �.� �i ��. i i � _._______ _1 .�,.� I _ � __ '� , � .T �� I ���� I � � -- ...._�._.�. , __ o� I � ��., m -I- L 60% PETER F. REILLY 136 ANDOVER STREET ANDOVER, MA 01810 (978) 375-3750 TITLE V OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL INSPECTION FORM PART A - CERTIFICATION Property Address: 1080 Turnpike Street, North Andover, MA 01845 Name of Owner: Larry Sturdivant Address of Owner: same Name of Inspector: Peter F. Reilly Company Name: same Mailing Address: 136 Andover Street, Andover, MA 01810 Telephone Number: (978) 375-3750 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. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000) The system: ✓ Passes N/A Conditionally Passes N/A Needs Further Evaluation By the Local Approving Authority N/A Fails Inspector's Signature: Date: August 25, 2001 Peter k RAY The system inspector shall submit a copy of this inspection report to the Approving Authority (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 regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. NOTES AND COMMENTS * * * * This report only describes conditions a the time of inspection and under 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 (See attached Disclaimer). OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL INSPECTION FORM PART A - CERTIFICATION (continued) Property Address: 1080 Turnpike Street, North Andover Owner's Name: Sturdivant Date of Inspection: 6/25/01 INSPECTION SUMMARY: A. SYSTEM PASSES: Check A, B, C, D, or E / ALWAYS complete all of Section D ✓ I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. COMMENTS: The system met the Pass Criteria of Title V. B. SYSTEM CONDITIONALLY PASSES: N/A One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Answer yes, no, or not determined (Y, N, ND). Describe basis of determination in all instances. If "not determined", explain why not) N The septic tank is metal, and over 20 years old* or the septic tank (whether metal or not) is structurally unsound, shows substantial infiltration or exfiltration, or tank failure is imminent. The system will pass inspection if the existing septic 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: N Observation of a sewage backup or breakout or high static water level in the distribution box is due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. The system will pass inspection if (with approval of the Board of Health): N/A broken pipe(s) are replaced N/A obstruction is removed N/A 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): N/A broken pipe(s) are replaced N/A obstruction is removed OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL INSPECTION FORM PART A - CERTIFICATION (continued) Property Address: 1080 Turnpike Street, North Andover Owner's Name: Sturdivant Date of Inspection: 8/25/01 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 the public health, safety and environment. System will pass unless Board of Health determines in accordance with 310 CMR 15.3030)(b) that the system is not functioning in a manner which will protect public health, safety and the environment: N/A Cesspool of privy is within 50 feet of a surface water N/A Cesspool or privy is within 50 feet of a bordering vegetated wetland or 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: N/A The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet to a surface water supply or tributary to a surface water supply. N/A The system has a septic tank and SAS and the SAS is within a Zone I of a public water supply well. N/A The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. N/A The system has a septic tank and SAS the SAS is less than 100 feet but 50 feet or more from a private water supply well.** Method used to determine distance N/A This system passes if the water well water analysis, performed at a certified DEP laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. A copy of the analysis must be attached to this form. 3. Other N/A OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL INSPECTION FORM PART A - CERTIFICATION (continued) Property Address: 1080 Turnpike Street, North Andover Owner's Name: Sturdivant Date of Inspection: 8/25/01 D. System Failure Criteria applicable to all systems: You must indicate "Yes" or "No" to each of the following for a// inspections: Yes No No Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. No Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. No Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. N/A Liquid depth in cesspool less than 6" below invert or available volume < % day flow. No required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: once No Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation. N/A Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. N/A Any portion of a cesspool or privy is within a Zone I of a private water supply well. N/A Any portion of a cesspool or privy is within 50 feet of a private water supply well. N/A 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 laboratory, for coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen is less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form). N/A The system fails. I have determined that one or more of the above failure criteria exist as defined in 310 CMR 15.303, therefore the system fails. The property owner should contact the Board of Health should be contacted to determine what will be necessary to correct the failure. E. Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. You Must indicate either "Yes" or "No" to each of the following: (The following criteria apply to a large system in addition to the criteria above) N/A The design flow of system is 10,000 gpd or greater (Large System) and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: Yes No N/A The system is within 400 feet of a surface drinking water supply N/A The system is within 200 feet of a tributary to a surface drinking water supply N/A The system is located in a nitrogen sensitive area (Interim Wellhead 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 such 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. OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL INSPECTION FORM PART B - CHECKLIST Property Address: 1080 Turnpike Street, North Andover Owner's Name: Sturdivant Date of Inspection: 8/25/01 Check if the following have been done. You must indicate either "Yes" or "No" as to each of the following: Yes No Yes Pumping information was provided by the owner, occupant, or Board of Health. No Were any of the system components pumped out in the previous two weeks ? Yes Has the system received normal flow in the previous two week period ? No Have large volumes of water been introduced to the system recently or as part of this inspection ? Yes Were as built plans of the system obtained and examined ? (If they were available note as N/A) Yes Was the facility or dwelling was inspected for signs of sewage backup ? Yes Was the site was inspected for signs of breakout ? Yes Were all system components, excluding the SAS, have been located on the site ? Yes Were the septic tank manholes uncovered, opened and the interior of the septic tank inspected for condition of baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum ? Yes Was the facility owner (and occupants of if different from the owner) provided information on the proper maintenance of subsurface sewerage disposal systems ? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: Yes No Yes Existing information. For example, a plan at the Board of Health. N/A Determined in the field if any of the failure criteria related to Part C is at issue (approximation of distance is unacceptable) [1 5.302(3)(b)]. OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL INSPECTION FORM PART C - SYSTEM INFORMATION Property Address: 1080 Turnpike Street, North Andover Owner's Name: Sturdivant Date of Inspection: 8/25/01 FLOW CONDITIONS RESIDENTIAL: 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 the residence have a garbage grinder (yes or no): Is the laundry on a separate sewerage system (yes or no): Laundry system inspected (yes or no): Seasonal use (yes or no): Water meter readings, if available (last 2 years usage [gpd]) Sump Pump (yes or no): Last date of occupancy: COMMERCIAL/INDUSTRIAL: Type of Establishment: Design Flow gpd (based on 15.203): Basis of Design Flow (seats/persons/sq.ft., etc): Grease trap present (yes or no): Industrial waste holding tank present (yes or no): Non -sanitary waste discharged to the Title 5 system (yes or no): Water meter readings, if available: Last date of occupancy/use: OTHER: (Describe) PUMPING RECORDS 4 4 440 god 4 no no (if yes, separate inspection required) N/A no about 250 gpd no current N/A N/A N/A N/A N/A N/A N/A N/A N/A GENERAL INFORMATION Source of Information: owner Was system pumped as part of inspection (yes or no): no if yes, volume pumped (gallons): N/A How was quantity pumped determined ? N/A Reason for pumping: N/A TYPE OF SYSTEM ✓ Septic tank/distribution box, soil absorption system Single cesspool Overflow cesspool Privy 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 the 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: Original system - installed in 1996 according to public records. Were sewerage odors detected when arriving at the site (yes of no): no OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL INSPECTION FORM PART C - SYSTEM INFORMATION (continued) Property Address: 1080 Turnpike Street, North Andover Owner's Name: Sturdivant Date of Inspection: 8/25/01 BUILDING SEWER: (locate on site plan) Depth below grade: about 12"-14" Materials of construction: cast iron 40 PVC ✓ other (explain) Distance from private water supply well or suction line N/A Diameter: 4" Comments: Condition of joints, venting, evidence of leakage, etc.) Building sewer was watertight and appeared sound at foundation. SEPTIC TANK: ✓ (locate on site plan) Depth below grade: about 8" - 10" Material of construction: ✓ concrete metal Fiberglass Polyethylene other (explain) If tank is metal, list age N/A Is age confirmed by Certificate of Compliance N/A (Yes/No) Dimensions: rectangular - 1,500 gallons Sludge depth: 1 "-2" Distance from top of sludge to bottom of outlet tee or baffle: 28" Scum thickness: 111-211 Distance from top of scum to top of outlet tee or baffle: 7" Distance from bottom of scum to bottom of outlet tee or baffle: 16" How dimensions were determined: observation / estimation Comments: (on pumping recommendations, of inlet and outlet tees or baffle condition, structural integrity, liquid level as related to outlet invert, evidence of leakage, etc.) Tank was watertight and appeared to be