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Miscellaneous - 140 BRADFORD STREET 4/30/2018
- -% ' iya � �- -- � /'yo /3.ud�sf \ Y, Residential Property Record Card#1 of 1 Parcel Year:2018 PARCEL ID: 210/061.0-0004-0000.0 MAP 061.0 BLOCK 0004 LOT 0000.0 PARCELADDRESS: 140 BRADFORD STREET as of:9/25/2017 PARCEL INFORMATION Use-Code: 101 Sale Price: 375000 Book: 10110 Tax Class: T Sale Date: 4/3/2006 Page: 313 Tot Fin Area: 1344 Sale Type: P Cert/Doc: Tot Land Area: 0.38 Sale Valid: Y Owner#1: GUGLIELMI, DOMENIC Grantor: HEINZE, ROBERT Owner#2: Inspect Date: 3/1/2017 Road Type: T Exempt-B/L%: 0/0 Address#1: 140 BRADFORD STREET Address#2: Meas Date: 3/1/2017 Rd Condition: P Resid-B/L%: 100/100 NORTH ANDOVER MA 01845 Entrance: X Traffic: M Comm-B/L%: 0/0 Collect ID: CE Water: Indust-B/L%: 0/0 Inspect Reas: C Sewer: Open Sp-B/L%: 0/0 RESIDENCE# 1 INFORMATION LAND INFORMATION NBHD CODE: 5 NBHD CLASS: 5 ZONE: R2 Style: RR Tot Rooms: 6 Main Fn Area: 1344 Attic: Seg Type Code Method Sq-Ft Acres Influ-1/2/3 Value Class Story Height: 1 Bedrooms: 3 Up Fn Area: Bsmt Area: 1300 Roof: G Full Baths: 2 Add Fn Area: Fn Bsmt Area: 650 1 P 101 S 16500 0.38 N 188258 Ext Wall: FB Half Baths: Unfin Area: 20 Bsmt Grade: Masonry Trim: 12 Ext Bath Fix: Tot Fin Area: 1344 Foundation: CN Bath Qual: T RCNLD: 231004 Kitch Qual: T Eff Yr Built: 1986 Mkt Adj: Heat Type: ER Ext Kitch: Year Built: 1970 Sound Value: Fuel Type: E Grade: A Cost Bldg: 231000 Fireplace: 1 Bsmt Gar Cap: 2 Condition: G Att Str Val1: DETACHED STRUCTURE INFORMATION Central AC: Y Bsmt Gar SF: Pct Complete: Att Str Val2: Str Unit Msr-1 Msr-2 E-YR-Blt Grade Cond %Good P/F/E/R Cost Class Att Gar SF: %Good P/F/E/R: /100/100/83 PA S 288 1988 A A /50//42 2900 1 Porch Type Porch Area Porch Grade Factor E 264 T 740 W 432 VALUATION INFORMATION, SKETCH 24 Current Total: 422200 Bldg: 233900 Land: 188300 MktLnd: 188300 Prior Tot: 391900 Bldg: 205600 Land: 186300 MktLnd: 186300 28 W 18 432 Sq.Ft. 18 PHOTO T 10 740 Sq.Ft. 22 12 24 22 E y U0412 264 Sq.Ft. 12 20 U 4 5 32 50 4 4 10 12 FM/B 1300 Sq.Ft. 26 26 FpA 1� 0 1--Fhd g 1 ^ 1 25 Sq.5t. 19 Sq.9t. 140 BRADFORD STREET • S�'fT1;ED�j�6' 0 PUBLIC HEALTH DEPARTMENT Town of North Andover Community and Economic Development Division CERTIFICATE OF COMMPLIANCE As of: November 20, 2017 This is to certify that the individual subsurface disposal system received a SATISFACTORY INSPECTION of the: Full Repair of On-Site Sewage Disposal System By: Peter Breen, Peter Breen Excavation At: 140 Bradford Street Map 61 Lot 4 North Andover, MA 01845 Issuance of this ce c all not be construed as a guarantee that the system will function satisfactorily. lic"heleE. Grant Public Health Inspector 120 Main St.,North Andover,Massachusetts 01845 Phone 978.688.9540 Fax 978.688.9542 Web www.northandoverma.gov i i �O •. �� A •�e�Ftw�;$D • L North Andover Health Department (ommunity and Economic Development Division COO August 31, 2017 Domenic Gugliemi 140 Bradford Street North Andover, MA 01845 Re: Subsurface Sewage Disposal System Plan for 140 Bradford Street(Map 61, Lot 004) Dear Mr. Gugliemi: The proposed wastewater system design plan for the above site dated August 1, 2017 with a final revision date of August 23, 2017 and received on August 28, 2017 has been approved. The Health Department has granted Local Upgrade Approvals for a reduced separation from the building sewer to the existing water service and for the allowance of one deep observation hole within the disposal area. The design plan has been approved for use in the construction of a new on-site septic system for a Three (3)bedroom home with a maximum of Seven(7)total rooms utilizing Infiltrator Systems Quick 4 Plus Standard LP Chamber system. This design plan approval is valid until August 31, 2020. During this time, a licensed septic system installer must obtain a permit and complete this work, and a Certificate of Compliance be endorsed by the installer, designer and the Town of North Andover. In the event an imminent health problem, such as sewage backup into the dwelling is occurring,the North Andover Board of Health may reduce the time period for which this plan is valid. This approval is also subject to the following conditions: 1. If site conditions are found in the field to be different from those indicated on the design plan and/or soil evaluation, the originally issued Disposal System Construction Permit is void, installation shall stop, and the applicant shall reapply for a new Disposal Systems Construction Permit(3 10 CMR 15.020(1)) Page 1 of 2 North Andover Health Department 120 Main Street North Andover, MA 01845 Phone: 978.688.9540 Fax: 978.688.9542 140 Bradford Street "-August 31, 2017 2. It is the responsibility of the applicant and/or the applicant's septic system designer, septic system installer or other representative to ensure that all other state and municipal requirements are met. These may include review by the Conservation Commission, Zoning Board, Planning Board, Building Inspector, Plumbing Inspector and/or Electrical Inspector. The issuance of a Disposal System Construction Permit shall not construe and/or imply compliance with any of the aforementioned requirements. Please feel free to contact the office with any questions you may have. We look forward to working with you to obtain a wastewater treatment and dispersal system which will be in compliance with all regulations and assure protection of public health and the environment of North Andover. Sincerely, 0/L �15c, 4/Brian YLaGrasse, CEHT Director of Public Health Encl. Installers list cc: Christiansen& Sergi, Inc., 160 Summer Street, Haverhill, MA 01830 File Page 2 of 2 North Andover Health Department 120 Main Street North Andover, MA 01845 Phone: 978.688.9540 Fax: 978.688.9542 Town of North Andover — Septic System b AS-BUILT CHECKLIST 1) ✓ 1 changes to the design plan have been reflected and noted on the as-built plan 2) As-built plan has a suitable scale; 0 inch= 40 feet or fewer for plot plans) 7 3 Street Address Assessor's Map and Lot Number 4) /Lot Lines and Location of Dwellings served by the system Locations,Elevations and Dimensions of As-built system components,including reserve (if applicable) 6) Ties to all tank openings,d-box,and leach area from dwelling or Permanent Structure Setback distances are shown on the as-built plan from system components to: Subsurface,interceptor&foundation drains Catch basins Property lines Dwellings or other structures Private water supply or irrigation wells Watercourses or wetlands 8) Locations ofWell Drains,Wetland Resource Areas within 150 feet of system 9) Location o Ovate ,gas,electric lines,cable,control panel (if applicable) 10) cation of Structures within 6 Inches of Finished Grade 11) Original Stamp&Signature 12) " Location and holder of any easements which could impact the system 13) Impervious Areas;Driveways,etc 14) North Arrow 15) Location&Elevation of Benchmark used 16) `/STATEMENT ON PLAN (NA 5.3) a. "I certify the locations, elevations, ties,cover material;exposed component covers etc., shown on this as-built substantially agree with the approved plan and have determined that the break out elevations,if applicable,have been met." Signature of Designer Date b. "If a STUCTURAL WALL IS PRESENT(NA 4.9)a Letter or statement on the as-built indicating the wall- was,or was not,constructed in accordance with the intended desiQrt and any manufacturer's specifications." Signature of Designer Date As of:Tuesday,March 17,2015 RECEIVED NOV 14 2017 •' ToHHEEADLTFH DEPARTMNORTH ENT ♦�S'1'4Fp�' `J �v —PUBUC HEALTH DEPART MIT_ . _ Community&tconomicDevelopment TOWN OFNORT11 ANDOVER SEPTIC DISPOSAL SYSTEM-INSTALLATION CERTIFICATION The undersigned hereby certify that the Sewage Disposal System( )constructed•,( )repaired; By:Peter Breen (N-int Name) :Located at:140 Bradford Street . (Installation Address) Was installed in conformance with the North Andover Board of Health approved plan,originally dated .8/1117 and last revised on 8/23/17 ,with a design flow of _.30 gallons per day. The materials used were in conformance with those specified on the approved plan;the system was installed in accordance with the provisions of 31.0.CMR 15.000,Title 5 and local regulations,and the final grading agrees substantially with the approved plan.All work is accurately represented on the As-built which has been submitted to the Board of 14c.11th. Bottom of Bed Inspection Date: angst""iccr Are And—Print Name Final Construction Inspection Date: C`r� ngne n;, en'a ive gnaturc) And-Print Name Installer: nature) Date: And-Print Name Engine L (Signature) Date: Phil Christiansen,P.E. And_Punt Name 120 Main Streei North Anttover,Massacit+usetts :, .�:... "1978.+6t38 9540 di 978 688 IS.R2�`""" . 'ltfeb l ttp 11www.northandeve g W L0 Commonwealth of Massachusetts Map-Block-Lot 061.00004 • BOARD OF HEALTH ? ----------------------- Permit No North Andov BHP-2017-0558 COv ----------------------- P.I. Fl FEE $350.00 DISPOSAL WORKS CONSTRUCTION PERMIT Permission is hereby granted Peter Breen to(Construct)an Individual Sewage Disposal System. at No 140 BRADFORD STREET as shown on the application for Disposal Works Construction Permit No. BHP-2017-055 ^ted Septe be 17 - ' Issued On: Sep-18-2017 ----------------- - ---- ARD F HEALTH • ,�-W Application for Septic Disposal System Construction Permit — TOWN OF TODAY'S DATE NORTH ANDOVER, MA 01845 $350.00-Full Repair $175.00-Component Important: Application is hereby made for a permit to: � When filling out forms on the El6�E1 RECEIVED Construct a new on-site sewage disposal system* 6 G G ® computer,use ❑ Repair or replace an existing on-site sewage disposal system* only the tab key SEP 18 2017 to move your ❑ Repair or replace an existing system component—What? cursor-do not TOWN OF NORTH ANDOVER use the return A. Facility Informatio�n� HEALTH DEPARTMENT key. /1-(© Address or Lot# tab City/Town 2.-*TYPE OF SEPTIC SYSTEM*: ➢ 7T ump ❑Gravity(choose one) ***If pump system, attach copy of electrical permit to application*** ➢ ❑Conventional System (pipe and stone system) ➢ ❑ Infiltrator or Biodiff user(Gravel-Less) (Attach a copy of your certification to install this type of system.) ➢ ❑ Pressure Distribution S.A.S.(No D-Box) ------- ----� ----=➢=g.P_ressure-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) Wlbat is the Make? What is the Model. 2. Owner Information .tri 6_NG Name Address(if different from above) City/Town State Zip Code Email address Telephone Number 3. Installer Information n Name Name of Company Address City/Town State Zip Code Telephone Number(Cell Phone#ifpossi a please) 4. Designer Information Name Name of Company Address City/Town State Zip Code Telephone Number(Best#to Reach) Application for Disposal System Construction Permit•Page 1 of 2 •a• • yn Application for Septic Disposal System �`'�• Construction Permit - TOWN OF TODAY'S DATE NORTH ANDOVER, MA 01845 $350.00-Full Repair $175.00-Component PAGE 2OF2 A. Facility Information continued.... 5. Type of Building: []Residential Dwelling or❑Commercial B. Agreement The undersigned agrees to ensure the construction and maintenance of the afore-described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code, as well as the Local Subsurface Disposal Regulations for the Town of North Andover. I understand that until a final Certificate of Compliance has been issued by this Board of Health, the installed system is not approved. Name Date Applicati App a y: (Board of Health Representative) (Z611 Name Date Application Disapproved for the following reasons: For Office Use Only: 1. Fee Attached? YesJ No 2. Project Manager Ohligation Form Attached.? Yes L No 3. Pump System? If so,Attach copy ofElectrical Permit Yes No Y/ Applicantreceived copy of "Electrical Inspection Notes for Septic Systems" Yes No Handout? 4. Reviewed approvalletter, all paperwork received. Yes V No Missing.• 5. Foundation As-Built?(new construction only): Yes No (Same scale as approved plan) i 6. Floor Plans?(new construction only): Yes No v Application for Disposal System Construction Permit•Page 2 of 2 +r SEPTIC SYSTEM INSTALLER PROJECT MANAGEMENT OBLIGATIONS As the North Andover licensed installer for the construction for the septic system for the property at: 1, cio &!d� 5 (address of septic system) For plans by /2 , (Engineer) Relative to the application of &1-Ltf, (Installer's name) And dated lC J Dated /J ,:,2®/7) (Original ate ( o ay s ate) With revisions dated 8-07 a C2 0/' (Last revised date) I understand the following obligations for management of this project: 1. As the installer,I am obligated to obtain all permits and Board of Health approved plans prior to performing any work on a site. I must have the approved plans and the permit on site when any work is being done. 2. As the installer, I must call for any and all inspections. If homeowner, contractor,project manager, or any other person not associated with my company schedules an inspection and the system is not ready, then item three shall be applicable. 