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Home My WebLink AboutMiscellaneous - 250 FARNUM STREET 4/30/2018O CD D o z CO C� o ml PUBLIC HEALTH DEPARTMENT Town of North Andover Community Development Division CERTIFICATE OF COMPLIANCE As of: 10/14/2014 This is to certify that the individual subsurface disposal system received a SATISFACTORY INSPECTION of the: Complete Repair of an On -Site Sewage Disposal System By: James Kellett At: 250 Farnum Street Map 107A Lot 0099 orth Andover, MA 01845 sh 11 not be construed as a guarantee that the system will function satisfactorily. Michele Grant Public Health Agen 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com North Andover Health Department Community Development Division ONSITE WASTEWATER SYSTEM CONSTRUCTION NOTES LOCATION INFORMATION ADDRESS: 250 Farnum St. INSTALLER: James Kellett DESIGNER: Ben Osgood PLAN DATE: 8/13/08 BOH APPROVAL DATE ON MAP: 107A LOT: 0099 PLAN: 9/12/08 INSPECTIONS TANK INSPECTION: 11/22/13 DATE OF BED BOTTOM INSPECTION: 10/24/13 DATE OF FINAL CONSTRUCTION INSPECTION: 12/10/13 DATE OF FINAL GRADE INSPECTION: JA ujl�l+ SITE CONDITIONS ® Contractor reports any changes to design plan ® Existing septic tank properly abandoned ® Internal plumbing all to one building sewer ® Topography not appreciably altered Comments: Boulder retaining wall installed instead of block retaining wall SEPTIC TANK ® Building sewer in continuous grade, on compacted firm base N/A Cleanouts per plan X Bottom of tank hole has 6" stone base X Weep hole plugged X 1500 gallon tank has been installed H-10 loading X Monolithic tank construction ® Water tightness of tank has been achieved by visual testing ® Inlet tee installed, centered under access port Sr a In N/A Comments: 12", neoprene boots DISTRIBUTION -BOX Comments: Outlet tee installed, centered under access port (effluent filter) 24" inch cover to within 6" of finish grade installed over outlet access port Hydraulic cement around inlet & outlet 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) SOIL ABSORPTION SYSTEM (General) X Bottom of SAS excavated down to C soil layer, as provided on plan X Size of SAS excavated as per plan X Title 5 sand installed, if specified on plan ® 40 Mil HDPE barrier installed ® Laterals installed and ends connected to header (and vented if impervious material above) ® Elevations of laterals and chambers installed as on approved plan ® Retaining wall (boulder) ❑ Final cover as per plan Comments: SOIL ABSORPTION SYSTEM (Presby Enviro-Septic) ® 28' Prebsy pipe per row ® Number of rows (trenches): 10 28'x30' 38'w/overdig x 38'6" / 52.4 from corner of barn to system FINAL GRADE F�Loamed Seeded Cover per plan Comments: DOCUMENTS NEEDED Certification of Installation Form submitted By engineer and signed and dated by Engi ler and installer [ As -Built Plan BM = 91.38 HR = 2.36 Hl = 93.74 SYSTEM ELEVATIONS ROD ELEVATION AS -BLT INVERT ELEV DESIGN INVERT ELEV Benchmark Building Sewer OUT 1.29 92.10 92.2 Septic Tank IN 2.87 90.52 90.60 Septic Tank OUT 3.15 90.24 90.35 Distribution Box IN 3.60 89.79 89.94 Distribution Box OUT 3.78 89.61 89.67 Lateral 1 TOP 3.92 Lateral 1 INVERT 89.47 89.49 Lateral 2 TOP 4.22 Lateral 2 INVERT 89.17 89.19 Lateral 3 TOP 4.53 Lateral 3 INVERT 88.86 88.89 Lateral 4 TOP 4.80 Lateral INVERT 88.59 88.59 Lateral 5 TOP 5.03 Lateral 5 INVERT 88.36 88.29 Lateral 6 TOP 5.38 Lateral 6 INVERT 88.01 87.99 Lateral 7 TOP 5.53 Lateral 7 INVERT 87.86 87.69 Lateral 8 TOP 5.94 Lateral 8 INVERT 87.45 87.39 Lateral 9 TOP 6.25 Lateral 9 INVERT 87.14 87.09 Lateral 10 TOP 6.54 Lateral 10 INVERT 86.85 86.79 CRITICAL SETBACK DISTANCES Mark those distances checked in the field against the design plan and regulatory setback 1 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 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 1 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 Town of North Andover - - AS -BUILT CHECKLIST 1) r/ All changes to the design plan have been reflected on the as -built 2) Is of suitable scale; (one inch = 40 feet or fewer for plot plans and one inch = 20 or fewer for details of system components) 3) i//Lot number, Street Name, Assessors Map and Parcel Number 4) Lot Lines and Location of Dwellings served by the system 5)cations, Elevations and Dimensions of system, including reserve (if applicable) 6) —.4zTies to dwelling or Permanent Structure & Wells a. From Septic Tank & Distribution (D) Box b. From Leach Area 7) T* s to Lot Lines from leach area 8) , Locations of Deep Holes & Peres 9). Top of Foundation Elevation 10)ations of Wells, Drains, Watercourses within 150 feet of system 11) , /Location of water, gas, electric lines, cable 12) `� Loc tion of Structures within 6 Inches of Finished Grade 13) O 'ginal Stamp & Signature 14) t' n and holder of any easements which could impact the system 15) Impervious Areas; Driveways, etc 16) No h Arrow 1' Loc ion & Elevations of Benchmark used 18) STATEMENT ON PLAN (NA 5.3) a. "1 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 design and anvmanufacturer's specifications. " Signature of Designer Date As of: Tuesday, December 10, 2013 two �� • �SSACNUS�S PUBLIC HEALTH DEPARTMENT Community Development Division TOWN OF, NORTH ANDOVER SEPTIC DISPOSAL SYSTEM — INSTALLATION CERTIFICATION The undersigned hereby certify that the Sewage Disposal System ( ) constructed; ( ) repaired; By: (Print Name Located at: Q-5-0 - C N (.J M (Installation Address) Was installed in conformance with the North Andover Board of Health approved plan, originally dated and last revised on with a design flow of 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 310. 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 Health. Bottom of Bed Inspection Date: A; Z ��g2 gn,. (f And - Print Name Final Construction Inspection Date: 3 And - Print Name Installer: , !"�� (Signature) Enginer: (f (Signature) �& cl� /(9 .10, Engineer Represe ative (Signature) Engineer Represent ve (Signature) Date:-l✓�� Z �f�'� And - Print Name Date: 10 -1q -1y / Il And - Print Name 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web http://www.townofnorthandovencom �L\ Commonwealth of Massachusetts FRECEIVED City/Town of North Andover Certificate of Compliance 2014 Form 3 TOWN OF NORTH ANDOVER M The issuance of this certificate shall not be construed as a guarantee that the system will function as designed. Approving Authority Signature Date t5form3.doc• 06/03 Certificate of Compliance • Page 1 of 1 DEP has provided this form for use by local Boards of Health. Other forms may be used, but the information must be substantially the same as that provided here. Before using this form, check with the local Board of Health to determine the form they use. This is to Certify that the following work on an On -Site Sewage Disposal System Important: When filling out forms ❑ Construction of a new system on the computer, ® Repair or replacement of an existing system use only the tab ❑ Repair or replacement of an existing system component key to move your cursor - do not use the return Has been done in accordance with Title 5 and the Disposal System Construction Permit (DSCP): key. n�ln,, i I DSCP Number DSCP Date � �� David Higgenbottom Facility Owner 250 Farnum Street Street Address or Lot # North Andover MA 01845 City/Town State Zip Code Designer Information: BENJAMIN C OSGOOD JR. Na Name of Company 12-9-13 Signature Date Installer Information: Name Name of Company Signature Date Use of this system is conditioned on compliance with the provisions set forth below: The issuance of this certificate shall not be construed as a guarantee that the system will function as designed. Approving Authority Signature Date t5form3.doc• 06/03 Certificate of Compliance • Page 1 of 1 Grant, Michele To: bosgood@pennoni.com Cc: Susan Sawyer (ssawyer@townofnorthandover.com); Blackburn, Lisa Subject: 250 Farnum Hi Ben, The owner of 250 Farnum has been in multiple times. Unfortunately we cannot issue a COC until we receive your As - Built and sign off on the "Installation Certification". Michele E. Grant Public Health Agent Town of North Andover 1600 Osgood St I Suite 2035 North Andover, MA 01845 Phone 978.688.9540 Fax 978.688.8476 Email mgrant@townofnorthandover.com Web www.TownofNorthAndover.com Blackburn, Lisa From: Isaac Rowe <irowe@millriverconsulting.com> Sent: Tuesday, December 10, 2013 2:26 PM To: Blackburn, Lisa; 'Susan Sawyer (ssawyer@townofnorthandover.com)' Cc: 'Dan Ottenheimer'; 'Pam Lally'; irowe@millriverconsulting.com Subject: RE: 250 Farnum Attachments: 250 Farnum St - Final inspection report.doc Susan/Lisa, Attached is the final inspection form for the above referenced property. Everything looked good. Let me know if you have any questions. Thanks, Isaac M. Rowe, R.S. Project Manager Mill River Consulting 6 Sargent Street 101 North Andover Health Department Community Development Division ONSITE WASTEWATER SYSTEM CONSTRUCTION NOTES LOCATION INFORMATION ADDRESS: 250 Farnum St. MAP: 107A LOT: 0099 INSTALLER: James Kellett DESIGNER: Ben Osgood PLAN DATE: 8/13/08 BOH APPROVAL DATE ON PLAN: 9/12/08 INSPECTIONS�.