functioning properly. GREASE TRAP: N/A (locate on site plan) Depth below grade: material of construction: concrete metal FRP other (explain) Dimensions: N/A Scum thickness: N/A Distance from top of scum to top of outlet tee or baffle: N/A Distance from bottom of scum to bottom of outlet tee or baffle: N/A Date of Last Pumping: N/A Comments: (on pumping recommendations, of inlet and outlet tees or baffle condition, structural integrity, liquid level as related to outlet invert, evidence of leakage, etc.) N/A OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL INSPECTION FORM PART C - SYSTEM INFORMATION (continued) Property Address: 1080 Turnpike Street, North Andover Owner's Name: Sturdivant Date of Inspection: 8/25/01 TIGHT or HOLDING TANK: N/A (tank must be pumped at time of inspection) (locate on site plan) Depth below grade: N/A material of construction: concrete metal Dimensions: N/A Capacity: N/A Design Flow: N/A Alarm Present (yes or no): N/A Alarm level: N/A Alarm in working order (yes or no): N/A Date of last pumping: N/A Fiberglass Polyethylene other (explain) gallons gallons per day Comments: (condition of alarm and float switches, etc.) N/A DISTRIBUTION BOX: ✓ (locate on site plan) 0" depth of liquid above outlet invert Comments: (note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box, recommendation for repairs, etc.) D -box was level. Two lines leading to SAS were accepting effluent evenly. D -box was 10" - 12" below surface. PUMP CHAMBER: N/A (locate on site plan) Pumps in working order (yes or no) N/A Alarms in working order (yes or no) N/A Comments: (note condition of pump chamber, condition of pumps and appurtenances, etc.) N/A OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL INSPECTION FORM PART C - SYSTEM INFORMATION (continued) Property Address: 1080 Turnpike Street, North Andover, MA Owner's Name: Sturdivant Date of Inspection: 8/25/01 SOIL ABSORPTION SYSTEM (SAS): ✓ (locate on site plan, if possible; excavation not required) If SAS not located, explain why: Type leaching pits, number leaching chambers and number leaching galleries and number ✓ leaching trenches, number, length leaching fields, number, dimensions overflow cesspool, number alternative system (name of technology) N/A N/A N/A 2 trenches, 60' long each, per "as -built" plan N/A N/A N/A Comments: (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.) Soils in area of SAS looked good, no evidence of ponding, damp soil, or breakout. CESSPOOLS: N/A (locate on site plan) Number and configuration N/A Depth -top of liquid to inlet invert N/A Depth of solids layer N/A Depth of scum layer N/A Dimensions of cesspool N/A Materials of construction N/A Indication of groundwater inflow (cesspool must be pumped as part of inspection) N/A Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, recommendations for maintenance or repairs, etc.) not applicable PRIVY: N/A (locate on site plan) Materials of construction Dimensions Depth of solids N/A N/A N/A Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, recommendations for maintenance or repairs, etc.) not applicable OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL INSPECTION FORM PART C - SYSTEM INFORMATION (continued) Property Address: 1080 Turnpike Street, North Andover, MA Owner's Name: Sturdivant Date of Inspection: 8/25/01 SKETCH OF SEWAGE DISPOSAL SYSTEM: Provide a sketch of the sewerage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100'. Locate where public water supply enters the building. SEPTIC TANK TIES: D -BOX TIES: NOTE: 1500GAL . SPT► c. k(� 14, ((� - T7�K A 'S.7 ' 1 -oviZ,ET' ])-Box FRoivr YARD A to Inlet (1) 29.5' A to Center (C) 33.3' A to Outlet (0) 36.6' A to Box 43.5' The system is in the front yard. B to Inlet B to Center B to Outlet B to Box 27.5' 27.8' 28.5' 36.0' OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL INSPECTION FORM PART C - SYSTEM INFORMATION (continued) Property Address: 1080 Turnpike Street, North Andover, MA Owner's Name: Sturdivant Date of Inspection: 8/25/01 SITE EXAM Slope mostly flat in area of system Surface water none observed Check cellar dry Shallow wells none observed Estimated Depth to Groundwater > 1 " (below bottom of SAS) Please indicate (check) all methods used to determine the high ground water elevation: Y Obtained from Design Plans on record - if checked, date of design plan reviewed: 1995 Y Observed site (abutting property, observation hole within 150 feet of SAS) Y Check with Local Board of Health - explain: information on file Y Check local excavators, installers - (attach documentation) N Accessed USGS Database - explain: website too complicated You must describe how you established the high ground water elevation.