3. As the installer, I am required to have the necessary work completed prior to the applicable inspections as indicated below. I understand that requesting an inspection,without completion of the items in accordance with Title 5 and the Board of Health Regulations may result in a$50.00 fine being levied against me and/or MY c0=any a. Bottom of Bed—Generally, this is the first (1'� inspection unless there is a retaining wall,which should be done first. The installer must request the inspection but does not have to be present. b. Final Construction Inspection—Engineer must first do their inspection for elevations, ties, etc. As-built of verbal OK (or e-mail to:healthdept@northandoverma.gov) from the engineer must be submitted to the Board of Health, after which installer calls for an inspection time. Installer must be present for this inspection. With a pump system, all electrical work must be ready and able to cause pump to work and alarm to function. c. Final Grade—Installer must request inspection when all grading is complete. Installer does not have to be on-site. 4. As the installer, I understand that only I may perform the work (other than simple excavation)and I am required to complete the installation of the system identified in the attached application for installation. I further understand that work done by others unlicensed to install septic systems in North Andover can constitute reasons for denial of the system and/or revocation or suspension of my license to operate in the Town of North Andover, significant fines to all persons involved are also possible 5. As the installer, I understand that I must be on-site during the performance of the following construction steps: a. Determination that the proper elevation of the excavation has been reached. b. Inspection of the sand and stone to be used. c. Final inspection by Board of Health staff or consultant. d. Installation of tank,D-Box,pipes, stone, vent,pump chamber,retaining wall and other components. 6. As the installer, I understand that I am solely responsible for the installation of the system as per the approved plans. No instructions by the homeowner, general conttactor or any other persons shall absolve me of this obligation. /J Undersigned Licensed Septic Installer: 1" (Today's Date) arae—Print) (Name—Signed) 140 Tsf 8021 Town of North Andover �,�'•;;:o.. HEALTH DEPARTMENT ,SSAcmusE4 CHECK#: 7.5'ZJ DA/TE: 9 -/69.1c LOCATION: /y6 1-31iz /t6/"d J# H/O NAME: 9 CONTRACTOR NAME: A !' Type of Permit or License: (Check box) ❑ Animal $ ❑ Body Art Establishment $ _ ❑ Body Art Practitioner $ ❑ Dumpster $ ❑ Food Service-Type: $ ❑ Funeral Directors $ ❑ Massage Establishment $ ❑ Massage Practice $ ❑ Offal(Septic)Hauler $ ❑ Recreational Camp $ ❑ Sun tanning $ ❑ Swimming Pool $ ❑ Tobacco $ s ❑ Trash/Solid Waste Hauler $ ❑ Well Construction $ SEPTIC Systems: ❑ Septic-Soil Testing f $ ❑ Septic Approval roval JJ� jr $ ep Septic Disposal Works Construction(DWC) $ ✓ �` ❑ Septic Disposal Works Installers(DWI) $ ❑ Title 5 Inspector $ ❑ Title 5 Report $ ❑ Other. (Indicate) $ Healbr4gent Initials White-Applicant Yellow-Health Pink-Treasurer 3 a North Andover Health Department (ommunity and Economic Development Division ONSITE WASTEWATER SYSTEM CONSTRUCTION NOTES LOCATION INFORMATION ADDRESS: 140 Bradford St MAP: 61 LOT: 4 INSTALLER: Peter Breen DESIGNER: Phil Christiansen PLAN DATE: 8/1/17 BOH APPROVAL DATE ON PLAN: 8/31/2017 INSPECTIONS TANK INSPECTION: DATE OF BED BOTTOM INSPECTION: DATE OF FINAL CONSTRUCTION INSPECTION: 10/4/17 DATE.OF FINAL GRADE INSPECTION:11/14/2017 SITE CONDITIONS N/A Contractor reports any changes to design plan N/A Existing septic tank properly abandoned ® Internal plumbing all to one building sewer' ® Topography not appreciably altered Comments: SEPTIC TANK ® Building sewer in continuous grade, on compacted firm base N/A 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 ® Watertightness of tank has been achieved by visual testing ® Inlet tee installed, centered under access port r l ® Outlet tee installed, centered under access port (effluent filter) ® 24" inch cover to finish grade installed over inlet, middle, outlet access ports ® Neoprene boots around inlet & outlet Comments: PUMP CHAMBER ® Bottom of tank hole has 6" stone base ® Weep hole plugged ® 1000 gallon Pump Chamber installed ® H-20 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 ® 24" cover at final grade installed over inlet, outlet access port s ® Water tightness of tank has been achieved by Visual testing ® Neoprene boots around inlet & outlet Comments: CONTROL PANEL ® Alarm & Pump are on separate circuits ® Alarm sounds when float is tripped ® Location of control panel: garage ® Alarm signal located inside: garage 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: 2" x 4" coupling and 4' section of 4" PVC before D-Box inlet to reduce velocity. i SOIL ABSORPTION SYSTEM (General) ® Bottom of SAS excavated down to C soil layer, as provided on plan ® Size of SAS excavated as per plan ® Title 5 sand installed, if specified on plan ® 40 Mil HDPE barrier installed ® Laterals installed and ends connected to header (and vented if impervious material above) ® Elevations of laterals and chambers installed as on approved plan N/A Retaining wall (boulder/ concrete /timber/ block) ❑ Final cover as per plan Comments: FINAL GRADE ® Loamed ® Seeded ® Cover per plan Comments: DOCUMENTS NEEDED ® Certification of Installation Form submitted By engineer and signed and dated by Engineer and installer ® As-Built Plan r, BM = 102.94 7.04 109.98 j SYSTEM ELEVATIONS ROD AS-BLT INVERT DESIGN INVERT ELEVATION ELEV ELEV Benchmark Cast Iron connection 4.55 105.08 105.67 Septic Tank IN 4.57 105.06 105.43 Septic Tank OUT 4.82 104.81 105.18 Pump Chamber In 4.86 104.77 105.08 Pump Chamber Out (2") 5.08 104.73 104.83 Distribution Box IN(4") 1.45 108.18 108.20 Distribution Box OUT 1.60 108.03 108.20 Lateral 1 TOP 1.79 Lateral 1 INVERT 107.84 107.80 Lateral 2 TOP 1.79 Lateral 2 INVERT 107.84 107.80 Lateral 3 TOP 1.79 Lateral 3 INVERT 107.84 107.80 Lateral 4 TOP 1.79 Lateral 4 INVERT 107.84 107.80 Lateral 5 TOP 1.79 Lateral 5 INVERT 107.84 107.80 Lateral 6 TOP 1.79 Lateral 6 INVERT 107.84 107.80 Lateral 7 TOP 1.79 Lateral 8 INVERT 107.84 107.80 Lateral 8 TOP 1.79 Bottom of chamber 2.45 107.53 107.52 t CRITICAL SETBACK DISTANCES Mark those distances checked in the field against the design plan and regulatory setback Tank SAS Sewer ® Property line 10 10 -- ® Cellar wall 10 20 -- ® Inground pool 10 20 -- ® Slab foundation 10 10 -- ® Deck, on footings, etc 5 10 -- ® Waterline 10 10 101 ® Private drinking well 75 1002 50 ® Irrigation well 75 100 ® Surface Water 25 50 ® Bordering Vegetated Wetland , Salt Marsh, Inland/Coastal Banka 75 100 ® Wetlands bordering surface water supply or trib. (in Watershed) 150 150 ® Trib. to surface water supply 325 325 ® Public well 400 400 ® Interim Wellhead Prot. Area ® Reservoirs 400 400 ® Drains (wat. supply/trib.) 50 100 ® Drains (intercept g.w.) 25 50 ® Drains (Other)Foundation 10(5) 20(10) ® Drywells 20 25 I ' Suction line 222(2) 2 100 feet is a minimum acceptable distance and no variance is allowed for a lesser distance(NA 5.02). 3 As defined in 310 CMR 10.55, 10.32, 10.54,and 10.30,respectively,pursuant to 15.211(3), also by NA wetland bylaws Commonwealth of Massachusetts Title 5 Official Inspection Form ID Subsurface Sewage Disposal System Form -Not for Voluntary Assessment C+� 140 Bradfordr Z,520�� St eet AVL IC00- Property Address Donenic Guglielmi ' ;�w Owner Owner's Name information is required for every North Andover MA 01845 6-21-2017 page. City/Town State Zip Code 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. Important:When A. General Information 02LURR filling out forms on the computer, use only the tab 1. Inspector: 7 -03- key to move your l� cursor-do not Neil J. Bateson use the return Name of Inspector key. Bateson Enterprises Inc. � Company Name 111 Argilla Road IL 0 Company Address Andover MA 01810 City/Town State Zip Code 978-475-4786 SI-15 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of. Title 5 (310 CMR 15.000).The system: i ❑ Passes ❑ Conditionally Passes ® Fails ❑ Needs Further Evaluation by the Local Approving Authority ro 6-21-2017 Inspec ors ignatu 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 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' rwill perform in the future under the same or different conditions of use. i ' t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ,•''t 140 Bradford Street Property Address Donenic Guglielmi Owner Owner's Name information is required for every North Andover MA 01845 6-21-2017 page. Citylrown 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 ass inspection if it is structural) sound not leaking and if a Certificate of p P P Y 9 Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): I t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 140 Bradford Street Property Address Donenic Guglielmi Owner Owner's Name information is required for every North Andover MA 01845 6-21-2017 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes(cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): I i ❑ 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.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 s C ommonwealth of Massachusetts W Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,•y'`� 140 Bradford Street Property Address Donenic Guglielmi Owner Owner's Name informationis required wirfor for every North Andover MA 01845 6-21-2017 page. Cityrrown State Zip Code Date of Inspection R. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ® ❑ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than %day flow t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 17 Commonwealth of Massachusetts in. . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 140 Bradford Street Property Address Donenic Guglielmi Owner Owner's Name information is North Andover MA 01845 6-21-2017 required for 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 tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ 0 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- 10'0009p d. ® ❑ The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ 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.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts 4 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments •''t 140 Bradford Street Property Address Donenic Guglielmi Owner Owners Name information isequiredorevery North Andover MA 01845 6-21-2017 page. City own State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ❑ ® Were as built plans of the system obtained and examined? (If they were not available note as WA) ® ❑ 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? I ® ❑ 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: ❑ ® Existinginformation. For example, plan at the Board of Health o P ® ❑ 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): NSA Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): N/A t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts u Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments M •�''r 140 Bradford Street Property Address Donenic Guglielmi Owner Owner's Name information is North Andover for every MA 01845 6-21-2017 page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundrys inspected? Y stem E] Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available(last 2 years usage(gpd)): Yes Detail: Sump pump? ❑ Yes ® No Last date of occupancy: CurrentDate i Commercial/Industrial Flow Conditions: j 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? El Yes ❑ No Water meter readings, if available: t5ins.doc•rev.6/16 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 140 Bradford Street Property Address Donenic Guglielmi Owner Owner's Name information is North Andover MA 01845 6-21-2017 required for every page. Cit own State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: P 9 Source of information: Pumped last year, owner Was system pumped as part of the inspection? ❑ Yes ® No i If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ! ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ 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.