� TANK INSPECTION: All DATE OF BED BOTTOM INSPECTION: 10/24/13 DATE OF FINAL CONSTRUCTION INSPECTION: DATE OF FINAL GRADE INSPECTION: SITE CONDITIONS ❑ Contractor reports any changes to design plan ❑ Existing septic tank properly abandoned ❑ Internal plumbing all to one building sewer ❑ Topography not appreciably altered Comments: SEPTIC TANK ❑ Building sewer in continuous grade, on compacted firm base ❑�' Cleanouts per plan Ru / Bottom of tank hole has 6" stone base /, Weep hole plugged RI/ 1500 gallon tank has been installed H-10 loading Monolithic tank construction ❑ Water tightness of tank has been achieved by visual testing ❑ Inlet tee installed, centered under access port Comments: ❑� Outlet tee installed, centered under access port (gas baffle/effluent filter) inch cover to within 6" of finish grade installed over one access port ❑ Hydraulic cement around inlet & outlet Comments: PUMP CHAMBER ❑ Bottom of tank hole has 6" stone base ❑ Weep hole plugged ❑ 1500 gallon Pump Chamber installed ❑ H-10 loading ❑ Monolithic tank construction ❑ Inlet tee installed, centered under access port ❑ Pump(s) installed on stable base ❑ Alarm float working ❑ Pump On/Off floats working ❑ Separate on/off floats ❑ Drain hole in pressure line ❑ cover at final grade installed over pump access port ❑ Water tightness of tank has been achieved by testing ❑ Hydraulic cement around inlet & outlet Comments: CONTROL PANEL ❑ Alarm & Pump are on separate circuits ❑ Alarm sounds when float is tripped ❑ Location of control panel: basement ❑ Alarm signal located inside: basement Comments: DISTRIBUTION -BOX ❑ Installed on stable stone base ❑ H-20 D -Box ❑ Inlet tee (if pumped or >0.08'/foot) ❑ Hydraulic cement around inlet & outlets ❑ Observed even distribution ❑ Speed levelers provided (not required) Comments: t SOIL ABSORPTION SYSTEM�eneral) El Bottom of SAS excavated down to C soil layer, as provided on plan [c�Size of SAS excavated as per plan Title 5 sand installed, if specified on plan ❑ 40 Mil HDPE barrier installed ❑ Laterals installed and ends connected to header (and vented if impervious material above) ❑ Elevations of laterals and chambers installed as on approved plan ❑ Retaining wall (boulder / concrete / timber/ block) ❑ Final cover as per plan Comments: SOIL ABSORPTION SYSTEM (Gravel -less Chambers) ❑ Brand and Model of Chamber: Standard Quick X 4 Infiltrator Chambers 77 ` ,r ❑ Number of chambers per row: 3�� f �( k�7�•� ❑ Number of rows (trenches): Comments: Total Chambers = I <Jq oln Wirn" 6o4k-� 40 3LF�� 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 J SYSTEM ELEVATIONS ROD AS -BLT INVERT DESIGN INVERT ELEVATION ELEV ELEV Benchmark Building Sewer OUT Septic Tank IN Septic Tank OUT Pump Chamber IN Pump Chamber OUT Distribution Box IN Distribution Box OUT Lateral 1 TOP Lateral 1 INVERT Lateral 2 TOP Lateral 2 INVERT Lateral 3 TOP Lateral 3 INVERT Lateral 4 TOP Lateral 4 INVERT Lateral 5 TOP Lateral 5 INVERT Lateral 6 TOP Lateral 6 INVERT Top of Chamber Bottom of Bed/Chamber SKETCH PLAN CRITICAL SETBACK DISTANCES Mark those distances checked in the field against the design plan and regulatory setback ' 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 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 10' ® 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 ' 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 THE PERMIT EXTENSION ACT UPDATED SEPTEMBER 18, 2012 FREQUENTLY ASKED QUESTIONS This document provides answers to frequently asked questions about the permit extension act as it affects permits issued by state agencies. It is not intended to provide guidance with respect to permits issued by a municipality. WHAT IS THE PERMIT EXTENSION ACT? The Permit Extension Act was created by Section 173 of Chapter 240 of the Acts of 2010 and extended by Sections 74 and 75 of Chapter 238 of the Acts of 2012. The purpose of this act is to promote job growth and long-term economic recovery and the Permit Extension Act furthers this purpose by establishing an automatic four-year extension to certain permits and licenses concerning the use or development of real property. With limited exceptions, the Act automatically extends, for four years beyond its otherwise applicable expiration date, any permit or approval that was "in effect or existence" during the qualifying period beginning on August 15, 2008 and extending through August 15, 2012. WHAT TYPES OF APPROVALS ARE INCLUDED IN THIS ACT? The Act applies to regulatory approvals issued by local, regional or state entities that concern the use or development of real property. "Approval" isAdefined broadly to include any permit, certificate, license, certification, determination, exemption, variance, waiver, building permit, or other approval or determination of rights, and any order, except for enforcement orders. I DOES THIS EXTENSION APPLY ONLY TO STATE -ISSUED PERMITS? No, this extension applies to all qualifying permits issued by any municipal, regional, or state entity. THE ACT REFERS TO A LIST OF STATUTES. DOES THE ACT COVER APPROVALS UNDER OTHER STATUTES? Yes. While the definition of "Approval" includes a particular list of statutes, it is not an exclusive list of all statutes affected by this Act. As such, the Act applies to all regulatory approvals concerning the use or development of real property, except those expressly exempted. ARE ANY TYPES OF APPROVALS EXEMPTED FROM THIS STATUTE? Yes. The following approvals are expressly exempted and therefore are NOT covered by the Act: ■ Permits or approvals issued by the Federal government, or by a state agency issued pursuant to federal law ■ Permits issued under sections 20 to 23 of Chapter 40B Hunting, fishing and aquaculture approvals issued by the Division of Fisheries and Wildlife under Chapter 131. Enforcement orders. ARE PRE -DEVELOPMENT ACTIVITIES CONSIDERED APPROVALS? No. Use or development of real property concerns buildings or structures, or site work specifically associated with the development of buildings or structures, rather than pre - development activities such as oil or hazardous material cleanup. Even though such actions may THE PERMIT EXTENSION ACT UPDATED SEPTEMBER 18, 2012 be deemed a precondition to making real property suitable for use or development, pre - development activities that are independently undertaken outside of the context of a larger development project are not covered by the Act. DOES THIS STATUTE APPLY TO PROPERTY RIGHTS GRANTED TO THIRD PARTIES TO USE STATE OWNED PROPERTIES? No. The Act does not apply to the property rights issued by the Commonwealth in its role as a landowner and as such does not apply to easements, leases, licenses for the use of property (except to the extent that a license may authorize the use or development of property, such as in the case of a license issued under Chapter 91 or a curb cut permit), and/or conservation or agricultural restrictions. IS THE 4 YEAR EXTENSION AUTOMATIC? Yes. The four year extension authorized by the Act is automatic, meaning it occurred by operation of law. Neither the permit holder nor the issuing agency needs to take action to implement the extension. DOES A PERMIT OR APPROVAL EXTENDED BY THE ACT REQUIRE ANY FURTHER REVIEW? No, unless the permit or approval by its terms called for such further review when in effect during the qualifying period. Permits or approvals issued prior to the qualifying period and in effect at any time during the qualifying period, and permits or approvals issued during the qualifying period have completed review and are valid for four additional years from the original date of expiration. WHAT IS THE NEW EXPIRATION DATE? The new expiration date is four years from the date that otherwise marked the end of the lawful term of the permit or approval. For example, a permit that expired on September 1, 2009 is now revived and will expire on September 1, 2013. ARE ISSUING AGENCIES REQUIRED TO ISSUE WRITTEN NOTICES OF EXTENSION TO APPROVAL HOLDERS? No. The Act does not require issuing agencies to provide written notice of extension and an approval holder does not need written notice of extension of its permit or approval. However, an issuing agency may post a general notice of the Act on its website and may issue a standard notice of extension eligibility to approval holders who request a document for financing or other purposes. DOES THE ACT APPLY TO BUILDING PERMITS? Yes. Any building permit issued or in effect between August 15, 2008 and August 15, 2012 has been extended by four years from the date on which the permit was otherwise set to expire. DOES THE ACT APPLY TO MASSACHUSETTS ENVIRONMENTAL POLICY ACT (MEPA) DECISIONS, CERTIFICATES OR WAIVERS? Yes. Certificates issued pursuant to MEPA are specifically listed in the definition of "Approval" included in the Act. Therefore, Certificates that were issued or were in effect between August 15, 2008 and August 15, 2012 will have four additional years before a "Lapse of Time" will have 2 THE PERMIT EXTENSION ACT UPDATED SEPTEMBER 18, 2012 occurred triggering either a Notice of Project Change or a new Environmental Notification Form (See 301 CMR 11.10). ASIDE FROM THE 4 YEAR EXTENSION, HAS THE PERMITTING OR CONSTRUCTION PROCESS OTHERWISE BEEN CHANGED BY THE ACT? No. WHAT IF I SUBMITTED AN APPLICATION FOR A PERMIT DURING THE QUALIFYING PERIOD, BUT IT WAS NOT ISSUED UNTIL AFTER THE PERIOD HAD PASSED? The permit does not qualify for extension. The Act only extends permits that were issued or already in effect at any point (e.g., even for one day) during the qualifying period. WHAT IF A PERMIT WAS ISSUED BY A BUILDING OFFICIAL DURING THE QUALIFYING PERIOD, BUT NEVER PICKED UP BY THE APPLICANT? If the permit was issued and never revoked, it qualifies for the extension regardless of whether it was ever picked up. WHAT IF I RECEIVED A PARTIAL BUILDING PERMIT DURING THE QUALIFYING PERIOD, BUT NOT A PERMIT FOR THE REST OF THE PROJECT? Only the permit that was issued or was already in effect is eligible for the four year extension. For instance, if a foundation permit was issued during the qualifying period, but other permits for the remainder of the project were issued outside of the qualifying period, only the foundation permit is extended. No approvals or permits that were not either issued or already in effect during the qualifying period are eligible for automatic extension. DOES THE ACT APPLY TO A PERMIT THAT EXPIRED DURING THE QUALIFYING PERIOD? Yes, the Act revives and extends any permit or approval that was valid during the qualifying period of August 15, 2008 through August 15, 2012. For instance, a permit that expired on July 1, 2009 is now revived and