* 1995 Design Plan revealed no groundwater in the area of the SAS. Grade changes and soil conditions indicate no groundwater in the SAS. However, this cannot be determined for certain without a soil evaluation test. *Inspector's Note: Soil Evaluation is the currently recognized method for determining or establishing the high groundwater elevation. Since I am not a licensed or certified soil evaluator, I am not qualified to determine or establish the high groundwater elevation beyond the public information available, such as recent design plans of the site or the nearby area. My estimation of the high groundwater elevation is based on a due diligence effort to obtain all available information both on and off the site and my experience as a certified subsurface disposal system inspector. (see attached Disclaimer) DISCLAIMER This passing septic inspection under Massachusetts Title V is in no way a guaranty or warranty of the inspected septic system. The inspection is a "snapshot in time" and does not constitute a complete assessment of the quality or potential longevity of the septic system. The pass/fail criteria are specific and outlined in detail in this report. Under the limited criteria of a Title V inspection, it is impossible to determine how long any septic system will last. The inspector made a diligent effort to certify the septic system based on the criteria required under Title V. Under Massachusetts Title V, soil evaluation is the accepted method of determining the high groundwater elevation. This inspector is not a certified soil evaluator and is therefore not qualified under Title V to determine or establish the high groundwater elevation. The method used to estimate the high groundwater for this inspection was based on the public records and methods of observation described on the previous page. Groundwater levels can vary greatly from season to season, year to year and soil evaluation is considered the most reliable method of groundwater determination under Title V. Peter F. Reilly Inspector August 25, 2001 DISNOANDOVER DISNAN/COR Tdtal EAS-NAND/COR 7z DISNAND/FIT 11 ToWNAND/FIT DISNAND/LOW Total DISNAND/LOW Total DISNOANDOVER Action King Enterprises,, Inc— Disposal Repan July 2000 Date Source Name dRlBtrm�la�euiYglBer 07/29/2000 DIM MET210 07/21/2000 COLONADE 07/19/2000 350 HOLT RD CRUSADER PAPER 07/28/2000 1080 TURNPIKE STREET; STARDIVANT 07/31/2000 BAYFIELD C �iJAt Q4 'm"MWrirlYVsfi411'N mum1A:'Im 500.00 1,000,00 3,500.00 1,500, 00 1,500.00 Action King Enterprises Confidential 8/1i00 Page 1,4 Town of North Andover, Massachusetts Fpm No. 3 BOARD OF HEALTH MORTM Ottf�•o °e,�p 1 1r2 19- L 10- A DISPOSAL WORKS CONSTRUCTION PERMIT ,SSACHUSSS Applicant s �-t x l��4 NAME ADDRESS TELEPHONE Site Location Permission is hereby granted to Construct Kor Repair ( ) an Indiviid-uall Soil Absorption Sewage Disposal System as shown on the Design Approval S.S. No.6 CHAIRMAN, BOAR OF HEALTH �V Fee D.W.C. No. 8 FORM U - IAT REIZASE FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable local or state law, regulations or requirements. ****************Applicant fills out this section***************** APPLICANT: APPLICANT : l� I LU K-'fi C� � � V � Phone6 , LOCATION: Assessor's Map Number 10�G Parcel -� Subdivision Lot(s) Street �c�r��le �-� St. Number_ ************************Official Use Only************************ RECOMMENDATIONS OF TOWN AGENTS: !____ Conservation Administrator Comments Date Approved Date Rejected Date Approved t0 Town Planner Date Rejected Comments Food Inspector -Health Septic Inspector -Health Comments Date Approved Date Rejected Date Approved Date Rejected Pu is works- sewer/water connections C�S Gcc) - driveway permit SI t S Fire Department Received by Building Inspector Date N C6 � n ............................. u.c ��� Srusit kA � t a W Y �o i�a N C6 � n ............................. u.c ��� Srusit kA � t a W Y L --j to 1!S O z O O H U W W 0 U w z z 'e� '� yILI a z GG aG cn ]' U u b G w° V)w° ° U w a W ° to c� o CO C U c » m O ` Z C +' C N o C=oq O Qac•-� O O Z C: RRA } 9 a � a =tea mom= d. W 4- CA o= c ... o 0 m c tCO) A !O cw Q 2 H W" ui W" W CO) ♦.. VJ m O cv = m .y M cc •- C O.i E o CD o --oC CL 0.5 pt y .0 p N CL� O :w z Q a a w W Li. co O , co L O , O Z y � v � .Q co 0 C v E m m 0 CD O O �O CLI—'C CD Q O O O om a o�Q N ca •C 'a o v cv O W Z 0 O d. O u vs cc H ca 9 IT z � w O � � o Q w � C2 w cq C/) f� � O f� O 1 Uz w �- ;� .= W W u.. W p W J MERRIMACK ENGINEERING SERVICES, INC. PROFESSIONAL ENGINEERS • LAND SURVEYORS • PLANNERS bb PARK STREET • ANDOVER, MASSACHUSETTS 01810 • TEL. (508) 475-3555, 373-5721 FAX (508) 475-1448 July 11, 1994 II , Ms. Sandy Starr Town of North Andover Board of Health Town Hall - 120 Main Street North Andover, MA 01845 RE: Subsurface Disposal System Plan Ferragamo - Turnpike Street North Andover, Massachusetts Dear Ms. Starr: Relative to the subject please find enclosed herewith prints of the septic system plan, submitted to you for review and approval. Please review the enclosure and contact me should you have questions or comments. Very truly yours, MERRIMACK ENGINEERING SERVICES 4�Lro4i Robert C. Daley, P.E. Project Engineer cd Enclosure cc: Mr. Paul Ferragamo TFC444 "Z. �-- r31:�'± - 15006AL L. SEP( c W(C.=.r1.+-1, kc -Te) �'A (o-DuTtrET' f) -Box �`lyl-1/6 T b"rQ Q. 9 -CH. 4P .P,Ve-. WV 11,.E e-s.T" = Zo&.77 Z66, 30 0uT0- D -Box p� ►, � � � , L IQ cer -r1z Z = Zo S. I S LI SCH • 41 o f 2F Q V e— IAUV. e- Flub ->-20, 1 = Zo S', 80 AS BUILT PLAN OF SUBSURFACE DISPOSAL SYSTEM LOCATED IN ANJI)OVER ,MA AS PREPARED FOR LAWRE:QC-E �TV2DIvAfQT DATE: DEEM 9ER 57, 1995 SCALE: I''= l�T TuRW Pi kF- sT m =T' MERRIMACK ENGINEERING SERVICES, INC. PROFESSIONAL ENGINEERS • LAND SURVEYORS • PLANNERS. 66 PARK STREET 0 ANDOVER, MASSACHUSETTS 01810 0 TEL. (**) 475-3555, 373-5721 S.TPn,11, (crR) :Iqi.Z' 28.2' D -Box s�.