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts a Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments •4 140 Bradford Street Property Address Donenic Guglielmi Owner Owner's Name information is required for every North Andover MA 01845 6-21-2017 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: Unknown Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 3 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.): Finished cellar unable to see piping Septic Tank(locate on site plan): Depth below grade: 2 feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 7'x5'x4' Sludge depth: 3" t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts N Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 140 Bradford Street Property Address Donenic Guglielmi Owner Owner's Name information is required for every North Andover MA 01845 6-21-2017 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 29" Scum thickness 2" Distance from top of scum to top of outlet tee or baffle 8" Distance from bottom of scum to bottom of outlet tee or baffle 13" 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.): Inlet baffle ok. Outlet baffle badly corroded. Depth of liquid at outlet invert. No evidence of leakage. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts u Tithe 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 140 Bradford Street Property Address Donenic Guglielmi Owner Owner's Name information is required for every North Andover MA 01845 6-21-2017 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: g gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): I "Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No I t5ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts a Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 140 Bradford Street Property Address Donenic Guglielmi Owner Owner's Name information is required for every North Andover MA 01845 6-21-2017 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 1" 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 cover broken, replaced same. D-box badly corroded, holes in same. D-box partially filled with dirt. Evidence of leakage. Evidence of.carryover. Liquid above pipes. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): i If SAS not located, explain why: i i I • i t5ins.doe-rev.6116 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 •�''� 140 Bradford Street Property Address Donenic Guglielmi Owner Owner's Name information isequired or every North Andover MA 01845 6-21-2017 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ® leaching trenches number, length: 3 trenches 40' ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: i 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 u ber and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer i Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 Commonwealth of Massachusetts 4 Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments •�''- 140 Bradford Street Property Address Donenic Guglielmi Owner Owner's Name information isequired or every North Andover MA 01845 6-21-2017 page. City/Town 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.): I t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 140 Bradford Street Property Address Donenic Guglielmi Owner Owner's Name information fo is every North Andover required for eve MA 01845 6-21-2017 page. Ci r—rown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately I ft ,mer � �` ✓31 r f S C d I I i t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 140 Bradford Street Property Address Donenic Guglielmi Owner Owner's Name information is required for every North Andover MA 01845 6-21-2017 page. Cityrr Nn 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: 1.5 to 3. 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: Date ® Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: Design plan ❑ Checked with local excavators, installers-(attach documentation) ® Accessed USGS database-explain: Essex County Soil Map. I i You must describe how you established the high ground water elevation: Essex County Soil Map, Sheet#23, Woodbridge Soil. Water 1.5'to 3' Deep. House across street has a pump system. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins.doc•rev.6116 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 M 140 Bradford Street Property Address Donenic Guglielmi Owner Owner's Name information is required for every North Andover MA 01845 6-21-2017 page. Cityrrown State Zip Code 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 i t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 .........._,.._._...._..._.. Town of North Andover Tax Map # 210-061.0-0004-0000.0 Parcel Id 10542 140 BRADFORD STREET DOMINIC GUGLIELMI 140 BRADFORD STREET NORTH ANDOVER, MA 01845 Class 101 Single Family Property Type 1 Residential Zoning2 1 Residential Zoning3 1 Residential Size Total 0.38 Acres FY 2017 UB Mailing Index Name/Address Type Loan Number Active/Inact. From Until DOMINIC GUGLIELMI Owner 140 BRADFORD STREET NORTH ANDOVER,MA 01845 HEINZE, ROBERT W. Previous Customer t Inactive 4/3/2006 525 HOWARD STREET LAWRENCE, MA 01841 I UB.Account Maint. Account No Cycle Occupant Name Active/Inactive Bldg Id. 15222.0-140 BRADFORD STREET Last Billing Date 3/6/2017 2120192 02 Cycle 02 Active UB Services Maint. Account No. 2120192 Service Code Rate Charge Multiplier/Users MISCFEE ADMIN FEE 0.635/8 7.82 1/ WTR WATER 01 ALL METER SIZE 38.00 /1 UB Meter Maintenance Account No.2120192 Serial No Status Location Brand Type Size YTD Cons 18736544 a Active ERT HH METE METE w Water 0.63 0.63 654 Date Reading Code Consumption Posted Date Variance 5/9/2017 927 a Actual 10 6% 2/10/2017 917 a Actual 10 3/14/2017 -80% 1119/2016 907 a Actual 49 12119/2016 -42% 8/12/2016 858 a Actual87 9/21!2016 751/ 5/12/2016 771 aActual 10 6/21/2016 -12% 2/12/2016 761 a Actual 12 3/28/2016 -83% 11/9/2015 749 aActual 66 12/30/2015 -40% 8/14/2015 683 a Actual 116 9/14/2015 1318% 5/14/2015 567 a Actual 8 6/22/2015 -27% 2/13/2015 559 a Actual 12 3/20/2015 16% 11/6/2014 547 aActual 9 12/15/2014 -58% 8/12/2014 538 aActual 22 9/11/2014 59% 5/15/2014 516 a Actual 14 6/12/2014 94% 2/14%2014 502 a Actual 8 3/17/2014 -24% 11/6/2013 494 aActual 9 12/20/2013 -63% 8/13/2013 485 a Actual 26 9/18/2013 409% 5/14/2013 . 459 a Actual 5 6/18/2013 -68% 2/14/2013 454 a Actual 18 3/13/2013 83% 11/5/2012 436 a Actual 8 12/13/2012 -53% 8/15/2012 428 a Actual 19 9/26/2012 45% 5/15/2012 409 a Actual 13 6/20/2012 -6% 2/14/2012 396 a Actual 15 3/14/2012 6% 11/7/2011 381 aActual 12 12/15/2011 22% 8/15/2011 369 a Actual 11 9/14/2011 -31% 5/13/2011 358 a Actual 15 6/13/2011 86% 2/14/2011 343 a Actual 9 3/15/2011 62% i Of NONTh, 7930 o;••y0 ? • O • Town of North Andover `*�;s :o::•� HEALTH DEPARTMENT S4CNUSt CHECK#: y3 DATE: 7 ZO LOCATION: i H/O NAME: 900 CONTRACTOR NAME: [ Type of Permit or License: (Check box) ❑ Animal $ ❑ Body Art Establishment $ ❑ Body Art Practitioner $ ❑ Dumpster $ ❑ Food Service-Type: $ ❑ Funeral Directors $ ❑ Massage Establishment $ ❑ Massage Practice $ ' ❑ Offal(Septic)Hauler $ ❑ Recreational Camp $ ❑ Sun tanning $ ❑ Swimming Pool $ ❑ Tobacco „ $ ❑ Trash/Solid Waste Hauler $ ❑ Well Construction $ SEPTIC S, stems: ❑ Septic-Soil Testing $ ❑ Septic-Design Approval $ ❑ Septic Disposal Works Construction(DWC) $ ❑ Septic Disposal Works Installers(DWI) $ F ❑ Title 5 Inspector $ Title 5 Report G $ ❑ Other:(Indicate) $ H6I"ent Initials White-Applicant Yellow-Health Pink-Treasurer r ' y ® TOWN OF NORTH ANDOVER '`.A. Commun t,,&Econottiic Development �(i O HEALTH DEPARTMENT } 120 Mainn Street j NORTH ANDOVER;MASSACHUSETTS 01845 (31< 978.68 978.68$.9540—Phone 978.688.9542—FAX lob t healtlidept@northandoveima.go N"vw,northandoveima.gov APPLICATION FOR SOIL TESTS DATE: 6/27/17 MAP&PARCEL: 061.0-0004 LOCATION OF SOIL TESTS: Front yard-failed system OWNER: Dominic Guglielmi Contact#: 781-858-9829 APPLICANT:Philip Christiansen Contact#:978-373-0310 r ADDRESS: ENGINEER: Phlip Christiansen Contact#: 978-373-0310 ! CERTIFIED SOIL EVALUATOR Philip Christiansen ll Intended Use of Land: 'Residential Subdivision Single Family Home Commercial i Is This: Repair Testing:X Undeveloped Lot Testing: Upgrade for Addition: 1 In the Lake Cochichewick Watershed? Yes No X i i THE FOLLOWING MUST BE INCLUDED WITH THIS FORM ➢ Proof of land ownership(Tax bill,or letter fiom owner permitting test) ➢ 8.51'x 1111 Plot plait&Location of Testing(please indicate test pit sites on the plan) ➢ tee of$585.00 per lot for new construction. This covers the minimum two deep holes and two percolation tests required for each disposal area. Fee of$440.00 per lot for reaairs or upgrades. GENERAL INFORMATION I ➢ Only Certified Soil Evaluators may perform deep hole inspections. ➢ Only Mass.Registered Sanitarians and Professional Engineers can design septic plans. ➢ At least two deep holes and two percolation tests are required for each septic system disposal area. i ➢ Repairs requite at least two deep holes and at least one percolation test,at the discretion of the BOH representative. I ➢ Full payment will be required for all additional tests within two weeks of testing. ➢ Within 45 days of testing,a scaled plan(no smaller than 1"-100')shall be submitted to the Board of Health showing the location of all tests(including aborted tests). ➢ Within 60 days of testing soil evaluation forms shall be submitted. Please Do Not Write Below This Line E i i N.A. Conservation Commissionproval Date. i Sigttalttre of Conservation Agent: Date back to Health Department:(st n in): 1 .0060 s, 1610-0061 061.0-00 6 -0037 V0-UQ55 61 060070054 061.0-0064 1 - 061 M0053 061.0-0065 o 061.0 0060 le, fG 06 .0-000a`r 061.0-0002:' 061.0-0001 061.0-0052 Cyd,` 061,0-0003 %061.0-0PIV,11 .061.0-0050 ✓moi^ 061.0 004 061.0-0103 W 0f,i 0�'noal MORTGA.a PLOT MAN E K SURVEY INC ; •H40HM VA 4 F'tla+e 879'-1_eo-,896,foi0T6�OD�70�8 • pEF�REf.�II� i QTRIP WI REf. — ADDRESS OF.pYlNCIPIF 8lJtI.DIMO SCALE:,'■lip' d Lal" i38 An, 13A, yqr 027 0 f • ® BoYfCRd J L T. CERTIFICATION TO: � RUDEL �[ Tea badw d IM Wh*11 aCtrctust TAY NOitl;ja�P►x aW+%"prspr!d W 7w Na Q C6..{L K.w gg@d gU*xWgrahw6�Wir�d ofgmM-r*od A � �!Mrn k 9pairbul*i b nwh■Flood H=sM Arr. � or on+ O��¢mt buElrn V h a Fbod bard Ams, Food Fkn+d ham 9r FEiAI rri*4 d otlwn. C+tad 1091 ?�ftOL I 'd SbOL-69b-6L6 98Ajns Na - ---- -- \�-)61`0-0069 °3�1;0-00f1 x pp 061.0005 61 -0037 °`+, Q .4? 5 ,\ v . 061�`Q'-'0054 061<Q-0064 -�- OG1:0 0053' 061.0.0065 t 0 Q61.Q-0060 061,0-0004_ 061.0-0001 061.0-0002; Ir- JY.�� ?? 061.0-0(152 o61.a-aoQ3 \061.£}-01! \""061-0-0050 ,,061.0-004 061.0-0103 �df E7ii l.0-004,1 �. MORTGAGE rLOT MAN E K SURVEY INC ♦HAVERHILL,IIIA Mom 875416-110 Fa97S-4W-70Q L4CRTOAl30R i ✓mss:' Qd&LJA4.w i DEED REF. 07 P0. .170 ADORESS Of PRINCIPLE 8URZIMCI PLAN REF. MaaoGrti Y' DATE Of INSPECTION m.4Eu/ Z444 - ,,,. ,j. SCALE:V■tJ0' d for 13$ �St 13A IFIL y41027t +, ® 6o1!lORD pkK — — B P1rQ�idL hL T. CERTIACATION TO:W.UQUbd Awham KumL,L D The lec� of em prt,clplo*udur". ll a ppm or0Y■od V&hoot t�lsodsd er tspeeeried �� A CISSf L�t tM loaf=*q boom In also Mrn=WAcW to be s p op■ty km a teed".This pin lo not b be used m-6 ex Y�, ham richt eetb oam� to aWAsh eery at Ux pr*"Inn r"pipme.No eodw under Mh S.L The Vt.Chop./6A,6eo.7. mopm6W Is a nded to the lend ower or accupe tt Bi t b AWkv is not In■Hood Heard Area. TNs mWcafian lsbred en R»bnstkx d euwy nw kar Q SL#emt bull p Y lns Flood lr mrd Area. Of di"M. Fbod Heard dAtmfied from the FRIM rtiep R Catsd 109 d V&LpoL T d 9bOL-69b-8L6 Renins )4a -•--- -- 1 — r ._...—.—..�.,—� —.._._ —.-.._-- ._.._. — � �•.::1 � C 1 f 1 I 1( —t I ( �•~ j � �� k �p� b Ta i1 II r f � t'--�� � ,�i—`—f ( --�� `�1�•�� +.� ����5� � � z ,��kS TM� .� � $s�4 PV � ; � 3 } t � � .Ql iU+/(, C I�" ✓ +C..j•���iCJ I ��. `,} �? gy,�r"I k' � 1 4 j� (� I { ol �, LOA t� { _ —� i p� •t -afro- � VA"� � d � - yo- *. M I t+ � Commonwealth hof Massachusetts City/Town of Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal A. Facility Inf ri ation.- 6- L/6- LZ 2 Owner Name Cx L3� Is_T AU /6qAp r p L Cog Street Address 3W rMiD %" [ I Map/Lot#11" V 52 City State Zip Code B. Site Inform alltion New Construction El Upgrade 1. (Check one) Repair 43 2. Soil Survey Available? ['(YesEj No If yes: C's ,— PAX IGS( Source Soil Map Unit Soil Name i –§o:jl—LimitationsAg's,F_ ^Y �6�)(-/,I F_ rl q -1 -11-(' D RvlAt,-T w'9 . Pi Geologic/Parent Material Landform 3. Surficial Geological Report Available? E;;/Yes El No If yes: "rnfi-%j"-:r 5 _t_7LIL, Year Published/Source Publication Scale Map Unit Is 4. Flood Rate Insurbnce Map Above the 500-ye'r ood boundary? E9 Yes ❑ No Within the 100-year flood boundary? E] Yes El No If Yes,continue to#5. 