set to expire on July 1, 2013. DOES THE ACT APPLY TO A PERMIT OR APPROVAL THAT WAS NOT DUE TO EXPIRE UNTIL AFTER THE QUALIFYING PERIOD? Yes. The Act provides an additional four years to the original "lawful term of the permit" or approval. If a permit or approval was due to expire on September 1, 2011, it will now automatically expire on September 1, 2015. DOES THE ACT APPLY TO A PERMIT THAT HAD AN EXPIRATION DATE THAT FELL WITHIN THE QUALIFYING PERIOD BUT HAS BEEN ADMINISTRATIVELY CONTINUED PAST AUGUST 15, 2012, PURSUANT TO A TIMELY APPLICATION FOR RENEWAL? Yes. The Act applies to any permit or approval valid during the qualifying period and extends the permit or approval four years in addition to the "lawful term of the approval." DOES THE ACT EXTEND THE TERM OF A PERMIT THAT WAS REVOKED DURING THE QUALIFYING PERIOD? No. The Act applies to permits or approvals that were "in effect or existence" during the qualifying period. Any permits or approvals that were revoked during the qualifying period were THE PERMIT EXTENSION ACT UPDATED SEPTEMBER 18, 2012 not in effect or existence for the purposes of this Act. The Act expressly preserves an issuing agency's authority to suspend or revoke an approval in accordance with the terms of approval itself, or the authorizing statute or regulations. DOES THE ACT APPLY TO A PERMIT THAT EXPIRED PRIOR TO THE QUALIFYING PERIOD, BUT WHICH HAD BEEN EXTENDED BY THE ISSUING AGENCY? Yes, provided the extension resulted in the permit being "in effect" during the qualifying period; if the permit application was pending but not granted during the qualifying period it was not "in effect or existence" for purposes of the Act. For example, a permit that was set to expire on January 31, 2007, but which was lawfully extended for three years by the issuing authority (until January 31, 2010), would now be set to expire on January 31, 2014. IF MY PERMIT WAS EXTENDED BY THE AGENCY DURING THE QUALIFYING PERIOD, SUCH THAT I HAD TWO VALID PERMITS FOR THE SAME PROJECT, ARE BOTH EXTENDED? While both permits may technically be extended, they would run concurrently, such that the four year extension on the second permit would be the controlling and relevant deadline. For example, if your permit were due to expire on August 15, 2009, and you applied for and received a one year extension until August 15, 2010, your new permit deadline would be August 1.5, 2014. CAN AN AGENCY REVOKE OR SUSPEND A PERMIT OR APPROVAL TO AVOID THE 4 YEAR EXTENSION? No. An issuing agency must have an independent reason authorized by the terms of the permit, the statute or the regulation to revoke or to suspend a permit. DOES THE ACT REVIVE PERMITS THAT EXPIRED DURING THE QUALIFYING PERIOD WHERE A REQUEST FOR AN EXTENSION OR RENEWAL WAS ALREADY DENIED? Yes. The Act only preserves certain rights of an agency to suspend or to revoke an approval. Even if an extension had been previously denied, the permit or approval is revived by the Act. However, a permitting authority retains its rights to revoke or modify a permit to the extent authorized permitted by the underlying permit, statutory or regulatory authority. CAN THE ISSUING AGENCY CONDITION THE EXTENSION TO CORRECT PROBLEMS, ERRORS, AND/OR PROJECT CHANGES SINCE THE PERMIT EXPIRED? No. The extension is automatic and no conditions can be placed on the extension. The Act automatically changes the expiration date of a qualifying approval. Any work that takes place under an extended permit or approval must conform to the existing performance standards. However, an issuing agency may modify the conditions of the extended permit or approval if the underlying statutory or regulatory authority would allow such modification. CAN THE ISSUING AGENCY MODIFY A PERMIT OR APPROVAL TO CORRECT PROBLEMS, ERRORS, AND/OR PROJECT CHANGES SINCE THE PERMIT EXPIRED? Yes. The Act preserves the issuing agency's authority to modify an approval if the underlying statutory or regulatory authority would allow a modification to correct problems, errors, or project changes. Any work that takes place under an extended permit or approval must conform to performance standards otherwise applicable to the permit as originally granted or previously extended. 4 THE PERMIT EXTENSION ACT UPDATED SEPTEMBER 18, 2012 DOES THE ISSUING AGENCY'S AUTHORITY TO MODIFY A PERMIT INCLUDE REVISING A WETLAND RESOURCE DELINEATION? Yes. The Act preserves the issuing agency's authority to modify an approval if the underlying statutory or regulatory authority would allow a modification to correct problems, errors, or project changes. Any work that takes place under an extended permit or approval must conform to performance standards otherwise applicable to the permit as originally granted or previously extended. CAN A WETLAND RESOURCE DELINEATION WHICH HAS BEEN EXTENDED BY THE PERMIT EXTENSION ACT BE AMENDED? Yes. Where the most recent governing wetland's approval (Determination of Applicability, Order of Resource Delineation or Order of Conditions) was extended by the PEA, a property owner or the owner's agent may file a request to amend the associated wetland delineation, provided that the request can only be submitted after the date the governing approval would have expired in the absence of the Permit Extension Act. CAN THE ISSUING AGENCY TAKE ENFORCEMENT ACTION TO ADDRESS NONCOMPLIANCE? Yes. The Act upholds the issuing agency's enforcement authority. DOES THE ACT AFFECT MITIGATION THAT WAS REQUIRED AS A CONDITION OF MY PERMIT? No. Any and all conditions that applied to the permit or approval extended by the Act continue to apply. IS ANYTHING OTHER THAN THE EXPIRATION DATE OF MY PERMIT OR APPROVAL CHANGED BY THE ACT? No. A permit or approval is subject to the same substantive terms that applied when it was issued by the agency, except that any interim deadlines established by the permit are extended for four years. Permits or approvals can be modified under the same terms that were originally contained in the permit or approval or that are authorized by the underlying statute or regulations. IF WORK UNDER A PERMIT OR APPROVAL REQUIRES OTHER PERMITS, ARE THEY ALSO AUTOMATICALLY EXTENDED? If such permits or approvals are covered by the Act and were issued or already in effect during the qualifying period, they would also be extended. IF AN APPROVAL HOLDER IS IN VIOLATION, DOES THE ACT EXTEND THE PERMIT OR APPROVAL? Yes, but the issuing agency can take appropriate enforcement action if a violation has occurred. The Act does not alter other substantive provisions of the permit or approval, or the authority of the issuing agency under which it was issued. WHAT IF A PERMIT WAS ISSUED DURING THE QUALIFYING PERIOD BUT WAS SUBJECT TO AN ADMINISTRATIVE APPEAL? A permit or approval that was pending adjudicatory appeal during the qualifying period is not extended because it is not a final permit or approval and as such is not "in effect or existence." THE PERMIT EXTENSION ACT UPDATED SEPTEMBER 18, 2012 However, if the administrative appeal that prevented the permit or approval from taking effect was resolved and a final permit was issued during the qualifying period, it is a permit in effect or existence and is entitled to the four year extension. If the administrative appeal is resolved and a final permit is issued after the qualifying period, the final permit is not entitled to the four year extension. WHAT IF A PERMIT WAS ISSUED DURING THE QUALIFYING PERIOD BUT IS NOW PENDING JUDICIAL APPEAL? As with any permit pending judicial appeal, it is subject to the court's ultimate decision. If a permit that would qualify for the extension is pending appeal, and the court upholds the permit, the permit will qualify for an extension. There is no need for an extension if the court invalidates the permit. WHAT IF A PERMIT WAS ISSUED DURING THE QUALIFYING PERIOD BUT WAS APPEALED TO COURT AND THE COURT'S DECISION UPHOLDING THE PERMIT WAS NOT ISSUED UNTIL AFTER THE QUALIFYING PERIOD? Because the permit was issued during the qualifying period, it was in effect or existence during the qualifying period and qualifies for an extension. IS THERE ANY REASON WHY A PERMIT OR APPROVAL EXTENDED PURSUANT TO THE ACT WOULD NOT BE ELIGIBLE FOR FUTURE EXTENSIONS PURSUANT TO THE STATUTES AND REGULATIONS THAT APPLY TO THAT PERMIT OR APPROVAL? No. Such permits would be subject to any substantive provision of the underlying statutes or regulations. CAN AN APPROVAL HOLDER REFUSE AN EXTENSION? No. If the Act applies to a permit or approval, it is automatically extended. However, an approval holder can surrender its approval under the same terms and conditions of that permit or approval that it could absent the Act. WHAT EDITION OF THE STATE BUILDING CODE (780 CMR) IS A PROJECT PROCEEDING UNDER AN EXTENDED PERMIT SUBJECT TO? A project should proceed in accordance with the edition of the State Building Code under which the permit was issued. UNDERSTANDING THAT CHAPTER 40B PERMITS ARE EXEMPT FROM THIS ACT, ARE THE NON - 40B PERMITS ASSOCIATED WITH A 40B PROJECT (SUCH AS WETLANDS PERMITS, ETC.)EXTENDED? Yes. Only permits issued under sections 20 to 23 of Chapter 40B are not extended. All other permits associated with the project are extended. ARE 40R PAYMENTS OR THE CLAWBACK OF ZONING INCENTIVE FUNDS EXTENDED? No. The Act applies only to the use or development of real property and does not extend Chapter 40R incentive payments. in n n' 0 G Commonwealth of Massachusetts Map -Block -Lot 107.A0099 ----------------------- BOARD OF HEALTH Permit No North Andover - BHP -2013-0903 ---------------------- P.I. FEE F.I. $250.00 ----------------------- DISPOSAL WORKS CONSTRUCTION PERMIT Permission is hereby granted James- Kellett ------------------------ ------------------------------------------ ----------- to (Repair) an Individual Sewage Disposal System. �li (Cp a ( 0 at No 250 FARNUM STREET 1 COPY ----- as shown on the application for Disposal Works Construction Permit No. 13HP-2013-090 Dated September 23, 2013 ----------------------------------------------------------------- Issued On: Sep -23-2013 BOARD OF HEALTH ---------------------------------------------------------------------------------- i 6591 Cf NORTH ,1 ❑ • Town of North Andover ❑ Body Art Establishment $ HEALTH DEPARTMENT S�cNust $ CHECK #: A I DATE: 3 I ?) LOCATION: r' H/O NAME: $ CONTRACTOR NA 6l B I 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 Sustems: ❑ Septic - Soil Testing $ ❑ Septic - Design Approval $ � I( !