�' 36,0' e `Ftp) f) -Box �`lyl-1/6 T b"rQ Q. 9 -CH. 4P .P,Ve-. WV 11,.E e-s.T" = Zo&.77 Z66, 30 0uT0- D -Box p� ►, � � � , L IQ cer -r1z Z = Zo S. I S LI SCH • 41 o f 2F Q V e— IAUV. e- Flub ->-20, 1 = Zo S', 80 AS BUILT PLAN OF SUBSURFACE DISPOSAL SYSTEM LOCATED IN ANJI)OVER ,MA AS PREPARED FOR LAWRE:QC-E �TV2DIvAfQT DATE: DEEM 9ER 57, 1995 SCALE: I''= l�T TuRW Pi kF- sT m =T' MERRIMACK ENGINEERING SERVICES, INC. PROFESSIONAL ENGINEERS • LAND SURVEYORS • PLANNERS. 66 PARK STREET 0 ANDOVER, MASSACHUSETTS 01810 0 TEL. (**) 475-3555, 373-5721 Town of North Andover, Massachusetts Form No. z of NORTv BOARD OF HEALTH o � , w A 4 s `�'•'�'r' DESIGN APPROVAL FOR Arso SACNUSEt� SOIL ABSORPTION SEWAGE DISPOSAL SYSTEM Applicant 0.- Test No. Site Location �T y Reference Plans and Specs ENGINEER Permission is granted for an individual soil absorption sewage disposal system to be installed in accordance with regulations of Board of Health. CHAIRMAN, BOARD OF HEALTH Ap- ©V Fee 6 Site System Permit No. (O-7 C Engineering Associates November 21, 2001 North Andover Board of Health 27 Charles Street North Andover, MA 01845 Attn: Ms Sandy Starr Re: 1080 Turnpike Street, North Andover Dear Sandy: #9166 235 Newbury Street -Danvers, MA 01923 (978) 777-3050 , Fax (978)774-7816 Bolton, MA (978)779-6767 Boston, MA (617)350-7906 This letter is written on behalf of our client, Mr. Michael Putnum, who is seeking to construct an addition onto the existing dwelling at 1080 Turnpike St., North Andover. As part of the project, he needs to request a variance from 310 CMR 15.211 (separation between Septic Tank and Dwelling). The proposed addition will be constructed on a slab foundation, 5 feet from the existing septic tank. He also needs to seek a variance from local regulation Section 5.02 (separation between septic tank and deck) as the septic tank is 4'+/- from the proposed deck. Because this is an existing dwelling with no increase in flow, we have filed a Form 9A — Local Upgrade Approval. The existing structure has eight (8) rooms, of which only three (3) are bedrooms. The North Andover Assessors office confirms the total room count, however they list the number of bedrooms as four (4). This is not an issue, as the septic system was designed to handle a four (4) bedroom dwelling. On the first floor there is an eat-in- kitchen/breakfast area/family room, a dining room, an office, a living room, and the 3 -season porch. On the second floor there are three (3) bedrooms (see Existing First Floor Plan and Second Floor Plan). The proposed addition consists of removing the 3 -Season Porch and constructing a Game Room. On the second floor they are enlarging the master bedroom, moving the master bathroom and one closet, and adding a second closet that has an area of 110 S.F.(see Proposed First Floor Plan and Second Floor Plan) The closet is an "unheated storage area" and thus does not increase the bedroom count per Title V, 310 CMR 15.002 (Definitions — Bedrooms). The total number of proposed rooms will be eight (8), five (5) on the first floor and three (3) on the second. This is the same as the existing room count, thus there is no increase in flow. Even if the closet were considered a room, then the total count would be nine (9) rooms, which also equates to a four (4) bedroom dwelling under Title V. Please let me know when this application might be discussed, as we would like to be present to answer any questions that might arise. Thank you for your review of the Form 9A Application and the enclosed plans. Sincerely :OC� ENGINE G ASS90ATES Scanlan : Engineer Cc: File #9166 Division of Hancock Survey Associates, Inc. NOV 2 � 2001 � N Pagel of 5 9A - APPLICATION FOR LOCAL UPGRADE APPROVAL Commonwealth of Massachusetts North Andover, Massachusetts Application for Local Upgrade Approval Title 5,310 CMR 15.000 DEP approved form required by 310 CMR 15.403(1) To be submitted to Local Approving Authority/Board of Health: For the upgrade of a failed or non -conforming system with a design flow of <10,000 gpd, where full compliance, as defined in 310 -CMR 15.404(1), is not feasible. To be submitted to DEP: For the upgrade of a failed or non -conforming system with a design flow of 10,000 up to 15,000 gpd and/or for upgrade of state of federal facility, where full compliance, as defined in 310 CMF 15.404(1), is not feasible. NOTE: Local upgrade approval shall not be granted for an upgrade proposal that includes the addition of new design flow to a cesspool or privy or the addition of new design flow above the existing approved capacity of a system constructed in accordance with either the 1978 Code or 310 CMR 15/000. 