5. Within a velocity orae? El Yes [g/No6. Within a Mappe !Ztland Area? 0 Yes E9/N No MassGIS Wetland Data Layer: IWetland Type 7. Current Water R6source Conditions (USGS): —74/17 Range: F� Above Normal Ejj/Normal 0 Below Normal Month/Year 8. Other references Ir viewed: t5form I 1.doc-rev.8/15 Form 11–Soil Suitability Assessment for On-Site Sewage Disposal Page 1 of 8 Commonwealth DT Massachusetts City/Town of Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal C. On-Site Review (minimum of two holes required at every proposed primary and reserve disposal area) Deep Observation Hole Number: -7/" () v S U f 1`f lf Date Time Weather I 1. Location 1. Ground Elevatio 'at Surface of Hole: Latitude/Longitude: / feet Description of Lobation: f A-U I 2. Land Use t) V(�1..: ILcr 7 ^rc N (b.g woodland,:agricultural field,vacant lot,etc.) Surface Stones(e.g.,cobbles,stones,boulders,etc.) Slope(1/6')_ �l. A eWAf Vegetation Landform Position on Landscape(SU,SH, BS, FS,TS) 3. Distances from: Open Water Body Drainage Way Wetlands feet feet feet Property Line Drinking Water Well Other feet feet feet 4. Parent Material: b—'ARil:! -T?LL_ Unsuitable Materials Present: ❑ Yes ❑KNo If Yes: ❑ Disturbed Soil ❑ Fill Material ❑ Impervious Layer(s) ❑ Weathered/Fractured Rock ❑ Bedrock 5. Groundwater Obs e ed: ❑ Yes �No If yes: (� t, Depth Weeping from Pit Depth Standing Water in Hole Estimated Depth.to High Groundwater: -7 i; inches elevation i' I i t5form11.doc•rev.8/15 Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal •Page 2 of 8 Commonwealth 'of Massachusetts City/Town of I' Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal C. On-Site Review (continued) Deep Observation ole Number: Coarse Fragments Redoximorphic Features o Soil I i by Volume Soil Horizon/Soil Matrix:Color- Soil Texture /a Depth(in.) Soil Structure Consistence Other Layer Moist(Munsell) (USDA) Cobbles (Moist) Depth Color Percent Gravel g Stones G ley 5 /An I' 1. l i � Additional Notes:' P L. ' I , i t5form11.doc•rev.8/15 i. Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal •Page 5 of 8 r Commonwealth �of Massachusetts =1 City/Town of Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal C. On-Site Review (continued) I Deep Observati i nl Hole Number: 7�1 �� L s C C t//Vil y Date Time Weather li 1. Location Ground Elevation at Surface of Hole: CG,s— Latitude/Longitude: / feet 2. Land Use 17 V (,� l U L-C T N9c 9 woodland,agricultural field,vacant lot,etc.) Surface Stones(e.g.,cobbles,stones,boulders,etc.) Slope(%) v',egetation Landform Position on Landscape(SU,SH, BS, FS, 3. Distances from: Open Water Body Drainage Way Wetlands feet feet feet �I Property Line I C! Drinking Water Well Other feet feet feet 4. Parent Material: �'� � CCAMI LCD 6r r► i'^rt l-17(, Unsuitable Materials Present: ❑ Yes Er"N o i ' If Yes: ❑ Disturbed Soil ❑ Fill Material ❑ Impervious Layer(s) ❑ Weathered/Fractured Rock ❑ Bedrock 1. 5. Groundwater Observed: ❑ Yes [�N0 If yes: Depth Weeping from Pit Depth Standing Water in Hole Estimated Depth'to High Groundwater: inches elevation I' I: I' t5form11.doc•rev.8/15 j Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal •Page 4 of 8 li Commonwealth of Massachusetts ra City/Town of Form 11 - Soi Suitability Assessment for On-Site Sewage Disposal C. On-Site Review (continued) Deep Observation Hole Number: I' f' I' Coarse Fragments I %b Soil Horizdn/Soil Matrix:Color- Redoximorphic Features Soil Texture Y Volume Soil Depth(in.) La er �; Moist Munsell (USDA Soil Structure Consistence Other Y (Munsell) ) cobbles Moist Depth Color Percent Gravel &Stones (Moist) A L j� I! Additional Notes I (� r �� I' ILQGT'S -?c� 7 cv� ' I i t5form11.doc•rev.8/15 Form 11—Soil Suitability Assessment for On-Site Sewage Disposal •Page 3 of 8 _ I f -~ . . . : 'f Massachusetts Commonwealth City/Town of Form 11 - S09 Suitability Assessment for On-Site Sewage Disposal C. On-Site Rev''" (continued) Deep Observation Hole Number: Date Time Weather 1. Location Ground Elevatio at!Surface of Hole: 0, Latitude/Longitude: pf_ feet VL 2. Land Use woodland,agricultural field,vacant lot,etc.) Surface Stones(e.g.,cobbles,stones,boulders,etc.F_ Slope(%) I 6tation Landform Position on Landscape(SU,SH, BS, FS, — Distances— from:—' feet feet feet Property Line Drinking Water Well Other feet feet feet 4. Parent Material: If Yes: El E i 3Lrbed Soil Fill Material El Impervious Layer(s) El Weathered/Fractured Rock Bedrock 5. Groundwater O LJ Yes E9,'N0 If yes: Depth Weeping from Pit Depth Standing Water inHole � Ea�matedDopt ighGroundvvater: / inches. elevation ' omnnl 1.doc`rev.nnn Form 11 -Soil Suitability Assessment for On-Site Sewage Disposal ^Page 4ofo ^ \ Commonwealth of Massachusetts City/Town of f; r� Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal C. On-Site Rev;iw (continued) 11 Deep Observation ole Number: Redoximorphic Features Coarse Fragments Soil Soil Horizon/Soil Matrix:Color- Soil Texture %by Volume Depth(in.) Layer ! Moist Munsell (USDA) Soil Structure Consistence Other Y (Munsell) ) CobblesMoist Depth Color Percent Gravel 8<Stones Cobbles ( ) ,r 1.I; Ii II Additional Notes: ' I i I I' I t5form11.doc-rev.8/15 i.I Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal • Page 3 of 8 � I Commonwealth :.f Massachusetts City/Town of Form 11 - So;il Suitability Assessment for On-Site Sewage Disposal C. On-Site Re, i�ew (continued) Deep Observatic11 Hole Number: Ll Z ,�f rad r 5V,N/V y Date Time Weather 1. Location Ground Elevationat Surface of Hole: l(�6 7 Latitude/Longitude: / feet 2.. Land Use ,�1=V P•Lr ?t~0 Lr 1 I\T (" e.g. woodland;agricultural field,vacant lot,etc.) Surface Stones(e.g.,cobbles,stones,boulders,etc.) Slope(%) Vegetation Landform Position on Landscape 3. Distances from: Open Water Body Drainage Way Wetlands feet feet feet Property Line jo Drinking Water Well Other I feet feet feet 4. Parent Material: I PKSP L-C/I fl V 0&P115 d 1 7-Lt, Unsuitable Materials Present: ❑ Yes o I If Yes: ❑ Dis urbed Soil ❑ Fill Material ❑ Impervious Layer(s) ❑ Weathered/Fractured Rock ❑ Bedrock 5. Groundwater Obl' e I ed: ❑ Yes NAo If yes: I' ^ Depth Weeping from Pit Depth Standing Water in Hole Estimated Depth,;to igh Groundwater: inches elevation ;l I'I, I i j (I i I I' is I t5form11.doc•rev.8/15 ! j Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal •Page 4 of 8 j:j . . 1 .I i Commonwealth of Massachusetts City/Town of- iI Form 11 Soil Suitability Assessment for On-Site Sewage Disposal C. On-Site Review (continued) Deep Observati iole Number: II j Redoximorphic Features Coarse Fragments Soil Horizon/Soil Matrix:Color- Soil Texture /o by Volume Soil Depth(in.) Layer Moist(Munsell) USDA Soil Structure Consistence Other Depth Color Percent ( ) Gravel Cobbles (Moist) &Stones ea I I; I � Ii 1 Additional Notes, illbA /`� 14 I; I � t5form11.doc-rev.8/15 I, Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal • Page 3 of 8 I I LI Commonwealth of Massachusetts City/Town of y Percolation Test ' Form 12 Percolation test results must be submitted with the Soil Suitability Assessment for On-site Sewage Disposal. DEP has provided this form for use by local Boards of Health. Other forms may be used, but the information must be substantially the same as that provided here. Before using this form, check with the local Board of Health to determine the form they use. Important:When filling out forms A. Site Information on the computer, use only the tab C` 1V Y (� V -L�r m key to move your Owner Name cursor-do not 1!„ Q (3R/1- r� R I) 57 use the return Street Address or Lot# _ eY• /� (",-1 Aty6CVM/1 i� City/Town State Zip Code Contact Person(if different from Owner) Telephone Number B. Test Results 7/l i 3 0 7/iSs/t 7 Date Time Date Time Observation Hole# .4 l Depth of Perc 3 y `I' ,I Start Pre-Soak q3 1,l End Pre-Soak Time at 12" L C 5 Time at 9" Time at 6" � - 1-1? r13 Time(9"-6") m1N 3S M, N Rate (Min./Inch) t 1 p Test Passed: []/ Test Passed: Test Failed: ❑ Test Failed: ❑ Board of Health Witness Comments: t5form12.doc•08/15 Perc Test-Page 1 of 1 i Commonwealth of Massachusetts City/Town of Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal D. Determination of High Groundwater Elevation 1. Method Used: Obs. Hole# Obs. Hole# I' ❑ Depth observed standing water in observation hole I' inches inches ❑ Depth weepi g from side of observation hole inches inches Depth to soil redoximorphic features (mottles) 5 F(--- L r✓r G-5 inches inches ❑ Depth to adjusted seasonal high groundwater(Sh) (USGS methodology) inches inches I I Index Well Number Reading Date Sh= Sc,—[Sr IX (OWE—OWmax)/OWr] i' Obs. Hole# i' SC Sr OWE OWmax OWr Sh r. Obs. Hole# I Sc Sr OWE OWmax OWr Sh I E. Depth of Pervious Material 1. Depth of Naturally Occurring Pervious Material a. Does at least"f lur feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil ab orption system? Yes ❑ No b. If yes, at whalt depth was it observed? Upper boundary: Lower boundary: inches inches c. If no, at whatl'depth was impervious material observed? Upper boundary: Lower boundary: inches inches it I. I' I` I� • t5form11.doc•rev.8/15 Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal •Page 6 of 8 I. SEX Commonwealthof Massachusetts City/Town of I: Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal F. Board of Health Witness p. `35 4RC P-6 L-/ Nc R-Iki 10 fy6c;v(. � Name of Board of Health Witness Board of Health !! I G. Soil Evalualtor Certification I certify that I am c�rrently approved by the Department of Environmental Protection pursuant to 310 CMR 15.017 toconduct soil evaluations and hat the above analysis has been performed by me consistent with the required training, expertise and experience described in 310 CMR 15.017. 1 further certify that the results of my soil evaluation, as indicated in the attached Soil Evaluation Form, are accurate andin accordance with 310 CMR 15.100 through 15.107. Si ure of Soil Evaluator Date Typed or Printed Name of Soil Evaluator/License# Expiration Dateof I-icense C}� r?"7 -:T,4� P,dy A N +) SI;P,LrI� C, l; Note: In accordance with 310 CMR 15.018(2)this form must be submitted to the approving authority within 60 days of the date of field testing, and to the designer and;tf ie property owner with Percolation Test Form 12. I. I I' I I , I C ' I I i. • t5form11.doc-rev.8/15 I Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal -Page 7 of 8 i • i. I` Commonwealth of Massachusetts City/Town of Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal I, Field Diagrams Use this sheet fo'�field diagrams: I' P I� I, Z� 9 I� �•z �3 I� I I j I t5form11.doc•rev.8/15 Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal •Page 8 of 8 i I F !' ,OR 7922 k ;; ,; Town of North Andover `,�'••; ::. HEALTH DEPARTMENT ,SSAC N�`�t4 CHECK#: y3 ) DATE: �6-�-.z 7 OO LOCATION: --_-- H/O NAME: CONTRACTOR NAME: �./1/"/•ST/ S� Type of Permit or License: (Check box) ❑ Animal $ ❑ Body Art Establishment $ ❑ Body Art Practitioner $ ❑ Dumpster $ ❑ Food Service-Type: $ ❑ Funeral Directors $ ❑ Massage Establishment $ ❑ Massage Practice $ ❑ Offal(Septic)Hauler $ ❑ Recreational Camp $ ❑ Sun tanning $ ❑ Swimming Pool $ ❑ Tobacco $ ❑ TrasWSolid Waste Hauler $ ❑ Well Construction $ SEPTIC Systems: Septic-Soil Testing $ ///❑ Septic-Design Approval $ ❑ Septic Disposal Works Construction(DWC) $ ❑ Septic Disposal Works Installers(DWI) $ ❑ Title 5 Inspector $ ❑ Title 5 Report $ ❑ Other:(Indicate) $ Health Agent Initials White-Applicant Yellow-Health Pink-7 Treasurer 14 w. D 0 TM 7A r; I 151 'y MO —A, O`� 3 _ c a i Town of North Andover a i i HEALTH DEPARTMENT ,SS4CMUSa4 _ /� CHECK#: 3 YV-23 DATE: 7 LOCATION: � � r H/O NAME: U?I e-//Y7 CONTRACTOR NAME: Type of Permit or License: (Check box) ❑ Animal $ ❑ Body Art Establishment $ ❑ Body Art Practitioner $ ❑ Dumpster $ ❑ Food Service-Type: $ ❑ Funeral Directors $ ❑ Massage Establishment $ ❑ Massage Practice $ ❑ Offal(Septic)Hauler $ ❑ Recreational Camp $ ❑ Sun tanning $ ❑ Swimming Pool $ ❑ Tobacco $ ❑ Trash/Solid Waste Hauler $ ❑ Well Construction `` $ SEPTIC Systems: f Septic-Soil Testing $/yL ❑ Septic-Design Approval $ ❑ Septic Disposal Works Construction(DWC) $ ❑ Septic Disposal Works Installers(DWI) $ ❑ Title 5 Inspector $ ❑ Title 5 Report $ ❑ Other:(Indicate) $ H gent Initials White-Applicant Yellow-Health Pink-Treasurer Commonwealth of Massachusetts City/Town of Form 9A - Application for Local Upgrade Approval DEP has provided this form for use by local Boards of Health. Other forms may be used, but the information must be substantially the same as that provided here. Before sing this form, check with your local Board of Health to determine the form they use. (' Form 9A is to be submitted to the Local Board of Health for the upgrade of a failed or nonconforming septic stem with a design flow of less than 10 000 d where full 9 p Y 9 9 p / compliance, as defined in 310 CMR 15.404(1), is not feasible. C CJ tem upgrades that cannot be performed in accordance with 310 CMR 15.404 and 405, or In full compliance with the requirements of 310 CMR 15.000, require a sol variance pursuant to 310 CMR 15.410 through 15.415. yD �J NOTE: Local upgrade approval shall not be granted for an upgrade proposal that includes the addition of a new design flow to a cesspool or privy, or the addition of a new design flow above the existing approved capacity of an on-site system constructed in accordance with either the 1978 Code or 310 CMR 15.000. A. Facility Information RECEIVED Important: When filling out 1. Facility Name and Address: AUG 2 8 2017 forms on the computer,use TOWN OF NORTH ANDOVER only the tab key to move your Name H cursor-do not 140 Bradford Street use the return Street Address key. North Andover MA 01845 City/Town State Zip Code 2. Owner Name and Address (if different from above): Domenic Guglielmi 140 Bradford Street Name Street Address North Andover MA City/Town State 01845 Zip Code Telephone Number 3. Type of Facility (check all that apply): Residential Institutional Commercial School 4. Describe Facility: Single Family Dweeling 5. Type of Existing System: t5form9a.doc•rev.7/06 Application for Local Upgrade Approval• Page 1 of 5 A jA 1/ t Privy Cesspool(s) Conventional Other (describe below): Conventional 6. Type of soil absorption system (trenches, chambers, leach field, pits, etc): leach field A. Facility Information (continued) 7. Design Flow per 310 CMR 15.203: Design flow of existing system: 330 gpd Design flow of proposed upgraded 330 system gpd 330 Design flow of facility: gpd B. Proposed Upgrade of System 1. Proposed upgrade is (check one): Voluntary Required by order, letter, etc. (attach copy) Required following inspection pursuant to 310 CMR 15.301: date of inspection 2. Describe the proposed upgrade to the system: Entire system upgrade 3. Local Upgrade Approval is requested for (check all that apply): Reduction in setback(s) — describe reductions: Redurtion in sethark of huilding sewer to wat r s ryes from 10'to 6-9'. redurtion of sethark from septiG tank to 2 MWOr service frim 10'to 4 Z - Reduction in SAS area of up to 25%: SAS size,sq.ft. %reduction Reduction in separation between the SAS and high groundwater: Separation reduction ft. t5form9a.doc-rev.7/06 Application for Local upgrade Approval• Page 2 of 5 r^ l a.( Percolation rate min./inch Depth to groundwater ft. B. Proposed Upgrade of System (continued) Relocation of water supply well (explain): Reduction of 12-inch separation between inlet and outlet tees and high groundwater Use of only one deep hole in proposed disposal area Use of a sieve analysis as a substitute for a perc test Other requirements of 310 CMR 15.000 that cannot be met- describe and specify sections of the Code: If the proposed upgrade involves a reduction in the required separation between the bottom of the soil absorption system and the high groundwater elevation, an Approved Soil Evaluator must determine the high groundwater elevation pursuant to 310 CMR 15.405(1)(h)(1). The soil evaluator must be a member or agent of the local approving authority. High groundwater evaluation determined by: Evaluator's Name(type or print) Signature Date of evaluation C. Explanation Explain why full compliance, as defined in 310 CMR 15.404(1), is not feasible. (Each section must be completed) 1. An upgraded system in full compliance with 310 CMR 15.000 is not feasible: LcC�t N Q F Hr ��aS �vG� yx 1 v 'r=tit= P, 75 L F 55 *1 H,+n/ t5form9a.doc•rev.7/06 'J �/ '7LG (�v G[.s-✓Ci V�—�/��� GL WpApplication for Local Upgrade Approval* Page 3 of 5 /i�r4 ^)F�TZC nA mrr L �h LrSs 7NAN lei FRO&\ -1H9k-IATE(L Ly,✓�;. Scz� 'tES7 r✓G y,rAs L)crrC, 11cRg:, tK 51 zC1 �,�Vt>VF-(� U(�' —[p 11-16 M,-75` -tet, - SAS, cwt *,( C Afe Tk=- -r p jTj S a. 'tHz4 j'!Rck9C11 S,AS. r 2. An alternative system approved pursuant to 310 CMR 15.283 to 15.288 is not feasible: C. Explanation (continued) 3. A shared system is not feasible: 4. Connection to a public sewer is not feasible: 5. The Application for Local Upgrade Approval must be accompanied by all of the following (check the appropriate boxes): J Application for Disposal System Construction Permit JComplete plans and specifications Site evaluation forms A list of abutters affected by reduced setbacks to private water supply wells or property lines. Provide proof that affected abutters have been notified pursuant to 310 CMR 15.405(2). Other (List): D. Certification "I, the facility owner, certify under penalty of law that this document and all attachments, to the best of my knowledge and belief, are true, accurate, and complete. I am aware that there may be significant consequences for submitting false information, including, but not limited to, penaltie r fin mprisonment for deliberate violations." ID Facility Owner's Signature Date Domenic Guglielmi Print Name James Melvin, P.E. Name of Preparer Date Date 160 Summer Street Haverhill Preparer's address City/Town t5form9a.doc-rev.7/06 Application for Local Upgrade Approval* Page 4 of 5 a MA 978 373 0310 State/ZIP Code Telephone i t5form9a.doc•rev.7/06 Application for Local Upgrade Approval• Page 5 of 5 I North Andover Health Department Community and Economic Development Division August 21, 2017 UQ G Philip Christiansen,P.E. Christiansen and Sergi, Inc. 160 Summer Street Haverhill, MA 01830 Re: 140 Bradford Street(Map 61,Lot 4) Dear Mr. Christiansen, The proposed wastewater system design plan for the above site dated August 1, 2017 and received on August 7, 2017 has been reviewed. Unfortunately, the plan cannot be approved until the following items are corrected. The specific section in Title 5: 310 CMR 15.000, or North Andover regulation that is not met by this design follows each item where applicable. 1. The design plan is missing a north arrow(310 CMR 15.220(4)). 2. A swale is required for finish grading within 5' of the property line(310 CMR 15.255(2)). 3. Local Upgrade Approval (LUA)requests are required for the following: a. Building sewer line less than 10' to the water line (310 15.405(1)(g)) b. Septic tank less than 10' to the water line (3 10 15.405(1)(g)) c. Only one deep observation test hole in the disposal area (310 15.405(1)(k)) Please submit the required Form 9A and depicted the LUAs on the design plan. 4. Specify the required annual maintenance for the effluent filter(3 10 CMR 15.227(7). 5. Indicate the flowback volume of the force main pipe (3 10 CMR 231(2)). 6. The pump performance curve was not depicted on the design plan(3 10 CMR 15.220(4)(r)). 7. Indicate the proposed locations of the inspection ports. 8. In order to assist the installer, please indicate the top and bottom elevation of the impervious barrier. i Page 1 of 2 North Andover Health Department, Town Hall, 120 Main Street, North Andover, MA 01845 Phone: 978.688.9540 Fax: 978.688. 9542 9. The elevation of the design ESHWT was not indicated on the design plan. 10. Since the Infiltrator Chamber system is proposed as an alternative soil absorption system the Standard Conditions for Alternative Soil Absorption Systems with General Use � Y Certification and/or Approved for Remedial Use"will apply. Please provide the following as required by the approval conditions Section II(18): c) certification by the Designer that the design conforms to the Approval, any Company Design Guidance, and 310 CMR 15.000; and d) a certification, signed by the Owner of record for the property to be served by the Technology, stating that the property Owner: 1. has been provided a copy of the Title 51/A technology Approval, the Owner's Manual, and the Operation and Maintenance Manual, «� and the Owner agrees to comply with all terms and conditions; iii if the design does not provide for the use of garbage grinders, the F , ,restriction is understood and accepted; and iv whether or not covered by a warranty, the System Owner understands the requirement to repair, replace, mods or take any _ other action as required by the Department or the LAA, if the Department or the LAA determines the System to be failing to protect public health and safety and the environment, as defined in 310 CMR 15.303. Please feel free to contact the office or Mill River Consulting at 978-282-0014 with any questions you may have. We look forward to working with you to obtain a wastewater treatment and dispersal system which will be in compliance with all regulations and assure protection of public health and the environment of North Andover. Sincer , Tian J. LaGrasse, CEHT Director of Public Health cc: Domenic Guglielmi File Page 2 of 2 North Andover Health Department,Town Hall, 120 Main Street, i North Andover,MA 01845 Phone: 978.688.9540 Fax: 978.688. 9542 R TOWN OF NORTH ANDOVER Community & Economic Development HEALTH DEPARTMENT , 120 Main Strcet NORTH ANDOVER,MASSACHUSETTS 01845 978.688.9540—Phone 978.688.9542—FAX E-MAIL:healtlidept@noi'thandoveiina.gov _ WEBSITE:http://Nvmv.northandovenna.gov SEPTIC PLAN SUBMITTAL FORM Date of Submission: RECEIVED E® AUG 97 2417 Site Location: 140 Bradford Street VER �,jFl DEPHRTMENT Engineer:Christiansen and Sergi, Inc. New Plans? Yes X $275/Plan Check# (includes 1"submission and one re- review only) Revised Plans?Yes $125/Plan Check# Site Evaluation Forms Included? Yes X No i Local Upgrade Form Included? Yes No X Telephone#:978 373 0310 Fax#: E-mail:TJ@Csi-engr.com Homeowner Name: Domenic Guglielmi OFFICE USE ONLY When the s ission is complete(including check): ➢ Date stamp plans and letter r Complete and attach Receipt Copy File;Forward to Consultant 9/-7/,0/7 Enter on Log Sheet and Database i i NORTf� 7972 Town of North Andover HEALTH DEPARTMENT S�1CMU5! CHECK#: DAT LOCATION: H/O NAME: h 16vI s CONTRACTOR NAME E �(,,ri 5 4( 1 Type of Permit or License: (Check box) ❑ Animal $ ❑ Body Art Establishment $ ❑ Body Art Practitioner $ ❑ Dumpster $ ❑ Food Service-Type: $ ❑ Funeral Directors $ ❑ Massage Establishment $ ❑ Massage Practice $ a ❑ Offal(Septic)Hauler $ ❑ Recreational Camp $ ❑ Sun tanning $ ❑ Swimming Pool $ ❑ Tobacco $ ❑ Trash/Solid Waste Hauler $ ❑ Well Construction $ SEPTIC Systems: ❑ Septic-Soil Testing $ ❑ Septic-Design Approval $ d ❑ Septic Disposal Works Construction(DWC) $ ❑ Septic Disposal Works Installers(DWI) $ ❑ Title 5Inspector $ ❑ Title 5 Report $ ❑ Other:(Indicate) qeav Initials White-Applicant Yellow-Health Pink-Treasurer CHRISTIANSEN & SERGI, INC. CS111 PROFESSIONAL ENGINEERS AND LAND SURVEYORS 160 SUMMER STREET,HAVERHILL,MA 01830 tel:978-373-0310 www.csi-engr.com fax 978-372-3960 August 24, 2017 Mr. Brian LaGrasse �� SNA Director of Public Health 0 , North Andover Health Dept. �Q � 1600 Osgood Street, Suite 20350�,�,0� North Andover, MA 01845 Re: Septic System Design Plan for 140 Bradford Street (Map 061.0 Parcel 004) Dear Mr. LaGrasse: We have received your August 21, 2017 comments on the above referenced plan, and we offer the following response. 1. A north arrow has been added to the design plan sheet 1 of 2. 2. A Swale has been proposed between the break out grading and the property line to the g 9 P p Y maximum extent possible. This system is a repair and space is very limited to locate the leaching field. The existing topography along the eastern property line shows a ridge directing runoff towards the abutting property. With limited room to grade, it is no possible to fully Swale the runoff from the system to remain on site due to the existing topography. 3. The recommended Local Upgrade Approvals have been requested. 4. Note 4 under the Septic Tank Detail addresses the required annual cleaning and inspection of the effluent filter. i j 5. In 40 years of designing septic systems. showing the drain back volume has never once been required on the plans. It is understood that it should be taken into account when determining emergency storage in the pump chamber, however is unnecessary when 250% of the daily flow is provided for in the available storage. It has been included on the plans. 6. The pump performance curve has been shown on sheet 2 of 2. 7. An inspection port has been added to the plan. 8. The top and bottom elevations of the impervious barrier have been added to the Profile View. 9. The design ESHWT has been added to the Profile View. 10. The designer certification has been added to the plan. The signed owners certification has been provided. I trust that these responses fully address all of your comments. Please contact me if you have any questions. Very truly yours, Christiansen &Sergi, Inc. Philip G. Christiansen i i 0 Page 2 CHRISTIANSEN & SERGI, INC. PROFESSIONAL ENGINEERS AND LAND SURVEYORS . 160 SUMMER STREET,HAVERHILL,MA 01830 tel:978-373-0310 www.csi-engr.com fax 978-372-3960 August 24, 2017 Mr. Brian LaGrasse RECEDE® Director of Public Health North Andover Health Dept. 2 8 2017 1600 Osgood Street, Suite 2035 j0VM0FNO North Andover, MA 01845 HEALTH DEQ ENT Re: Septic System Design Plan for 140 Bradford Street (Map 061.0 Parcel 004) Dear Mr. LaGrasse: We have received your August 21, 2017 comments on the above referenced plan, and we offer the following response. 