❑ ' Septic Disposal Works Construction (DWC) $Q��0 Septic Disposal Works Installers (DWI) $ ❑ Title 5 Inspector $ ❑ Title 5 Report $ ❑ Other. (Indicate) $ Health Agent Initials White - Applicant Yellow - Health Pink - Treasurer MORTM Application for Septic Disposal System a"Construction Permit —TOWN OF '', ,•r- ORTH ANDOVER, MA 01845 SaACaNgEt Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. Application is hereby made for a permit to: Construct a new on-site sewage disposal system* ❑ Repair or replace an existing on-site sewage disposal system* ❑ Repair or replace an existing system component — What? A. Facility Information Address or Lot # Cityl�o1')�1_ DIaLj�S... 2.- *TYPE OF SEPTIC SYSTEM*: ❑ Pump Gravity (choose one) ***If pump system. attach copy of electrical permit to application*** TODAY'S DATE $ 250.00 - Full Repair $125.00 - Component ❑ Conventional System (pipe and stone system) ❑ Infiltrator or Biodiffuser (Gravel -Less) (Attach a copy of your certification to install this type of system. ❑ Pressure Distribution S.A.S. (No D -Box) (Attach Draft Maintenance Agreement) ❑ Pressure Dosed (D -Box Present) S.A.S. 2. City/Town -- I i-- _...... _ .. -- 61Bt4s -. - - State Zip Code WE SES' 23 2013 OF NORTH ANDOVER -TN, DEPARTMENT Telephone Number 3. Installer Information Ncl i m Jme�l1n-XC'ccvCc hJC , _(G o� SQ Lem '............... ..... __ ................ Address cn -fi le m �►q -----CC — ity! own State Zip Code --- Telephone Number (Cell Phone # if possible please) 4. Deslaner Informaxion ress ..... -1 ...... - City/Town at p_ q Zip Code -- 66 J174l� Tele one Number (Best #to Reach) Application for Disposal System Construction Permit • Page 1 of 2 Application for Septic Disposal System of ,..•`�1N0 onstruction Permit —TOWN OF TODAY'S DATE $ 250.00 — Full Repair ORTH ANDOVER MA 01845 $125.00 -Component PAGE 2 OF 2 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, and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Name (5ate Application Approved By: (Board of Health Representative) Name Date Application Disapproved for the following reasons: For Office Use Only: 1. Fee Attached. Yes No 2 Project Manager Obligation Form Attached? Yes 3. Pump System? If so, Attach cony ofFJectrical Permit Yes 4. Foundation As -Built? mew construction ronly). Yes (Same scale as Tprovedplan) 5. Floor Plans? mew construction only). Yes No No No No Application for Disposal System Construction Permit • Page 2 of 2 i / a SEPTIC SYSTEM INSTALLER PROJECT MANAGEMENT OBLIGATIONS As the North Andover licensed installer for the construction for the septic system for the property at: Z6 —LQ Spree 1 (Address of septic system) For plans by Relative to the application of_�. nstalle2s n z � And dated Dated 3 ng na ate; e ayes ate With revisions dated (Last revised date) I understand the following obligations for management of this project: 1. As the installer, I am obligated to obtain all permits and Board of Health approved plans prior to performing any work on a site. I must have the approved plans and the permit on site when any work is being done. 2. As the installer, I must call for any and all inspections. If homeowner, contractor, project manager, or any other person not associated with my company schedules an inspection and the system is not ready, then item three shall be applicable. 3. As the installer, I am required to have the necessary work completed prior to the applicable inspections as indicated below. I understand that requesting an inspection, without completion of the items in accordance with Title 5 and the Board of Health Regulations may result in a $50.00 fine being levied against me and/or My company. a. Bottom of Bed — Generally, this is the first (1S) inspection unless there is a retainingwall, 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: healthdepGf_a-�tov�nc fnorthandover.com) from the engineer must be submitted to the Board of Health, after which installer calls for an inspection time. Installer must be present for this inspection. With a pump system, all electrical work must be ready and able to cause pump to work and alarm to function. c. Final Grade — Installer must request inspection when all grading is complete. Installer does not have to be on-site. 4. As the installer, I understand that only I may perform the work (other than simple excavation) and I am required to complete the installation of the system identified in the attached application for installation. I further understand that work done by others unlicensed to install septic systems in North Andover can constitute reasons for denial of the system and/or revocation or suspension of my license to operate in the Town of North Andover, significant fines to all persons involved are also possible. 5. As the installer, I understand that I must be on-site during the performance of the following construction steps: a. Determination that the proper elevation of the excavation has been reached. b. Inspection of the sand and stone to be used, c. Pinal 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 contractor, or any other persons shall absolve me of this obligation. I Undersigned Licensed Septic Installer: ��ue ilej� rf Q NORT!{ O�tt�eo i6�� • O L O �n N � e PUBLIC HEALTH DEPARTMENT Community Development Division September 12, 2008 David Higgenbottom 250 Farnham Street North Andover, MA 01845 RE: Septic System Design, 250 Farnham Street, North Andover, Map 107A, Lot 99 Dear Mr. Higgenbottom, The North Andover Board of Health has completed the review of the septic system design plans, for the above referenced property, submitted on your behalf by New England Engineering Services, dated June 3, 2008, last revised August 13, 2008. This plan has been approved. The approval includes; 1) a Local Upgrade Approval for the request to have only one test pit within the area of the proposed system. 2) A Local Upgrade Approval for the request for the use of a sieve analysis in lieu of a percolation test 3) To allow the use of an impervious barrier and segmental wall in lieu of a poured concrete wall. Please keep a copy of the attached 9b document for your records. This plan is valid for two years from the date of this approval. The design has been approved for use in the construction of an onsite septic system for a 4 - bedroom house (maximum 9 -room). 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 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. 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 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com 1 44 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 or imply compliance with any of the aforementioned requirement. The Presby Enviro-Septic Leaching System has requirements as set forth in the DEP approval (see attached document) Review section V. Conditions Applicable to the System Owner. 2. The System owner shall at all times properly operate and maintain the on-site sewage disposal system. The System owner shall have the System inspected annually by an operator trained by the Company and shall submit the results of that inspection, on a technology checklist, to the local approving authority. 5. Prior to the issuance of a Certificate of Compliance or the System, the System owner shall record and/or register in the appropriate Registry of Deeds and /or Land Registration Office, a Notice disclosing or/ the existence of the alternative septic system subject to this Approval on the property and the Department's approval of the System. If the property subject to the Notice is unregistered land, the Notice shall be marginally reference on the owner's deed to the property. Within 30 days of recording and/or registering the Notice, the System owner shall submit the following to the Department and the local approving authority: (i) a certified Registry copy of the Notice bearing the book and page/instrument number and/ or document number; and (ii) if the property is unregistered land, a Registry copy of the owner's deed to the property, bearing the marginal reference. Your effort to provide a properly functioning septic system for your dwelling is greatly appreciated. The Health Department may be reached at 978-688-9540 with any questions you may have. Since y, Susan Y. Sawyer, /RS Public Health Director Encl: list of licensed septic system installers Cc: New England Engineering Services 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com Commonwealth of Massachusetts City/Town of a Local Upgrade Approval Form 913 Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. V' LI DEP has provided this form for use by local Boards of Health if they choose to do so. The Local Upgrade Approval is to be completed by the local Board of Health and a signed copy provided to the system owner. A. Facility Information 1. Facility Name and Address David Higgenbottom Name 250 Farnham Street Street Address North Andover CitylTown 2. Owner Name and Address (if different from above): Name City/Town Zip Code 3. Type of Facility (check all that apply): MA State Street Address State Telephone Number ® Residential ❑ Institutional ❑ Commercial ❑ Sc 4. Design flow per 310 CMR 15.203: 440 gpd 5. System Designer: Ben Osgood Jr. - Name 1600 Osgood St North Andover 01845 Address City/Town B. Approval 1. Local Upgrade Approval is granted for: ❑ Reduction in setback(s) — specify: ❑ Reduction in SAS area of up to 25%: SAS size, sq. ft. hool State, ZIP 01845 Zip Code % reduction 250 Farnham 9b • rev. 7/06 Local Upgrade Approval* Page 1 of 2 Commonwealth of Massachusetts City/Town of Local Upgrade Approval Form 9B B. Approval (continued) ❑ Reduction in separation between the SAS and high groundwater: Separation reduction Percolation rate Depth to groundwater ❑ Relocation of water supply well (explain): ft. min./inch ft. ❑ Reduction of 12 -inch separation between inlet and outlet tees and high groundwater ® Use of only one deep hole in proposed disposal area ® Use of a sieve analysis as a substitute for a perc test List local variances granted not requiring DEP approval per 310 CMR 15.412(4): Allow the use of an impervious barrier and segmental block retaining wall in liieu of constructing a poured concrete wall List variances granted requiring DEP approval: North Andover BOH Approving Authority Susan Sawyer 09-12-08 Print or Type Name and Title ignature Date 250 Farnham 9b • rev. 7/06 Local Upgrade Approval* Page 2 of 2 PUBLIC HEALTH DEPARTMENT Community Development Division September 12, 2008 David Higgenbottom 250 Farnham Street North Andover, MA 01845 RE: Septic System Design, 250 Farnham Street, North Andover, Map 107A, Lot 99 Dear Mr. Higgenbottom, The North Andover Board of Health has completed the review of the septic system tdesign plans, for the above referenced property, submitted on your behalf by New England Engineering Services, dated June 3, 2008, last revised August 13, 2008. This plan has been approved. The approval includes; 1) a Local.Upgrade Approval for the request to have only one test pit within the area of the proposed system. 2) A Local Upgrade Approval for the request for the use of a sieve analysis in lieu of a percolation test 3) To allow the use of an impervious barrier and segmental wall in lieu of a poured concrete wall. Please keep a copy of the attached 9b document for your records. This plan is valid for two years from the date of this approval. The design has been approved for use in the construction of an onsite septic system for a 4 - bedroom house (maximum 9 -room). 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 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. 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 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com Q r' 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 or imply compliance with any of the aforementioned requirement. 3. The Presby Enviro-Septic Leaching System has requirements as set forth in the DEP approval (see attached document) Review section V. Conditions Applicable to the System Owner. 2. The System owner shall at all times properly operate and maintain the on-site sewage disposal system. The System owner shall have the System inspected annually by an operator trained by the Company and shall submit the results of that inspection, on a technology checklist, to the local approving authority. 5. Prior to the issuance of a Certificate of Compliance or the System, the System owner shall record and/or register in the appropriate Registry of Deeds and /or Land Registration Office, a Notice disclosing or/ the existence of the alternative septic system subject to this Approval on the property and the Department's approval of the System. If the property subject to the Notice is unregistered land, the Notice shall be marginally reference on the owner's deed to the property. Within 30 days of recording and/or registering the Notice, -the System owner shall submit the following to the Department and the local approving authority: (i) a certified Registry copy of the Notice bearing the book and page/instrument number and/ or document number; and (ii) if the property is unregistered land, a Registry copy of the owner's deed to the property, bearing the marginal reference. Your effort to provide a properly functioning septic system for your dwelling is greatly appreciated. The Health Department may be reached at 978-688-9540 with any questions you may have. Since y, Susan Y. Sawyer, /RS Public Health Director Encl: list of licensed septic system installers Cc: New England Engineering Services 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com Commonwealth of Massachusetts City/Town of Local Upgrade Approval Form 913 lug DEP has provided this form for use by local Boards of Health if they choose to do so. The Local Upgrade Approval is to be completed by the local Board of Health and a signed copy provided to the system owner. 250 Farnham 9b • rev. 7/06 Local Upgrade Approval* Page 1 of 2 A. Facility Information Important: When filling out 1. Facility Name and Address forms on the computer, use David Higgenbottom only the tab key Name to move your 250 Farnham Street cursor -do not use the return Street Address key. North Andover MA 01845 City/Town State Zip Code 2. Owner Name and Address (if different from above): Name Street Address Cityrrown State Zip Code Telephone Number 3. Type of Facility (check all that apply): ® Residential ❑ Institutional ❑ Commercial ❑ School 4. Design flow per 310 CMR 15.203: 440 9pd 5. System Designer: Ben Osgood Jr. ® PE ❑ RS Name 1600 Osgood St North Andover 01845 Address City/Town State, ZIP B. Approval 1. Local Upgrade Approval is granted for: ❑ Reduction in setback(s) — specify: ❑ Reduction in SAS area of up to 25%: SAS size, sq. ft. % reduction 250 Farnham 9b • rev. 7/06 Local Upgrade Approval* Page 1 of 2 Commonwealth of Massachusetts City/Town of Local Upgrade Approval Form 9B B. Approval (continued) ❑ Reduction in separation between the SAS and high groundwater: Separation reduction Percolation rate Depth to groundwater ❑ Relocation of water supply well (explain): ft. min./inch ft. ❑ Reduction of 12 -inch separation between inlet and outlet tees and high groundwater ® Use of only one deep hole in proposed disposal area ® Use of a sieve analysis as a substitute for a perc test List local variances granted not requiring DEP approval per 310 CMR 15.412(4): Allow the use of an impervious barrier and segmental block retaining wall in liieu of constructing a poured concrete wall List variances granted requiring DEP approval: North Andover BOH Approving Authority Susan Sawyer 09-12-08 Print or Type Name and Title j ignature Date 250 Farnham 9b • rev. 7/06 Local Upgrade Approval, Page 2 of 2 R, 11 COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE WINTER STREET, BOSTON, MA 02108 617-292-5500 ��Z'.��•ei,'jf��i� DEVAL L. PATRICK IAN A. BOWLES Governor Secretary TIMOTHY P. MURRAY ARLEEN O'DONNELL Lieutenant Governor Commissioner MODIFIED APPROVAL FOR REMEDIAL USE Pursuant to Title 5, 310 CMR 15.000 Name and Address of Applicant: Presby Environmental, Inc. 143 Airport Road Whitefield, NH 03598 RECEIVED SEP'l 2�00 TOWN OF NORTH ANDOVER HEALTH DEPARTMENT Trade name of technology and model: Presby Enviro-Septic Leaching System (Hereinafter called the "System"). The "Massachusetts Enviro-Septic® Wastewater Treatment System Quick Reference Guide" including schematic drawings of typical Systems, a technology checklist, and a System Installation Form are part of this Certification. Transmittal Number: W021550 Date of Issuance: November 21, 2005, Revised May 22, 2006, Revised June 2, 2006. Revised March 16, 2007, Modified July 11, 2007 Date of Expiration: November 21, 2010 Authority for Issuance Pursuant to Title 5 of the State Environmental Code, 310 CMR 15.000, the Department of Environmental, Protection hereby issues this Approval to: Presby Environmental, Inc., 143 Airport Road, Whitefield, NH 03598 (hereinafter "the Company"), approving the System described herein for Remedial Use in the Commonwealth of Massachusetts. Sale and use of the System are conditioned on compliance by the Company 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. Glenn Haas, Acting Assistant Commissioner Bureau of Resource Protection Department of Environmental Protection 1 11, 2007 Date This information is available in alternate format. Call Donald M. Gomes, ADA Coordinator at 617-556-1057. TDD Service -1-800-298-2207. MassDEP on the World Wide Web: http://www.mass.gov/dep 0 Printed on Recycled Paper i Modified Approval for Remedial Use Presby Enviro-Septic Leaching System Page 2 of 8 I. Purpose 1. The purpose of this approval is to allow Remedial Use of the System in Massachusetts with the necessary permits and approvals required by 310 CMR 15.000. 2. With the necessary permits and approvals required by 310 CMR 15.000, this Approval for Remedial Use authorizes the use and installation of the System in Massachusetts. 3. The System may only be installed where conditions meet the criteria of 310 CMR 15.284(2). The System is an alternative system approved in accordance with 310 CMR 15.280 through 15.289 and is used to treat and dispose of wastewater. 4. This Approval for Remedial Use allows the use of the System where the local approving authority finds that the System is for upgrade of a failed, failing or nonconforming system. The Title 5 design flow for the facility must be less than 10,000 gallons per day. II. Design and Construction Standards 1. The System is a subsurface unit that replaces a soil absorption system (SAS) designed in accordance with 310 CMR 15.000. The System consists of an 11 5/8 -inch diameter corrugated, high-density plastic pipe with a 9.5 -inch interior diameter and a length of 10 feet. The exterior of the pipe has ridges on the peak of each corrugation. The pipe is perforated with eight holes equally distributed around its inner circumference. Each hole has a plastic skimmer extending inwards. The exterior of the pipe shall have a minimum of two layers of material. The inner layer shall be a thick layer of coarse, randomly oriented polypropylene fibers. The outer layer shall be a non -woven geo- textile polypropylene fabric. The pipe shall be installed in a concrete system sand bed and surrounded on all sides by a minimum of six inches of system sand. Depth to the high groundwater elevation shall be measured from the bottom of the system sand underlying the pipe. 2. The System sand shall meet ASTM C-33. 