1) Facility/System Owner: Name: MjC_NA-EL PcJTIJ,r tq Address: logo 7-,gjUpj KC_ ST 41. ,4 jD0j1� iZ Phone #: X78, 68(-7900 Address of facility: 10'80 Tu,-,vP/,eC- S -F /V. 14NDOVE Z 2) Applicant (if different from above) Name: Address: SAME - Phone #: 3) Type of Facility: XResidential (Specify) Commercial School Institutional Page 2 of 5 4) Type of Existing System: _privy cesspools) conventional system other(describe) Type of soil absorption system (trenches, chambers, pits, etc.) 5) Design Flow Based on 310 CMR 15.203: a) Design flow of existing system q/ -/o gpd Approved: _yes Approval date- Ia95 ± no Why: iZ�S� b) Design flow of proposed upgraded system _gpd Why c) Design flow of facility _ -0 gpd 6) Proposed upgrade of existing system is: No (> r I�rvPo� a) Voluntary 84 required by order, letter, etc. (attach copy) Required following inspection required by 31 CMR 15.301 (provide date inspection form was submitted to the approving authority) (date) b) Describe the proposed upgrade to the system: c) Which of the following are applicable to the proposed upgrade? JL Reduction of setback(s) (list setbacks to be reduced with proposed setback dlStanC8S#31OCrnR, 15 .7-11 -')FPA2IjTiON Bc—iWIZ-'t-! SLAG A+-iD sCP•nc 7-AfJK.. REQ�Rif-�-77� t eAh I PEc 7' FZOV DED 5.5 FEETi Qz ��rtoiu s o z - na .v�13��ty -z,�G AR -7, -,) � o Qvi.2ED S Ft-�-'T MOUtDC-D 4,2 FEET -Up } Up to 25% reduction in subsurface disposal area design requirements (state required & proposed size) Relocation of water supply well (identify well, describe relocation) Reduction of required separation between bottom of SAS & high groundwater (specify proposed reduction & perc rate) Page 3 of 5 Other requirements of 310 CMR 15.000 that cannot be met (specify sections of the code) System upgrades that cannot be performed in accordance with 31 CMR 15.404 & 15.405, or in full compliance with the requirements of 310 CMR 15.0009 require a variance pursuant to 310 CMR 15.410-15.417. 7) If the proposed upgrade involves a reduction in the required separation between the bottom of the soil absorption system and the high groundwater elevation, an Approved Soil Evaluator must determine the high ground water elevation pursuant to 310 CMR 15.405(1)(1)(1). The evaluator must be a member or agent of the local approving authority: Distance from soil absorption system to high groundwater feet As determined by: Evaluator's name: Evaluator's Signature: Date of evaluation: 8) Notice to Abutters: No application for upgrade approval in which the setback from property lines or a private water supply well is reduced shall be complete until the applicant has notified all abutters whose property 9or well is affected by certified at least ten days before the Board of Health meeting at which the upgrade approval will be on the agenda. Such notice shall include the date, time and place where the upgrade approval will be discussed. If the department is the approving authority, then such notice to abutters must be completed prior to the date of submission of the application to the department. The notices to abutters shall include a copy of the completed application form and shall reference the standards set forth in 310 CMR 15.402 through 15.405, Page 4 of 5 - List of affected abutters: Abutter Name Date notified Address Abutter Name Date notified Address Abutter Name Date notified Address Abutter Name Date notified Address 9) Explain why full compliance, as defined in 310 CMR 15.404(1), is not feasible (each section must be completed): a) An upgraded system in full compliance with 310 CMR 15.000 is not feasible: b) An alternative system approved pursuant to 310 CMR 15.283-15.288 is not feasible. c) A shared system is not feasible. d) Connection to a sewer is not feasible. 10) An application for a disposal system construction permit, including all required attachments (e.g. plans & specifications, site evaluation forms), must accompany this application. Is the DSCP application attached? yes �_ no Na CGNS�v�c�G�/� �/✓ C Page 5 of 5 _ 11) Certification "I, the facility owner, certify under penalty of law that this document and all attachments, to the best of my knowledge and belief, are true, accurate, and complete. I am aware that there may be significant consequences for submitting false information, including, but not limited to, penalties or fine and/or imprisonment for knowing violations." acility Owner's Signature Print Name ame of Preparer Telephone No. & Address of Preparer NOTE: Title 5,310 CMR 15.403(4) requires the system owner or operator to submit to the Department a copy of the local upgrade approval upon issuance by the Board of Health and prior to commencement of construction. ri f W, Engineering Associates November 21, 2001 North Andover Board of Health 27 Charles Street North Andover, MA 01845 Attn: Ms Sandy Starr Re: 1080 Turnpike Street, North Andover #9166 235 Newbury Street --Daavers, MA 01923 (978)777-3050 Fax (978)774-7816 Bolton, MA (978)779-6767 Boston, MA (617) 350-7906 qX��' �)G6,Pro- ,�0 ` Dear Sandy: {� 5.j 1 &. V iii This letter is written on behalf of our client, Mr. Michael Putnum, who is seeking to construct an addition onto the existing dwelling at 1080 Turnpike St., North Andover. As part of the project, he needs to requeriance from 310 CMR 15.211 (separation.between Septic Tank and Dwelling). The proposed addition will be constructed on a slab foundation, 5 feet from the existing septic tank. He also needs to seek a variance from local regulation Section 5.02 (separation between septic tank and deck) as the septic tank is 4'+/- from the proposed deck. Because this is an existing dwelling with no increase in flow, we have filed a Form 9A — Local Upgrade Approval.— NO — A107— DO ,q.NYToo- OC 7-0Y37Z- >- The existing structure has eight (8) rooms, of which only three (3) are bedrooms. The North Andover Assessors I1= office confirms the total room count, however they list the number of bedrooms as four (4). This is not an issue, as"'V/ ,, V the septic system was designed to handle a four (4) bedroom dwelling. On the first floor there is an eat-in- kitchen/breakfast area/family room, a dining room, an off_ice,'a living room, and the 3 -season porch. On the second floor there are three (3) bedrooms (see Existing First Floor Plan and Second Floor Plan).