1. A north arrow has been added to the design plan sheet 1 of 2. 2. A Swale has been proposed between the break out grading and the property line to the maximum extent possible. This system is a repair and space is very limited to locate the leaching field. The existing topography along the eastern property line shows a ridge directing runoff towards the abutting property. With limited room to grade, it is no possible to fully Swale the runoff from the system to remain on site due to the existing topography. 3. The recommended Local Upgrade Approvals have been requested. 4. Note 4 under the Septic Tank Detail addresses the required annual cleaning and inspection of the effluent filter. 5. In 40 years of designing septic systems.showing the drain back volume has never once been required on the plans. It is understood that it should be taken into account when determining emergency storage in the pump chamber, however is unnecessary when 250% of the daily flow is provided for in the available storage. It has been included on the plans. 6. The pump performance curve has been shown on sheet 2 of 2. 7. An inspection port has been added to the plan. 8. The top and bottom elevations of the impervious barrier have been added to the Profile View. 9. The design ESHWT has been added to the Profile View. 10. The designer certification has been added to the plan. The signed owners certification has been provided. I trust that these responses fully address all of your comments. Please contact me if you have any questions. Very truly yours, Christiansen &Sergi, Inc. Philip G. Christiansen • Page 2 I Owner's Certification for 140 Bradford Street, North Andover I, Domenic Guglielmi the Owner of record of 140 Bradford Street, hereby certify to the following: 1 . 1 have been provided a copy of the Title 5 Innovative Alternative Technology Approval, the Owner's Manual, and the Operation and Maintenance Manual for the Infiltrator Chambers, and I agree to comply with all terms and conditions 2. The design does not provide for the use of garbage grinders. This restriction is understood and accepted; 3. Whether or not covered by a warranty, I understand the requirement to repair, replace, modify or take any other action as required by the Department or the Local Approving Authority (LAA), if the Department or the LAA determines the System to be failing to protect public health and s a d the environment, as defined in 310 CMR 15.303. Domenic uglielmi August 24, 201 RECEIVED AUG 2 8 2011 TOWN H DEPAR EN r� Commonwealth of Massachusetts Executive Office of Energy &Environmental Affairs Department of Environmental Protection One Winter Street Boston, MA 02108.617-292-5500 Charles D.Baker Matthew A.Beaton Governor Secretary Karyn E.Polito Martin Suuberg Lieutenant Governor Commissioner APPROVAL FOR GENERAL USE Pursuant to Title 5, 310 CMR 15.000 Name and Address of Applicant: Infiltrator Water Technologies,LLC. P.O. Box 768 6 Business Park Road Old Saybrook,CT 06475 Trade name of technology and model: High Capacity chamber, High Capacity H-20 chamber', Quick4 High Capacity chamber, Quick4 High Capacity HD chamber, Quick4 Plus High Capacity chamber (8- inch invert), Quick4 Plus High Capacity chamber (13-inch invert), Standard chamber, Quick4 Standard chamber, Quick4 Standard HD chamber, Quick4 Plus Standard chamber (5.3-inch invert), Quick4 Plus Standard chamber (8.0-inch invert), Quick4 Plus Standard LP (Low Profile) chamber (3.3-inch invert), Quick4 Plus Standard LP (Low Profile) chamber (8-inch invert), Infiltrator 3050 (Storm Tech SC-740) chamber, Equalizer 24 chamber, Quick4 Equalizer 24 chamber, Equalizer 36 chamber, Quick4 Equalizer 36 chamber, Quick4 Equalizer 24 LP (Low Profile) chamber(6 inch invert), and Quick4 Equalizer 24 LP (Low Profile) chamber(2 inch invert) (hereinafter the"System"). Schematic drawings of the System and a design and installation manual are a part of this Certification. This approval allows the installation of the above identified chambers without aggregate. Transmittal Number: X259183 Date of Revision: February 19,2015,modified June 12,2015 Authority for Issuance Pursuant to Title 5 of the State Environmental Code, 310 CMR 15.000, the Department of Environmental Protection hereby issues this Certification to: Infiltrator Water Technologies, LLC., P.O. Box 768, 6 Business Park Road, Old Saybrook, CT 06475 (hereinafter "the Company"), for General Use of the System described herein. The sale, design, installation, and use of the System are conditioned on compliance by the Company, the Designer, the Installer and the System Owner with the terms and conditions set forth below. Any noncompliance with the terms or conditions of this Approval constitutes a violation of 310 CMR 15.000. OJ44--", June 12,2015 David Ferris,Director Date Wastewater Management Program Bureau of Water Resources This information is available in alternate format.Call Michelle Waters-Ekanem,Diversity Director,at 617-292-5751.TTY#MassRelay Service 1-800-439-2370 MassDEP Website:www.mass.gov/dep Printed on Recycled Paper p J Infiltrator Chamber;Infiltrator Water Technologies. Page 2 of 6 Approval for General Use—June 12,2015 I. Design Standards 1. The models listed in Table 1 are covered under this Certification. Table 1: Chamber Dimensions Dimensions Invert Model W x L x H Height Inches Inches Equalizer 24 15 x 100x 11 6 Quick4 Equalizer 24 16 x 48 x 11 6 Quick4 Equalizer 24 LP (6-inch invert) 16 x 48 x 8 6z Quick4 Equalizer 24 LP (2-inch invert) 16 x 48 x 8 2 Equalizer 36 22 x 100 x 13.5 6 Quick4 Equalizer 36 22 x 48 x 12 6 Standard Chamber 34 x 75 x 12 6.5 Quick4 Standard 34 x 48 x 12 8 Quick4 Standard HD 34 x 48 x 12 8 Quick4 Plus Standard(5.3-inch invert) 34 x 48 x 12 5.3 Quick4 Plus Standard(8-inch invert) 34 x 48 x 12 8 Quick4 Plus Standard LP (3.3-inch invert) 34 x 48 x 8 3.3 Quick4 Plus Standard LP (8-inch invert) 34 x 48 x 8 83 Infiltrator 3050 or StormTech SC-740 51 x 85.4 x 30 22.254 High Capacity Chamber 34 x 75 x 16 11 High Capacity H-20'Chamber 34 x 75 x 16 11 Quick4 High Capacity 34 x 48 x 16 11.5 Quick4 High Capacity HD 34 x 48 x 16 11.5 Quick4 Plus High Capacity(8-inch invert) 34 x 48 x 14 8 22ick4 Plus High Capacity(13-inch invert) 34 x 48 x 14 135 i 1 This approval allows the use of the high capacity H-20 chambers but makes no determination as to the chambers meeting the H-20 loading requirements. ' Includes Infiltrator MultiportTM invert adapter attached to the side of the end cap. 3 Includes Quick4 Plus Periscope adapter attached to the top of the Quick4 Plus All-in-One 8 Endcap. 4 Only systems installed with this invert height shall be allowed to use the effective leaching area associated with this model in Table 2. 5 Includes Quick4 Plus Periscope adapter attached to the top of the Quick4 Plus All-in-One 12 Endcap. 2. The System is an open-bottom leaching unit molded from polyolefin resin. It can be installed without aggregate or distribution pipe as an absorption trench or as a bed or field. If the System is installed with stone aggregate then the "Effective Leaching Area" in Tables 2 and 3 is not applicable, and must be designed in accordance with the provisions of 310 CMR 15.000. i Infiltrator Chamber,Infiltrator Water Technologies. Page 3 of 6 Approval for General Use-June 12,2015 3. The total effective leaching area for any Chamber Model shall be calculated by multiplying the Effective Leaching Area per square foot of chamber times the total length of chamber from end cap to end cap including end caps. 4. For new construction or upgrades, the applicant can size the System in a trench configuration,using the effective leaching areas presented in Table 2. Table 2: Effective Leaching Area in Trench Configuration for New Construction and Remedial Sites' Effective Effective Model Leaching? Leaching Area Area SF/LF SF/LF Equalizer 24 3.76 N/A Quick4 Equalizer 24 3.90 N/A Quick4 Equalizer 24 LP 6-inch invert) 3.90 N/A Quick4 Equalizer 24 LP (2-inch invert) 2.78 N/A Equalizer 36 4.73 N/A Quick4 Equalizer 36 4.73 N/A Standard Chamber 6.53 N/A Quick4 Standard 6.96 N/A Quick4 Standard HD 6.96 N/A Quick4 Plus Standard(5.3-inch invert) 6.20 N/A Quick4 Plus Standard(8-inch invert) 6.96 N/A Quick4 Plus Standard LP (3.3-inch invert) 5.65 N/A Quick4 Plus Standard LP (8-inch invert) 6.96 N/A Infiltrator 3050 or StormTech SC-740 N/A 6.71 High Capacity Chamber 7.79 N/A High Capacity H-20' Chamber' 7.79 N/A Quick4 High Capacity 7.93 N/A Quick4 High Capacity HD 7.93 N/A Quick4 Plus High Capacity 8-inch invert) 6.96 N/A Quick4 Plus High Capacity(13-inch invert) 7.93 N/A 6 Effective April 21,2006,310 CMR 15.25l(1)(b)maximum trench width is 3 feet. '.Effective leaching area is equal to 1.67(bottom width+(2x invert height))for Systems 3 feet or less in width. 8. Effective leachingare i + a s equal to 1.0 (3 (2x invert Height)) for Systems with a width greater than 3 feet. 9.The maximum trench width allowed to calculate effective leaching area is 3 feet. � g 5. Systems installed on remedial sites shall be allowed to utilize the effective leaching areas presented in Tables 2 or 3, or additional reductions in soil absorption system may be allowed. In no instance shall the reduction in the soil absorption system required in 310 CMR 15.242 exceed the maximum reduction allowed for alternative systems approved in accordance with 310 CMR 15.284. Infiltrator Chamber,Infiltrator Water Technologies. Page 4 of 6 Approval for General Use—June 12,2015 6. For new construction or an upgrade,the applicant can size the System in bed or field configuration,using the effective leaching areas presented in Table 3. Table 3: Effective Leaching Area for Bed or Field Configuration New Construction and Remedial Sites Effective Model Leaching10 Area SF/LF Equalizer 24 2.09 Quick4 Equalizer 24 2.23 Quick4 Equalizer 24 LP (6-inch invert) 2.23 Quick4 Equalizer 24 LP (2-inch invert) 2.23 Equalizer 36 3.06 Quick4 Equalizer 36 3.06 Standard Chamber 4.73 Quick4 Standard 4.73 Quick4 Standard HD 4.73 Quick4 Plus Standard(5.3-inch invert) 4.73 Quick4 Plus Standard(8-inch invert) 4.73 Quick4 Plus Standard LP (3.3-inch invert) 4.73 Quick4 Plus Standard LP (8-inch invert) 4.73 Infiltrator 3050 or StormTech SC-740 7.10 High Capacity Chamber 4.73 High Capacity H-20' Chamber 4.73 Quick4 High Capacity 4.73 Quick4 High Capacity HD 4.73 Quick4 Plus High Capacity(8-inch invert) 4.73 Quick4 Plus High Capacity(13-inch invert) 4.73 10. Effective Leaching area is equal to 1.67 times bottom width only. 7. When the System is used with a secondary treatment unit approved in accordance with 310 CMR 15.284 or 15.288, additional reductions in soil absorption system may be allowed. In these situations the reduction in the SAS cannot exceed the maximum allowed under the secondary treatment units approval. In no instance shall the reduction in the soil absorption system area required in 310 CMR 15.242 exceed the maximum reduction allowed for alternative systems approved in accordance with 310 CMR 15.284. II. Special Conditions 1. The System is an approved Alternative Chamber for use as an Alternative Soil Absorption System. In addition to the Special Conditions contained in this Approval, the System shall comply with the "Standard Conditions forAlternative SAS with General Use Certification and/or Approved for Remedial Use" (the f Infiltrator Chamber,Infiltrator Water Technologies. Page 5 of 6 Approval for General Use—June 12,2015 'Standard Conditions'), except where stated otherwise in these Special Conditions. 2. New Construction This Certification is for the installation of a System to serve new construction or an existing facility with a proposed increase in flow, for which a site evaluation in compliance with 310 CMR 15.000 has been approved by the Approving Authority and the site meets the siting requirements for new construction, as provided in Paragraph 6 in section II Design and Installation Requirements of the Standard Conditions. 3. Remedial Site This General Use Certification also applies to the installation of a System for the upgrade or replacement of an existing failed or nonconforming system,provided that the facility meets the siting requirements for upgrades, as provided in Paragraph 7 in section II Design and Installation Requirements of the Standard Conditions 4. The System shall be exempt from the minimum inlet spacing requirements of 310 CMR15.253. 5. The System shall have a minimum of one inspection port through the top of one of the chambers. The inspection port shall be capped with a screw type cap and accessible to within three inches of finish grade. 