3. Systems shall be installed with a differential venting for aeration and inspection at end of each run of pipe, section or serial bed and whenever the System is installed under impervious surfaces._ 4. The System shall be designed and installed using distribution boxes for inspection ports. The pipe between the distribution box and the System shall be installed at a minimum slope of 0.02 feet/foot. Modified Approval for Remedial Use Presby Enviro-Septic Leaching System Page 3 of 8 Serial distribution laterals shall be limited to no more than 500 gpd. Multi-level systems shall not be allowed. 6. The System shall be installed in a bed or field configuration, as defined in 310 CMR 15.252. The effective leaching area shall be the bottom area (length times width) of the field or bed as presented in the Company's "Massachusetts Enviro-Septic® Wastewater Treatment System Quick Reference Guide". Effluent loading rates adjusted to reduce the soil absorption system by 40 percent shall be in accordance with 310 CMR 15.242. No System shall be installed with a leaching area of less than 400 square feet. The System shall not require pressure distribution. The System may be used in soils with a percolation rate of up to 90 minutes per inch (MPI). For soils with a percolation rate of 60 to 90 MPI, the effluent loading rate shall be 0.15 GPD/SF III. Allowable Soil Absorption System Design Reduction of the Required Separation Distance to High Groundwater Elevation - An Applicant is eligible for a reduction in separation (four feet in soils with a recorded percolation rate of more than two minutes per inch or five feet in soils with a recorded percolation rate of two minutes or less per inch) between the bottom of the SAS and the high groundwater elevation, where all of the following conditions are met. A. A minimum two foot separation (in soils with a recorded percolation rate of more than two minutes per inch) or a minimum three foot separation (in soils with a recorded percolation rate of two minutes or less per inch) between the bottom of the sand underlying the SAS and the high groundwater elevation is maintained. Any such reduction must first be approved by the local approving authority and then approved by the Department pursuant to 310 CMR 15.284. B. No further reduction, than specified in Section II (7), in the required SAS size is allowed. C. No reduction in the required four feet of naturally occurring pervious material is allowed unless the Applicant has demonstrated that the four foot requirement cannot be met anywhere on the site. Any such reduction must first be approved by the local approving authority and then approved by the Department pursuant to 310 CMR 15.284. D. Where full compliance with all of the minimum set back distances in 310 CMR 15.211 is not feasible, the local approving authority may allow a Modified Approval for Remedial Use Presby Enviro-Septic Leaching System Page 4 of 8 reduction under a local upgrade approval in accordance with 310 CMR 15.405 (1) (a), (b), (f), (g), and (h). E. Where full compliance with all of the minimum set back distances in 310 CMR 15.211 is not feasible, even taking into account provisions for local upgrade approval as described above, then pursuant to 310 CMR 15.410, the applicant first must obtain variance(s) from the local approving authority and then approval of the Department. 2. Reduction of the Requirement for Four Feet of Naturally Occurring Pervious Material — An Applicant is eligible for a reduction in the required four feet of naturally occurring pervious material in an area of no less than two feet of naturally occurring pervious material, where all of the following conditions are met. A. The Applicant has demonstrated that the four foot requirement cannot be met anywhere on the site. Any such reduction must first be approved by the local approving authority and. then approved by the Department pursuant to 310 CMR 15.284. B. No further reduction, than specified in Section II (7), in the required SAS size is allowed. C. No reduction in the required separation (four feet in soils with a recorded percolation rate of more than two minutes per inch or five feet in soils with a recorded percolation rate of two minutes or less per inch) between the bottom of SAS and the high groundwater elevation is allowed unless such a reduction is first approved by the local approving authority and then approved by the Department pursuant to 310 CMR 15.284. D. Where full compliance with all of the minimum set back distances in 310 CMR 15.211 is not feasible, the local approving authority may allow a reduction under a local upgrade approval in accordance with 310 CMR 15.405 (1) (a), (b), (f), (g), and (h). E. Where full compliance with all of the minimum set back distances in 310 CMR 15.211 is not feasible, even taking into account provisions for local upgrade approval as described above, then pursuant to 310 CMR 15.410, the applicant first must obtain variance(s) from the local approving authority and then approval of the Department. Modified Approval for Remedial Use Presby Enviro-Septic Leaching System Page 5 of 8 IV. General Conditions All provisions of 310 CMR 15.000 are applicable to the use of this System, the System owner and the Company, except those that are varied by the terms of this Approval. 2. All sample analysis must be conducted by an independent U.S. EPA or DEP approved testing laboratory, or a DEP approved independent university laboratory. It is a violation of this Approval to falsify any data collected, to omit any required data or to fail to submit any report required by such plan. 3. The facility served by the System and the System itself shall be open to inspection and sampling by the Department and the local approving authority at all reasonable times. 4. In accordance with applicable law, the Department and the local approving authority may require the System owner to cease operation of the system and/or to take any other action as it deems necessary to protect public health, safety, welfare and the environment. The Department has not determined that the performance of the System will provide a level of protection to public health and safety and the environment that is at least equivalent to that of a sewer system. No System shall be installed, upgraded or expanded, if it is feasible to connect the facility to a sanitary sewer, unless as allowed by 310 CMR 15.004. When a sanitary sewer connection becomes feasible, the facility served by the System shall be connected to the sewer, within 60 days of such feasibility, and the System shall be abandoned in compliance with 310 CMR 15.354, unless a later time is allowed, in writing, by the approving authority. 6. Design, installation and operation shall be in strict conformance with the Company's DEP approved plans and specifications, 310 CMR 15.000 and this Approval. V. Conditions Applicable to the System Owner 1. The System is approved for the treatment and disposal of sanitary sewage only. Any wastes that are non -sanitary sewage generated or used at the facility served by the System shall not be introduced into the System and shall be lawfully disposed. 2. The System owner shall at all times properly operate and maintain the on-site sewage disposal system. The System owner shall have the System inspected annually by an operator trained by the Company and shall submit the results of that inspection, on a technology checklist, to the local approving authority. Modified Approval for Remedial Use Presby Enviro-Septic Leaching System Page 6 of 8 3. The System owner shall furnish the Department any information that the Department requests regarding the operation and performance of the System, within 21 days of the date of receipt of that request. 4. No System owner shall authorize or allow the installation of the System other than by a person trained by the Company to install the System. 5. Prior to the issuance of a Certificate of Compliance for the System, the System owner shall record and/or register in the appropriate Registry of Deeds and/or Land Registration Office, a Notice disclosing both the existence of the alternative septic system subject to this Approval on the property and the Department's approval of the System. If the property subject to the Notice is unregistered land, the Notice shall be marginally referenced on the owner's deed to the property. Within 30 days of recording and/or registering the Notice, the System owner shall submit the following to the Department and the local approving authority: (i) a certified Registry copy of the Notice bearing the book and page/instrument number and/or document number; and (ii) if the property is unregistered land, a Registry copy of the owner's deed to the property, bearing the marginal reference. VI. Conditions Applicable to the Company By January 31St of each year, the Company shall submit a report to the Department, signed by a corporate officer, general partner or Company owner that contains information on the System, for the previous calendar year. The report shall state: the number of units of the System sold for use in Massachusetts including the installation date and date of start-up during the previous year; the address of each installed System, the owner's name and address, the type of use (e.g. residential, commercial, school, institutional) and the design flow; and for all Systems installed since the date of issuance of this Approval, all known failures, malfunctions, and corrective actions taken and the address of each such event. 