`' The proposed addition consists of removing the 3 -Season Porch and constructing a Game Room. On the second floor they are enlarging the master bedroom, moving the master bathroom and one closet, and adding a second closet that has an area of 110 S.F.(see Proposed First Floor Plan and Second Floor Plan) The closet is an "unheated storage area" and thus does not increase the bedroom count per Title V, 310 CMR 15.002 (Definitions — Bedrooms). A I. —9 (51G 9 The total number of proposed rooms will be eights), five(�S on the first floor and three (3) on the second. This is the same as the existing room count, thus there is no increase in flow. Even if the closet were considered a room, then the total count would be nine (9) rooms, which also equates to a four (4) bedroom dwelling under Title V. Please let me know when this application might be discussed, as we would like to be present to answer any questions that might arise. Thank you for your review of the Form 9A Application and the enclosed plans. Sincerely HANCOCK ENGINEE G ASS ATES Va. i L 1---a rris Scanlan ,Project Engineer �OV 2 Cc: File 99166 Division of Hancock Survey Associates, Inc. Page 1 of 5 9A - APPLICATION FOR LOCAL UPGRADE APPROVAL Commonwealth of Massachusetts North Andover, Massachusetts Application for Local Upgrade Approval Title 5, 310 CMR 15.000 DEP approved form required by 310 CMR 15.403(1) To be submitted to Local Approving AuthorilyMoard of Health: For r the upgra- de^of a failed or non confing system with a design flow of <10,000 gpd, where full compliance, as defined in 310•CMR 15.404(1), is not feasible. To be submitted to DEP: For the upgrade of a failed or non -conforming system with a design flow of 10,000 up to 15,000 gpd and/or for upgrade of state of federal facility, where full compliance, as defined in 310 CMF 15.404(1), is not feasible. NOTE: Local upgrade approval�shall not be granted for an upgrade proposal that includes the addition of new design flow to a cesspool or privy or the addition of new design..flow above the_existing_approved..capacity of a system constructed in accordance with either the 1978 Code or 310 CMR.15/000._.._. --- ---' 1) Facility/System Owner: Name: MICHA-EL R)T/,l4v1 Address: lo80 7-,/,�jupj KC 5T nl. ,41jD0VC-12 Phone #: � 18.68(,-IgDO Address of facility: 1080 Tue-,(JP1,eC SF /t/. 41kIDOVE Z 2) Applicant (if different from above) Name: Address: - 5,4MC - Phone #: 3) Type of Facility: Residential Commercial School Institutional (Specify) 4) Type of Existing System: privy cesspools) Page 2 of 5 conventional system other(describe) Type of soil absorption system (trenches, chambers, pits, etc.) 5) Design Flow Based on 310 CMR 15.203:�P �- ravct a) Design flow of existing system qyOgpd Approved: ✓ yes Approval date- J ag 5 ± no Why: IZ 5 q S� b) Design flow of proposed upgraded system _____gpd Why c) Design flow of facility 4L f2_gpd 6) Proposed upgrade of existing system is: /No racL iz P06:5 a) Voluntary required by order, letter, etc. (attach copy) Required following inspection required by 31 CMR 15.301 (provide date inspection form was submitted to the approving authority) (date) b) Describe the proposed upgrade to the system: _KION - c) Which of the following are applicable to the proposed up�grar del Reduction of setback(s) (list setbacks to be reduced with proposed setback distances9310cm;,> l5.7 -H 5EPA2.(npN 2ciwtj:�-N SL4f3 /SND sCPnG T-ArJK- RECLv QED, �� ratT MOV WD 5.5 FEET I Up to 25% reduction in subsurface di disposal area design requirements (stat`e � required & proposed size) Relocation of water supply well (identify well, describe relocation) Reduction of required separation between bottom of SAS & high groundwater (specify proposed reduction & perc rate) Other requirements of 310 CMR 15.000 that cannot be met (specify sections of the code) System upgrades that cannot be performed in accordance with 31 CMR 15.404 & 15.405, or in full compliance with the requirements of 310 CMR 15.000, require a variance pursuant to 310 CMR 15.410-15.417. 7) If the proposed upgrade involves a reduction in the required separation between the bottom of the soil absorption system and the high groundwater elevation, an Approved Soil Evaluator must determine the high ground water elevation pursuant to 310 CMR 15.405(1)(1)(1). The evaluator must be a member or agent of the local approving authority: Distance from soil absorption system to high groundwater feet As determined by: Evaluator's name: Evaluator's Signature: Date of evaluation: 8) Notice to Abutters: No application for upgrade approval in which the setback from property lines or a private water supply well is reduced shall be complete until the applicant has notified all abutters whose property 9or well is affected by certified at least ten days before the Board of Health meeting at which the upgrade approval will be on the agenda. Such notice shall include the date, time and place where the upgrade approval will be discussed. If the department is the approving authority, then such notice to abutters must be completed prior to the date of submission of the application to the department. The notices to abutters shall include a copy of the completed application form and shall reference the standards set forth in 310 CMR 15.402 through 15.405. Page 4 of 5 - List of affected abutters: Abutter Name Date notified Address Abutter Name Date notified Address Abutter Name Date notified Address Abutter Name Date notified Address 9) Explain why full compliance, as defined in 310 CMR 15.404(1), is not feasible (each section must be completed): a) A,n�upgraded system in full compliance with 310 CMR 15.000 is not feasible: l ArInlyi.. V-rr -. b) An alternative oZI?Ul_I approved pursuant to 310 CMR 15.283-15.288 is not feasible. c) A shared system is not feasible. d) Connection to a sewer is not feasible. 