6. When the System is installed in trench configuration, then the system shall comply with these requirements: a) Length(each trench) 100 feet maximum(3 10 CMR 15.251(1)(a)); b) Width(each trench) 2 feet minimum to 3 feet maximum(3 10 CMR 15.251(1)(b)). -Chambers greater than 3 feet wide, when specifically approved, are subject to other Special Conditions and limitations; c) The minimum separation distance between any two trenches shall be two times the effective width or depth of each trench,whichever is greater, or where the area between trenches is designated as reserve area, three times the effective width or depth of each trench, whichever is greater(3 10 CMR 15.251(1)(d)); d) The effective leaching area shall be calculated using the bottom area and a maximum of two feet(per side) of side wall area for each trench(3 10 CMR 15.251(l)(e)); i e) Trenches shall be situated,where possible,with their long dimension perpendicular to the slope of the natural soil. Where possible they shall follow the contour lines (3 10 CMR 15.251(2)); f) Trenches constructed at different elevations shall be designed to prevent effluent from the higher trench es flowing into the lower trench es 310 CMR 15.251(3)); g) The area between trenches may be designated as system reserve area only where the separation distance between the excavation sidewalls of therimar p Y trenches is at least three times the effective width or depth of each trench, whichever is greater(310 CMR 15.251(4)) - Chambers greater than 3 feet I Infiltrator Chamber,Infiltrator Water Technologies. Page 6 of 6 Approval for General Use—June 12,2015 wide, when specifically approved, shall be separated by three times the actual width and are subject to other Special Conditions and limitations; and h) Effluent distribution lines exceeding 50 feet in length shall be connected and venting provided in accordance with 310 CMR 15.241 (3 10 CMR 15.251(11)). 7. When installed in trench configuration, approved Alternative Chambers greater than 3 feet wide: a) shall be installed with a minimum separation distance between any two trenches of two times the actual width of the chamber, or where the area between trenches is designated as reserve area, three times the actual width of the chamber; and b) shall only be entitled to a maximum effective width of 3 feet for the purposes of calculating total effective leaching area. 8. When installed in a bed or field configuration, the System may be installed without distribution piping, but must comply with the following requirements in 310 CMR 15.252: a) the use of leaching beds or fields is restricted to systems with a calculated design flow of less than 5,000 gpd per leaching bed or field(3 10 CMR 15.252(1)); b) the maximum length of chambers in series shall be 100 feet (3 10 CMR 15.252(2)(b)); c) separation distance between adjacent beds/fields shall be ten feet(3 10 CMR 15.252(2)(0); and d) the effective leaching area shall include only the bottom area, not the sidewalls (3 10 CMR 15.252(2)(1)). 9. For Systems constructed in fill and installed, the System shall be installed as specified in 310 CMR 15.255 Construction in Fill, except the minimum 15 foot horizontal separation distance to be provided between the soil absorption area and the adjacent side slope shall be measured horizontally from the top of the chamber. 10. The System is exempt from 310 CMR 15.287, specifically items: (5)requiring written notification of alternative system prior to property transfer, (6)need for a certified operator, (9)need for an operation and maintenance contract with an operator and(10) deed notice requirement. i i i � I'I tlF jes t�Cv. 5� � ,�3 1 w� 'F r c �ej iav" &�: i it4, 6 H7 e 4a�a u.. y �_ i?i,nr. rt _ ,,,�t,. �� �;�a`' i '��: �P �\ `rd4r.;. t� v4� .,;cn� s,�iC� ,�+ ;.i{ 'M1•-,.,.,r. . ri; sa u,4:,.i.' =�`n =':l'��'•� � � ' „�,i�' gt3 �,r '�� ..-:A" � 't �,, ; �t yr,txl?;+� $t�t Aj (SIn .,?.. ,�.. �i...t`�•�'r�i.Y... ? �1 :tt F" 'r t yi"��''' �.. �•r�t� ,a- :�.� �: rr�. - "4' }3j EL�y"�a�. { f Tv•rc^ sr z 4' ' i •a.. ��Se c a( "h r1 A�Jj �',. ��,,.- ,. uzx t't!, y t�' t i Y ro�Z. r r- ^':»,...-- ,y �• ��. d�. r �: Z"+7 1 N F I LRAT=C� f 6 t t � .. n A s � �+'�, d ��.�rl s n a� � 1 a• rcR„"". t water t is s v.. ?��a�?i'.• + ���^� ��l 3 �S Yr 6� t ,_�y, `h, �9 fi i � � �• ��Anlm v :, F, � t ��� i°�w p i� �x k � ( 4 y _ �+2. � • Q' d' ir;�' ��"���� � � U, '�'hyt+�,. att�t�s �N�d '4 •;:t`g,� nl. a.,t T�y� ���'� � y }r C4i� tZn '� `' a,rt+' t ,tX..h+ a .fti'• Wy ..x 1 g,t .t' .��4(��'� ,� (i{"�Y��'f"'.q��'lt ( j� � l��lxi ,..,�� •:,f � .. c` YNR P 7 "vn'i -.tiA'� ��, -... 4�uy,. rq# �M% "Z� -', ,�:,• � 1. ,��.'�, � `� ... wk"VH'�'A1�1.{t�'p�j� nr �1 ',) ' �4 SWddtt 1 1, 9 r � � x s s g•t ,e t Z. }rc �� i1 � t �r ��,', 4 a+ i" r , r r i �2 + Dear Septic System Owner, What's Inside Clean water is our heritage—it's also our responsibility.As the population t grows and more land is developed, we must all find new ways to safeguard Page 3 our environment for future generations. 7 The Residential Septic System: I 'r" Your Onsite Wastewater y At Infiltrator, we're doing our part by using science to design better ` Treatment Plant performing septic systems. We manufacture reliable products from primarily recycled materials. Our reduced footprint minimizes disruption " Page 7 of the environment.All of this provides septic system owners with The Infiltrator Product System: products they can trust for superior performance, ease of maintenance, Today's Modern Solution and long-term value. What started nearly 30 ago as an idea for a better leachfield, is now Page 10 years g Care and Maintenance a worldwide company with a broad range of products in service in North ` of Your Infiltrator System America and around the world. Today, 50% of the systems installed in North America uses an Infiltrator product. This Septic System Owner's Manual explains how septic systems work, describes the benefits of the J :. Infiltrator system, and provides valuable tips for proper system maintenance. This is part of our commitment to making sure that clean water is CONGRATULATIONS ... everyone's business. Your leachfield system is constructed with Infiltrator products. r Infiltrator products, manufactured of recycled materials, interlock w• together to form a continuous drainage area. These state-of-the-art Roy Moore, Presider#&CEO systems offer many advantages over old-fashioned stone and pipek ' ter;l'echnolo ies r systems.They treat more effluent, more efficiently, in a smaller area 9 � :��, rr•-tE=, � III � _ ',���xpy. j4�;� � f` .. •�s v�-',1 r Y+ ''tib. A it �,;:.h' TM� ty� • .,, r i'_r -x,1 .. ''�`d� a t �:, E}j } t Y% h��i 7"• S F t t f� iT4�Y yy�il�# ".- ^Fii;.. `. 9 gq ! �. �' �- �, �F f A RESIDENTIAL SEPTIC SYSTEM: Your onsite wastewater treatment plant What is a Septic System? Plurfibing tYeht y A septic system is an onsite wastewater treatment system that processes and purifies household waste (effluent). The effluent consists of blackwater (toilet wastes) and graywater (kitchen sink, bathtub and laundry wastes). 7 ■ � J • A septic system has two components: a septic tank and a leachfield or drainfield. Primary treatment occurs in the septic tank, where bacteria digest organic materials in the ' ' ' ' • ' ' ' wastewater. The effluent then flows into the leachfield for secondary treatment. Here bacteria complete the digestion and purification process G f Ott A standard septic system has two components aseptic} dr,, 1 W as the wastewater slowly leaches or infiltrates into the soil. ;} `g , t �r-his �,.. �'t}, qM`' 'l�� rr r. a�'<•�. '�F��t$"'Gv's^v r ty,.,. 'M hoe i. .i SYSTEM COMPONENTS: THE SEPTIC TANK The septic tank is a watertight underground box, about eight feet Found in all three of these layers are billions of bacteria that live long, four feet wide, and five feet deep. It typically has at least a naturally in the tank and perform the first phase of treatment to 1,000-gallon capacity for retaining, storing, and treating solids, in break down solid matter. The bacteria digests the solid materials. addition to releasing effluent into the leachfield, sometimes called In the process, gases are produced, which are vented from the a drainfield. septic tank through the plumbing vent on your rooftop. As wastewater flows into the tank, heavy solids settle to the bottom into a sludge layer, while grease and fats float to the top farming a layer of scum. Between these two layers is a clear zone of liquid called the clarified zone. Access port Scum layer Baffle Access port Inlet pipe ,Ja —� -E—Outlet { k Clanfied.zone , �= 7��� Z n � t,�� 1 G�� L (�J✓-: 4� 31 S �,: � ��f i � 4 �y�t I. V y i�. ���R f �Yht 1 }F 1 ,.,.:?.. �,,Y �i�..;a1+'S a�,t '�rJ7�.ti. ;gar, ,.,.:5'rr,.1 ,,,.,,a�'S rf���`��a;L4i' ..,... . .. ,. _. ...,. � 4. ,�',•. i,r.,, « 1 .,r �',:, U c-..., 1..r,r� u.a, .....,. .. .,.�r.�n.f.Y.a✓ �+....,o-. r i ,,..ry,.. � ..m .. 6v..s:. ,. _ "?I y� �,���� �{'`h�,'`r, 'f�-,A P�, rv-.�tt .z��+rr: l�e7`t tt 1. .y2 '. 1 � 'l f !,. �k r,, , .. ,�.� � ,<� u��w, ,,4�.., 5 dx .C.•,..1.,,�, a., t � t a,M. �r;,15'{�S �,� lv,.e, ✓ 1,c�.. r �1- �4._ 5 'b �. �1'-� ';.�� a �m n �e r,. ;�adl r• �at �h G .f �}, N ;�- ��� � .L- na ifs�v�m i � '; �a4"{r C T'> e M ,f ti � a � .. 4 v.. 2 ,..... �.., F i...a.�, . �., ,.., r - �J d,. ,.�, 1: , �:. � 1¢ ,t .1 .a -a. ,_ a, �✓�.. ',4 11�� n A?rti � .. ;t. ��..rti ti.. k'� .. .. _,,..-�_._.�<. _��_],,,...ats.,.,.,,M1 9 ., h, �,� �5 ,� �� .� �.,b M �,oS�s,,"5�5a CJ�i. ��,. �"ur,,. � Pub 5. �,�.�. il� a 6.� ..,.,��,.� &ib..,.�,�-�`,fl,��!s�e�,nxra,raSaw•a�.br`, 110 SYSTEM COMPONENTS: THE LEACHRELD - url ` 1 G rl�l l III wlii,^I YGr��� From t hea ti partially s p c tank, p rt ally treated effluent flows into a leachfield, which typically has two or more trenches. This is where effluent is naturally purified as it percolates down through the soil. . • For proper effluent purification, the distance between the trench bottom and the water table should be equal to or greater than the minimum distance allowed by your local health department. The soil acts as a biological filter, removing harmful substances before the effluent reaches the groundwater. Infiltrator Water Technologies manufactures chamber systems and • . • EZflow Geosynthetic Aggregate systems which are both used in • - leachfield installations. M1 k� ' off'., x `' ��� Effluent flows into the leach�'teld'where�t is natural) ur�frecl as it ercolates . .. -= down th�ough'ttre shit , k. •'fib Sex.�� r 1 �1 Gr 4��'� �l '�t1aa L�, 1 a 1 q. � t�r , G �, q�: _ .. ,. <� tit , �._.� Y�' •. .. :_ ,...:::.. ...., ....__ ... ,_:. ...;. .:,...., ...: �'.. ..:u. 1.7 :.. _e. .�, •:-:.. Fay' a� a r... � +. i .a,.'., � �. ... .. '., `�.: ;,.� �„ �. .. .,. ..�. ,..,.,. i .,.K ,.,,.. a',. ..� !.•v. ._2-.,,..... din. .� ., ,.,r <. �„ � Soil intrudes into 'unprotected surfaces - • • -• • &?' x 4iipe does_not provide' • • • • • 4 w - -�„,even distribution , • • • •. • • • •- • L y, Geotextile is required to s, • •• -. • • • . • • • • • • stop soil intrusion M. '. � 'yds�, ,4 , • •. -• • • u M 11 f z'A„ � �qd.€'�”" �h .! i f,"° •' • • •• q'�� W r r�i N,+�r', '3yW i 9� 1,�11PPM r � Solids between stones limit infiltration 'A' i I TODAY'S MODERN SOLUTION: INFILTRATOR CHAMBER SYSTEMS. Infiltrator Chamber Systems EZflow Systems Infiltrator chambers are hollow structures that attach end-to-end. EZflow is an environmentally friendly replacement to traditional They are installed in trenches or beds without gravel (except stone in septic drainfields using an engineered geosynthetic where local codes require the use of gravel). The entire bottom of aggregate modular design. The EZflow system is designed to the trench is open for unobstructed infiltration of water. The large improve infiltrative performance by eliminating the fines and storage volume within the hollow chambers accommodates peak reducing compaction and embedment associated with crushed flows of effluent from the home. Infiltrator chambers also feature stone. patented sidewall louvers that allow lateral leaching of effluent into the soil. loInfiltrator chamber jo- EZflow geosynthetic systems' design systems replace stone eliminates the need in a traditional system for stone. The reducing compaction entire trench and fines. bottom is open for unobstructed infiltration. t. Septic System Owner's Manual 7 1� e 1 ADVANTAGES OF INFILTRATOR PRODUCTS Ar OVER STONE AND PIPE F t Infiltrator products are today's superior alternative to .P p old-fashioned stone and i e because they: pa � — Provide long-term savings due to longer life and greater 4 ' operating efficiency ' a' " — Offer worry-free, long-term service with only simple, F yyppS 1 ; routine maintenance AoYF wbp y Protect landscape from damage caused by heavy equipment Provide greater treatment area to handle more wastewater with higher efficiency Offer a greener approach utilizing recycled plastic resins W pow. to manufacture the products E , — Are backed by a minimum 1-year warranty and a reputable, 4 service oriented company — Can be installed in tight, sloped and curved areas creating less site disruption 1�,. Infiltrator systems are designed to safeguard our environment for future generations. ° yy .xtT53kY 3 ,.