10) An application for a disposal system construction permit, including all required attachments (e.g. plans & specifications, site evaluation forms), must accompany this application. Is the DSCP application attached? yes _ ( no lNe (G�S11�ccf��h/��u/✓�i{�iC ��s-�r �S pio�OpSCG�) Page 5 of 5 11) Certification "I, the facility owner, certify under penalty of law that this document and all attachments, to the best of my knowledge and belief, are true, accurate, and complete. I am aware that there may be significant consequences for submitting false information, including, but not limited to, penalties or fine and/or imprisonment for knowing violations." Facility Owner's Signature Print Name ame of Preparer / 11,9 ' / / / L2 t) /la Telephone No. & Address of Preparer NOTE: Title 5,310 CMR 15.403(4) requires the system owner or operator to submit to the Department a copy of the local upgrade approval upon issuance by the Board of Health and prior to commencement of construction. IZP, PVO /5 64 P,//,,? December 27, 2001 Mr. Michael Putnam 1080 Turnpike Street No. Andover, MA 01845 Re: 1080 Turnpike Street Dear Mr. Putnam: This is to inform you that the proposed plans for the site referenced above have been disapproved and have technical deficiencies as follow: � 1. Soil tests,'erformed prior to 1995. ' comply with current Title 5. 2. New construction must comply in all respects to Title 5. /� 1 % art � Q �' h -e ,4d 5 3 3. �'xisting soil absorption system supplies at :4432 gallons per day. iisufficient -4 Kb 6 e , .68 loading) -489 gallons per day,,` 'i 5 p rD U� o un3, ct fe4(ei ` iKeeds to be classified ground water check and percy � e-rh c° P 5. HM-To—u unhhe an a that is��ntec ddition? 6. This is not a local upgrade. You are proposing actions that will cause the septic system to be in violation of regulations. The purpose of ag" varia%ces is to allow the repair of a failed system that will better protect public health and the environment when nothing else can be done. Approving this project creates the problems. Variances exist so that dwellings/homes will not have to be condemned because a 100% complaint septic system cannot be installed on the site. /I Deed restrictions are used in North Andover if/when the septic system is as large as it can be because of site restrictions and house has more than seven (7) rooms. North Andover does not allow deed restrictions for new construction. Septic system must be size needed to serve the new proposed house. If septic system can't be large enough for a four (4) bedroom house, then the house design must be changed to agree with septic system capacity. Possible options for 1080 Turnpike: a) only build garage b) decrease size of addition c) perform soil tests to 1) identify soil class 2) locate groundwater I re&rrimAd option brad have dis. sedthe same with-firn) Scanlon of Hancock 2 !;can iat . Beca s �liis fieldwox�C'is for confirmation-� not/for official -d sign rates, o this as -soon as nossile conditional -on -soil conditions and -weather. If you lave any questions, please do not hesitate to call the Board of Health Office. Sincerely, Sandra Starr, R.S., C.H.O. Health Director cc: Pgrino Scanlon file ib Wp1�. W 1� a .r ti '- Lu a z M N 6 LU O N ZoZ 00 Wp1�. W 1� '- Lu a z M N 6 Commonwealth of Massachusetts City/Town of System Pumping Record r Form 4 MAY 0 2010 TOWN DEP has provided this form for use by local Boards of Health. Other �taD4@ T information must be, substantially the same as that provided here. Before using with your local Board of Health tQ determine the form they use. The System Pumping Record must be submitted to the local Board of Health or-oth r.approving authority. A. Facility Information 1. System Location: Left side of house, Right side of hous eft front of house fight front of house, Left rear of house, Right rear of house. Left rear of building. Rig rear o building. Address 10 gd TosV\ City/Town State Zip Code 2. System Owner: Name Address (if different from location) City/Town State _ Zi ode rg e r7 s 1�-sLILI Telephone Number B. Pumping Record 1. Date of Pumping 3. Type of system: ❑ ❑ Other (describe): 0-d'z�> -1 o Date -. Quantity Pumped: Cesspool(s) I5 -0c) Gallons eptic Tank ❑ Tight Tank 4. Effluent Tee Filter present? ❑ Yes to If yes, was it cleaned? ❑ Yes ❑ No 5. Condition of System: 6. System Pumped By: Neil Bateson Name Bateson Enterprises Inc Company 7. Location where contents were disposed: .L.S.D Lowell Waste Water Signature of Hauler t5form4.doc• 06/03 F5821 Vehicle License Number uate System Pumping Recons • Page 1 of 1