- ftF,� y t 4 1.� x +-+R i� ��y'f1 �d .,, 'i M'� w �yv`1, �f}y 1 i'�'V t �'�R•HS d�R..,rj ��P� ����F ' x lei '�rY� �,. o ' ���} y«�f". ti �� L ,,��°'}•�Le'��`,,n'w ���-'�'�UY�� � 'J�Sa c•.� '�. t,I � + fiv p F a r{ .1 "—,.i� { jyx��"'� ��• �+ �",{L� �'�1>�.�ory • • • •• ?'A'wp ed w v" ,a e3krx >, y, x t i i .e, a, `yyw. �wa • •' • • • f "��" ,� ,w �,4,�'t s'�1�"��'`E�s"�. �,.. s rt � '�a than ' • I ` ' n $ a �R ",...:. ;.) .,„ } N �njt�. >,y+k.°"•,�x 14;,J°��"„ymp1�r#i • • ••• • I• • •• • • • �' " z _ - n t, a.,• a,t 4,� y-a.'� J+`&k4-�.wa 61sR t� �� 4T a • '� �s r2°. d�aG^�rq '"! s s�y.Q' T ��{y4f{i° "# � acrev,,�,y,. a° �r,a �".• sd' w„ i-n,.; �, _ d, P.'�r� a •7- �'�. G' �r..of rh•y,`°, • as `& B x y fix^ . • • •• • ' f .• ��,� �,� *% „ ,.' �J',�k�# �; t��dal � ��,� #..x,� �' 6. nix a.•.�h d� 'N°� -4w a .1y� . � a �r ♦ ��,`� °sK� .� yd � {��S t �o� tll' �Y 5�,. ��. ���' �� ��a t#}�� h • 1. n 71 4 f � i� yyq �t -,�xR _ '� w� ,�4��� Ax�;,� • � ia�,.r Y'h`- 4�•;��� c} n 8 ��� wnA ��a� i s :� J.£, x '+a krba f'w��' .+" :�c ��� -� '•t'�r,m��+�� � ' � �<y� �� {i5'w" J nW aw _L.7 P� tt� aP"^ '� r r" + «,.'f': y:�,r, ,4°{ '�"' '� t r '� ?y�°�,�?��\^ .,r.e°'".� ���� - w �"• d�*t r '}�� z.. ..„��• �X�iy.4�����' lw.�}y u T lnS4S.'{N, StA"' Moll �S�ah1�'apg`.:. st,. r he YY�k # t � 4� : �"' a.'�w\ "�., r J,�.•', !'n a;.'.._ •:;.i; -,)::... s9 '�•s ryipa�"^5�� r�h S �k V'x{•., , � �'x,A" vi-s +,Yw'k }��+ f." r as �.8x ,#artt a -,a ti r v 5;'k' � , `.. t t.. �'f .:� �. aY'��+�y�,�'`�'�,�e*�'�-i pR � �� ��r i MG' � �' �tt; !�•w CARE AND MAINTENANCE OF YOUR INFILTRATOR SYSTEM A septic system may be out of sight, but it definitely should not be Why the Tank Needs Pumping Periodically out of mind. With proper standard maintenance and by being more aware of your daily living habits, you will greatly improve the life About 95 percent of the sludge and scum that is in your septic .and health of your system. Here are some guidelines to help you tank is broken down by bacteria. The other 5 percent remains in protect your septic system investment. the tank and builds up in the sludge layer. Consequently, your septic tank must be pumped out regularly. Otherwise, solids would eventually fill the tank and wash-out into the leachfield. This is u detrimental to the overall health and longevity of your system. rF. 4�dn r3•nN(bUTLHI 5 '...V".... CAUTION: If solids do overflow from the septic tank into the leachfield, they will prematurely clog the soil pores (openings). Pumping out the septic tank at that point will not restore the system. The most likely solution would be installing a new leachfield in a different area, which can be very expensive and disruptive to your property. ..::........ Have your tank checked by a septic system contractor every two to three years. If you have high water usage or a garbage disposal, the inspections should be more frequent. Use the septic system maintenance record on page 11 to enter and date each inspection Infiltrator Septic Tank and pumping. 10 www.infiftratorwatercom LOCATING THE SEPTIC TANK SEPTIC SYSTEM MAINTENANCE RECORD Use the chart below to record standard system maintenance such It's very important to know where the tank is in order to have it as the dates the tank was pumped. inspected and pumped. Here are three different ways to find your septic tank. DATE PROCEDURE 1. Ask to see the septic system permit for your property at your local health department, town or city hall. It will have a diagram of your system on it. 2. See where the sewer line leaves your house, the tank should be about 10 feet outside the foundation wall. 3. Have your septic contractor probe with a steel rod, taking care to avoid damaging the tank or underground utilities. Septic System Owner's Manual 11 DIAGRAMMING THE LOCATION Once you know where the septic tank is, use the septic system on the layout equal 5 feet x 5 feet or 10 feet x 10 feet. Measure layout below to sketch the location of your house, driveway, septic and record the exact footage from the house to each septic tank tank, and leachfield. Depending on your lot size, let each square access port or cleanout spot. Contractor: Contact Info: Permit Number: Your septic system layout 12 www.infiftratorwatercom THE DAILY INS AND OUTS OF A HEALTHY SEPTIC SYSTEM THE INSIDE STORY V No paints, oils, chemical drain cleaners, thinners, solvents, You can protect the performance and life of your system by poisons, or pesticides. These toxic chemicals not only controlling what goes into and through your septic system. kill helpful bacteria, they may also contaminate the Here's how: groundwater. N Conserve water. Large volumes of water over a short period V No grease or cooking oils. Grease may harden in the septic of time will flush untreated solids out of the septic tank into the tank's scum layer and build up until it blocks the inlet or leachfield. outlet. If you melt grease and pour it down the drain, it may run through the septic tank and then harden, clogging the Practice conservation every day. For example, turn off soil pores in your leachfield. the faucet while brushing your teeth. ✓ V Space out heavy water-using activities such as washing Go easy with your garbage disposal. Using a garbage disposal typically doubles the rate of solids buildup in the clothes and taking showers. septic tank. To avoid frequent pumpouts, compost your J Repair leaky faucets and valves. Consider replacing old garbage or put it in the trash. toilets that use 15 to 5 gallons per flush with f s sjK new 1.6 gallon fixtures. ■ Be cautious with household chemicals. Disinfectants, ,+ ammonia, bathroom cleaners, bleach, etc. can kill the bacteria ;asp , ■ Keep your drains clean. Remember your system needs in order to operate properly. Allow the f that a septic system uses natural system to dilute and neutralize them a little at a time. JSf;1, biological processes, so only V Infiltrator doesn't recommend the use of additives that claim L biodegradable waste should go in it. to boost the bacteria count or extend septic system life. ,y k V No cigarette butts, tissues, Bacteria are already present by the billions, and additives � sanitary napkins, disposable won't affect the need for periodic pumping. diapers, catbox litter, coffee ^I grounds or cotton swabs. Septic System owner's Manual 13 :: THE DAILY INS AND OUTS OF A HEALTHY SEPTIC SYSTEM THE OUTSIDE STORY NOW YOU'RE AN INFORMED Here's how you can control what happens outside your septic INFILTRATOR SEPTIC SYSTEM OPERATOR system. Most problems with septic systems are due to lack of proper care. N Keep surface water away. Divert downspouts, roof drainage, With a little attention, your Infiltrator chamber or EZflow septic driveway runoff, and sump pump discharge away from the system can be a valuable asset to your property. It all comes down leachfield. Landscape your yard to channel rainwater away. to knowing where your system is, protecting it from internal and ® Encourage the right plants. Remove trees such as willows external problems, giving it regular maintenance, and calling a that like "wet feet." Their roots may penetrate and damage the professional septic contractor when you need help. If you follow leachfield. Grow grass or ground cover over the septic system these simple guidelines, it will benefit the environment, as well as to prevent soil erosion. Plant beneficial trees such as pines yourself. Infiltrator chamber and EZflow septic systems are the near the leachfield to absorb.water. premier onsite wastewater systems and, now, you're an informed ® Avoid-physical damage. Don't drive over the system or septic system operator. compact the soil with heavy equipment. Don't dig in the leachfield or build anything over it. Don't cover the tank or leachfield with concrete or blacktop. For more information on septic products, Call Infiltrator Water Technologies: 5 1-800-221-4436 '. w Or visit our website: u www.infiltratorwater.com i 14 www.infifratorwatercom INFILTRATOR'S FAMILY OF PRODUCTS Quick4& Quick4 Plus Chamber Systems Infiltrator chamber systems are a direct replacement for old-fashioned a -VYAC*4, stone and pipe leachfields. Infiltrator chambers give designers engineers . installers and homeowners great flexibility in placement of the septic leachfieId. EZflow 49, EZflow EZflow is an environmentally friendly replacement to traditional stone and pipe drainfields .� MFILTRATOR using an engineered geosynthetic aggregate modular design. The EZflow system is designed to improve infiltration performance by eliminating the fines associated with crushed stone, and reducing compaction and embedment associated with stone. Septic Tanks CI N FI LTRAro R' Infiltrator septic tanks provide a revolutionary improvement in plastic septic s,ptIc tanks tank design, offering exceptional strength comparable to concrete tanks. There's a full range of tank sizes to best suit your needs. Met Risers and Lids EZSet EZset risers and lids are made from glass reinforced polypropylene, ny INFILTRATOR providing superior strength and durability. Ideal for use with any concrete or plastic tank. The slip resistant lids are fastened using stainless steel screws and can be further secured by installing locking rings. Aquaworx IPC Panels,bAQUAworx Aquaworx IPC Panels provide an innovative approach to pump control where a pump ria9m b,INfILiRATORis required. These panels use a floatless pressure transducer technology, monitorsliquid levels, controls pumping time intervals and logs events in real-time. Panels are 9 . rh available in simplex or duplex. Septic System Owner's Manual 15 .:.. ... ,;:- { >,• 4 tial rrs��}5� �,�„�Sy4�� ,I1`r< � � r � t + p r - r - s y ) y J r r' �fizA't �Yi fz�4J�r4��f4ft F1s1�” � , R. C,.{+ r v:,,,t.dth�t 1(• -hvi��.n'� S�6 `..@� ». .Sq. �@.r,�''�J�} dv+1 r.✓,c+ t +��.{ } 4 l uit�Yl'uR 3t�t'v.:rl ay fl�r ti ,�� !� ,� +.'. �7 ✓J 1� S'�(t'�'+t � I q1 y z { rr fs t F r I ih�;sy't",�he}iP u4fi, p`�13' `'j4il .�r J r 4 Business Park Road I P.O.Box 768 1 Old Saybrook GT.U6475 ® INFILTRATOR Tel 860-577-7000 1 Fax 860-577-7001 water technologies 1-800-221-4436 I www.infiltratorwatercom q l e a U.S.Patents:4,759,661;5,017,041;5,156,488;5,336,017;5,401,116;5,401,459;5,51.1,903;5,716,163;5 588,778 5 839,844 Canadian Patents 1 329 959 2344564 Other paents°pehdmg " i 'rY e �"rx Infiltrator,Equalizer,Quick4 and Sidewinder are registered trademarks of Infiltrator Water Technologies.Infiltrator Is a registered trademark in France.Infiitra or Wate Teehnolagies I a r glsterad t aderriark"r ,`,; rIoo'-- in Mexico.Contour,Contour Swivel Connection,MicroLeaching,MultiPort,PolyTuff,SnapLock ChamberSpacer PosiLock gUlckPlay and QUlakCut are tr de'marks of Infiitra�tor'Water lechnolag ©2015 Infiltrator Water Technologies,LLC. Not responsible for any typographic errors.Printed In U.S.A.a q5p+�p15 f vow REC6=-111ED Noy JY3'T- -1 PIJMPINQ RpC,o l SEP s 7 2005 TOWN OF NORTH ANDOVER S ti $r'�M — -HE-A TH DEPP,RTaENT DATE OP PUMygNQ QUANTITY PL!WpCC 3POOL; N0�_.... Yfry rvx� C)p Ub4tdA Y-A ► f1UN3. 00000 MmOI fl( N)N ; rU ���` ryY f'ZAY 0�8r498 "kl� .___ B AYYI 8S !N N 1 A i.:� R40T3 '. 1.EitiCKF�1 e+XCr� Ms SoLlp$ — .., 1p KUNBA<J, DEI) $OLfpCAIt1�YQYUR�_ PLOOO NER EXPLAIN Commonwealth of Massachusetts City/Town of MOM w° System Pumping Record y` Form 4 Nov 3 4Ur sv � DEP has provided this form for use by local Boards of Health. Other formsjay'&' ,�ql'_'�#ENTER information must be substantially the same as that provided here. Before uVi I11, ur 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 Locatio Le /Righ front of hous Left/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 f� ��'�u�,�`v City/Town� L;� State Zip Code 2. System Owner: 4 4L2- Name Name Address(if different from location) City/TownSt Zi d Telephone Number B. Pumping Record 1. Date of Pumping L ' 1 2. Quantity Pumped: Date Gallons 3. Type of system: ❑ Cesspool(s) eptic Tank ❑ Tight Tank i ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes [�o If yes,was it cleaned? ❑ Yes ❑ No 5. Condifon of System: �0 cvv\ek,l 6. System Pumped By: Neil Bateson F5821 Name Vehicle License Number Bateson Enterprises Inc Company 7. Location w ntents were disposed: L S. Lowell Waste Water Sign toe Haul e- Date t5form4.doc•06103 System Pumping Record•Page 1 of 1