2. The Company shall notify the Director of the Watershed Permitting Program at least 30 days in advance of the proposed transfer of ownership of the technology for which this Approval issued. Said notification shall. include the name and address of the proposed new owner and a written agreement between the existing and proposed new owner containing a specific date for transfer of ownership, responsibility, coverage and liability between them. All provisions of this Approval applicable to the Company shall be applicable to successors and assigns of the Company, unless the Department determines otherwise. The Company shall develop and submit to the Department: an operating manual, including information on substances that should not be discharged to the System and a recommended schedule for maintenance of the System essential to consistent successful performance of the installed Systems within 60 days of the effective date of this Approval. Modified Approval for Remedial Use Presby Enviro-Septic Leaching System Page 7 of 8 4. The Company shall make available, in print and electronic format, the referenced procedures in paragraphs 3 above to System owners, operators, designers and installers. 5. The Company shall institute and maintain a training program in the proper design, installation and inspection techniques of its System and provide a training course at least annually for prospective designers, installers and inspectors. The Company shall certify that installers and inspectors have completed the Company's training class, maintain a list of trained installers and inspectors, submit a copy to the Department, and update the list annually. Updated lists shall be forwarded to the Department. 6. The Company shall furnish the Department any information that the Department requests regarding the System, within 21 days of the receipt of that request. The Company shall include copies of this Approval and the procedures in Section VI (3) with each System that is sold. In any contract executed by the Company for. distribution or re -sale of the System, the Company shall require the distributor or re- seller to provide each purchaser of the System with copies of this Approval and the procedures described in Section VI (3). 8. The Company shall comply with 310 CMR 15.000 and all Department policies and guidance that apply and as they may be amended from time to time. 9. If the Company wishes to continue this Approval after its expiration date, the Company shall apply for and obtain a renewal of this Approval.. The Company shall submit a renewal application at least 180 days before the expiration date of this Approval, unless written permission for a later date has been granted in writing by the Department. This approval shall continue in force until the Department has acted on the renewal application. VII. Conditions Applicable to Installers of the System Each Installer shall install the System in accordance with Company training on the installation of the System and the conditions of this Certification. 2. No Installer shall install the System unless the Installer has been trained by the Company on installation of the System or the installation is overseen by a Company representative(s). 3. Installers shall complete the System Installation Form and forward a copy to the Company and the local approving authority. Modified Approval for Remedial Use Presby Enviro-Septic Leaching System Page 8 of 8 4. The System installer shall provide the System owner and the local approving authority with a bill of lading certifying that the sand fill meets ASTM C-33. VIII. Reporting All notices and documents required to be submitted to the Department by this Approval shall be submitted to: Director Wastewaters Management Program Department of Environmental Protection One Winter Street - 5th floor Boston, Massachusetts 02108 IX. Rights of the Department 1. The Department may suspend, modify or revoke this Approval for cause, including, but not limited to, non-compliance with the terms of this Approval, non-payment of the annual compliance assurance fee, for obtaining the Approval by misrepresentation or failure to disclose fully all relevant facts or any change in or discovery of conditions that would constitute grounds for discontinuance of the Approval, or as necessary for the protection of public health, safety, welfare or the environment, and as authorized by applicable law. The Department reserves its rights to take any enforcement action authorized by law with respect to this Approval and/or the System against the owner, or operator of the System and/or the Company. X. Expiration Date Notwithstanding the expiration date of this Certification, any System installed prior to the expiration date of this Certification, and approved, installed and maintained in compliance with this Certification (as it may be modified) and 310 CMR 15.000, may remain in use unless the Department, the local approving authority, or a court requires the System to be modified or removed, or requires discharges to the System to cease. yv f NORT#t OL O T SS^GHuSE� Health Department July 24, 2008 Mr. Benjamin C. Osgood, Jr., P.E. 1600 Osgood Street Building 20 Suite 2-64 North Andover, MA 01845 Re: Septic System Repair Plan for 250 Farnum Street Map 107A, Lot 99 Dear Mr. Osgood: The proposed wastewater system design plan for the above site dated June 3, 2008 and received on June 27, 2008 has been reviewed. Unfortunately, the plan cannot be approved until the following items are corrected. The specific section in Title 5: 310 CMR 15.000, or North Andover (NA) regulation that has not met by this design follows each item for your convenience. 1. Only one (1) deep observation hole is utilized in the primary soil absorption area. Please request a Local Upgrade Approval (15.102(2)). ` Please specify and depict where appropriate, a riser to within 6" of final grade for the Y distribution box (15.232(3), 221(13), 228(1)). v3 Please provide buoyancy calculations for the septic tank or describe why calculations are not provided (15.221(8)). ,4 Under "Design Data", the sand bed area provided (32'x 25'= 800 S.F.) does not reflect °� what is shown on the site plan (30'x 28' = 840 S.F.) or depicted in the "End Layout ZDetail". Please clarify the correct sand bed area proposed. 5Under "Design Data", the Enviro-Septic system size provided (9 Rows of 30' Chambers Spaced at 2.75' = 270 L. F.) does not reflect what is shown on the site plan (10 Rows of 26' Chambers Spaced at 3.0'= 260 L.F.) or depicted in the "End Layout Detail". Please clarify the correct size of the Enviro-Septic system. 6. Please provide the DEP approval letter (general or remedial use) for the Enviro-Septic system that is being proposed. Please indicate on the plan the maintenance requirements of the Enviro-Septic system in accordance with the DEP approval letter. $. In accordance with the Alternative To Percolation Testing Guidance, the soil evaluator v must determine whether the soils are compacted or uncompacted. Please provide this determination. 1600 Osgood Street HEALTH DEPARTMENT Page 1 of 1 Building 20; Suite 2-36 E -Mail: healthdept@townofnorthandover.com North Andover, MA 01845 Phone: 978.688.9540 Fax: 978.688.8476 Although not reasons for disapproval, you may consider the following: 1. Providing an Enviro-Septic system with 30' length lines instead of 26'. Each Enviro- Septic line has a length of 10'. This would eliminate the need for the installer to cut the pipes during installation. 2. According to the sieve analysis, the percentage of sand is 70.3 which would allow the use of a loading factor of 0.66 GPD/SF in accordance with the Alternative To Percolation Testing Guidance. 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. Sincere , usan Y. Saw/RE�S/RS Public Health Director cc: Owner File 1600 Osgood Street HEALTH DEPARTMENT Page 2 of 2 Building 20; Suite 2-36 E -Mail: healthdept@townofnorthandover.com North Andover, MA 01845 Phone: 978.688.9540 Fax: 978.688.8476 NEw IENGLAAD 1ENGINEEIUNG SER\V1,CES, INC. 1600 Osgood Street Building 20 Suite 2-64 North Andover, MA 01845 Thl: (978) 686-1768 • Fax: (978) 327-6138 www.neengineeringinc.com July 29, 2008 Susan Sawyer North Andover Board of Health 1600 Osgood Street North Andover, MA 01845 Re: 250 Farnum Street, North Andover Septic system design Dear Susan: RECEIVE[) SEP 0 8 2008 TOWN OF NOR7 ANDOVER HEALTH DEPARTMENT Enclosed are 5 copies of revised plans for the above referenced septic system design. Changes have been made to address comments in your letter dated July 24, 2008. The changes/comments are as follows: 1. We would like to request the board approve the design plan on the condition that an additional test pit be performed prior to construction to confirm soil conditions on site. 2. A note has been added to the profile to provide a riser on the distribution box within 6" of finish grade. 3. buoyancy calculations have been included on page 2. 4. The design data has been revised to indicate a sand bed size of 28' x 30' = 840 sq. ft. 5. The design data has been revised to indicate 10 rows of chambers spaced at 3.0' on center = 260 If. 6. A copy of the DEP Approval for remedial use has been included with this submittal. 7. Maintenance requirements have been added to page 1. 8. The soils encountered on the site were determined to be uncompacted. If you have any questions, or need additional information, please do not hesitate to contact this office. Sincerely, nlamm C. Osgood, Jr., P.E. President Commonwealth of Massachusetts City/Town of No. Andover a o Form 9A — Application for Local Upgrade Approval G N DEP has provided this form for use by local Boards of Health. Other forms may be used, but the information must be substantially the same as that provided here. Before using this form, check with your local Board of Health to determine the form they use. Form 9A is to be submitted to the Local Board of Health for the upgrade of a failed or nonconforming septic system with a design flow of less than 10,000 gpd, where full compliance, as defined in 310 CMR 15.404(1), is not feasible. Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. rab System upgrades that cannot be performed in accordance with 310 CMR 15.404 and 15.405, or in full compliance with the requirements of 310 CMR 15.000, require a variance pursuant to 310 CMR 15.410 through 15.415. NOTE: Local upgrade approval shall not be granted for an upgrade proposal that includes the addition of a new design flow to a cesspool or privy, or the addition of a new design flow above the existing approved capacity of an on-site system constructed in accordance with either the 1978 Code or 310 CMR 15.000. A. Facility Information 1. Facility Name and Address: David Higgenbottom Name 250 Farnham Street Street Address No. Andover City/Town 2. Owner Name and Address (if different from above): Same as Above Name City/Town Zip Code 3. Type of Facility (check all that apply): ® Residential ❑ Institutional 4. Describe Facility: Single Family Dwelling 5. Type of Existing System: MA 01845 State Zip Code Street Address State Telephone Number ❑ Commercial ❑ School ❑ Privy ❑ Cesspool(s) ® Conventional ❑ Other (describe below): 6. Type of soil absorption system (trenches, chambers, leach field, pits, etc): Leach Field Form 9A Application for Local Upgrade Approval revised.doc • rev. Application for Local Upgrade Approval* Page 1 of 4 7/06 4 Commonwealth of Massachusetts City/Town of No. Andover a Form 9A - Application for Local Upgrade Approval DEP has provided this form for use by local Boards of Health. Other forms may be used, but the information must be substantially the same as that provided here. Before using this form, check with your local Board of Health to determine the form they use. A. Facility Information (continued) 7. Design Flow per 310 CMR 15.203: Design flow of existing system: Design flow of proposed upgraded system Design flow of facility: B. Proposed Upgrade of System 1. Proposed upgrade is (check one): a-ff, gpd 440 gpd 440 gpd ❑ Voluntary ❑ Required by order, letter, etc. (attach copy) ® Required following inspection pursuant to 310 CMR 15.301: 2. Describe the proposed upgrade to the system: Replace leach field and system components 3. Local Upgrade Approval is requested for (check all that apply): ❑ Reduction in setback(s) — describe reductions: Unknown date of inspection ❑ 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 Percolation rate min./inch Depth to groundwater ft Form 9A Application for Local Upgrade Approval revised.doc • rev. Application for Local Upgrade Approval* Page 2 of 4 7/06 w� Commonwealth of Massachusetts City/Town of No. Andover a Form 9A - Application for Local Upgrade Approval M DEP has provided this form for use by local Boards of Health. Other forms may be used, but the information must be substantially the same as that provided here. Before using this form, check with your local Board of Health to determine the form they use. B. Proposed Upgrade of System (continued) ❑ Relocation of water supply well (explain): ❑ Reduction of 12 -inch separation between inlet and outlet tees and high groundwater K Use of only one deep hole in proposed disposal area ® Use of a sieve analysis as a substitute for a perc test ❑ Other requirements of 310 CMR 15.000 that cannot be met— describe and specify sections of the Code: If the proposed upgrade involves a reduction in the required separation between the bottom of the soil absorption system and the high groundwater elevation, an Approved Soil Evaluator must determine the high groundwater elevation pursuant to 310 CMR 15.405(1)(h)(1). The soil evaluator must be a member or agent of the local approving authority. High groundwater evaluation determined by: Randy Burley Evaluator's Name (type or print) Signature C. Explanation 3/24/08 Date of evaluation Explain why full compliance, as defined in 310 CMR 15.404(1), is not feasible. (Each section must be completed) 1. An upgraded system in full compliance with 310 CMR 15.000 is not feasible: No other location on the lot 2. An alternative system approved pursuant to 310 CMR 15.283 to 15.288 is not feasible: An alternative system is not cost prohibitive. Form 9A Application for Local Upgrade Approval revised.doc • rev. Application for Local Upgrade Approval• Page 3 of 4 7/06 Commonwealth of Massachusetts City/Town of No. Andover Form 9A - Application for Local Upgrade Approval �,M • •` DEP has provided this form for use by local Boards of Health. Other forms may be used, but the information must be substantially the same as that provided here. Before using this form, check with your local Board of Health to determine the form they use. C. Explanation (continued) 3. A shared system is not feasible: No other adjacent is available 4. Connection to a public sewer is not feasible: Public sewer is not available in the area. 5. The Application for Local Upgrade Approval must be accompanied by all of the following (check the appropriate boxes): ❑ Application for Disposal System Construction Permit ❑ Complete plans and specifications ❑ Site evaluation forms ❑ A list of abutters affected by reduced setbacks to private water supply wells or property lines. Provide proof that affected abutters have been notified pursuant to 310 CMR 15.405(2). ❑ Other (List): D. Certification "I, the facility owner, certify under penalty of law that this document and all attachments, to the best of my knowledge and belief, are true, accurate, and complete. I am aware that there may be significant consequences for submitting false information, including, but not limited to, penalties or fine and/or imprisonment for deliberate violations." Facility Owner's Signature Benjamin C. Osgood Jr. P.E. (Agent for Owner) Print Name New England Engineering Services; Inc. 1600 Osgood Streeet Preparer's address 01845 State/ZIP Code Form 9A Application for Local Upgrade Approval revised.doc • rev. 7/06 Date 6/5/08 Date No. Andover, MA City/Town (978)686-1768 Telephone Application for Local Upgrade Approval* Page 4 of 4 Page 1 of 1 DelleChiaie, Pamela From: DelleChiaie, Pamela Sent: Thursday, September 04, 2008 10:26 AM To: Osgood Ben (bosgood@neengineeringinc.com); Kimberly J. Brown (KBrown@NEengineeringinc.com) Subject: FW: 250 Farnham Street - Plan Disapproval From: noreply@yourcopier.com [mai Ito: noreply@you rcopier.com] Sent: Thursday, September 04, 2008 11:19 AM To: DelleChiaie, Pamela Subject: 250 Farnham Street - Plan Disapproval 9/4/2008 Blank DelleChiaie, Pamela Page 1 of 1 From: Marianne Peters[mpeters@millriverconsulting.com] Sent: Monday, June 30, 2008 1:32 PM To: 'Daniel Ottenheimer'; Isaac Rowe; Grant, Michele; DelleChiaie, Pamela; 'Randy Burley'; Sawyer, Susan Subject: rec'd 250 Farnham plan review in today's mail River Consulting < I Marianne Peters Office Manager ph 800-377-3044 ph 978-282-0014 fx 978-282-0012 web: www.miUriverconsultigg.com 6/30/2008 °f NORTH ,h 3364 O 9 . � w Town of North Andover `�.'•�;, o :. HEALTH DEPARTMENT ,SS4CMU56t CHECK #: m116 DATE: LOCATION: �"► 17 H/O NAME:.3i�',J C CONTRACTOR NAME: Type of Permit or License: (Check box) ❑ Animal $ ❑ Body Art Establishment $ ❑ Body Art Practitioner $ ❑ Dumpster $ ❑ Food Service - Type: $ ❑ Funeral Directors $ ❑ Massage Establishment $ ❑ Massage Practice $ ❑ Offal (Septic) Hauler $ ❑ Recreational Camp $ ❑ Sun tanning $ ❑ Swimming Pool $ ❑ Tobacco ' $ ❑ Trash/Solid Waste Hauler $ ❑ Well Construction" $ SEPTIC Systems: ❑ ,Septic - Soil Testing $ ��Septic - Design Approval $ ❑ 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 - Treasurer TOWN OF NORTH ANDOVER Office of COMMUNITY DEVELOPMENT AND SERVICES` HEALTH DEPARTMENT h '� 1600 OSGO OD STREET; BUILDING 20; SUITE 2-36 NORT:1-1: ANDOVER. MASSACHUSETTS 0:1.845 �Cr,� 978.688.9540 — Phone Susan Y. Sawyer, .RFHS/.RS 978.688.8476- FAX Public Health Director E-NIAIL:liealthde«t(i?,townofnortliandover.conl WEBSITE: lztt:p://Nv ww.tow-i..iofnortli indover.cona SEPTIC PLAN SUBMITTAL FORM Date of Submission:�()y�%Qr')� UN 2 7 2008 Site Location: darn Towfv car N -) TH A ,r • - HEALTH OEPArR`i ENTER Engineer: 6S New Plans? Yes X$225/Plan Check # (includes ls` submission and one re- review only) Revised Plans?Yes $75/Plan Check # Site Evaluation Forms Included? Yes No Local Upgrade Form Included? Yes No Telephone #: q 1 Fax #: Y79 - ,W -E-mail: U� D0� eery in r .coni, Homeowner Name: �GLUICI OFFICE USE ONLY When the sub ission is complete (including check): ➢ Date stamp plans and letter ➢ Complete and attach Receipt ➢ �/ Copy File; Forward to Consultant ➢ Enter on Log Sheet and Database NEw ENGLANDENGINEERING SERVICES, INK. 1600 Osgood Street Building 20 Suite 2-64 North Andover, MA 01843 'Irel: (978) 686-1768 • Fax: (978) 327-6138 www.neengineeringinc.com Ms. Susan Sawyer North Andover Board of Health 1600 Osgood Street North Andover, MA 01845 June 4, 2008 Project # 1506 — JUN 2 7 2006 TOWN OF NORTH.ANriOVSR HEALTH aEPA�TM NT Re: 250 Farnum Street, North Andover, MA Local Upgrade Approval Request & Local Bylaw Variance Request Dear Ms. Sawyer, The purpose of this letter is to request that the above referenced property be included in the upcoming Board of Health meeting agenda to discuss the following Local upgrade approval and Local Bylaw Variance request: Local Upgrade Approvals Required: . 1. Allow the use of a sieve analysis to determine loading rate in lieu of performing a percolation test. Title 5, section 15.405(1). Local Bylaw Variance Required: 1. Allow the use of an impervious barrier and segmental block retaining wall in lieu of constructing a poured concrete wall (NA 9.02) If you have any comments or questions please do not hesitate to contact this office. Sincerely, Befi amin C. C rsgojol r. P.E. President A I Commonwealth of Massachusetts City/Town of No. Andover Form 9A - Application for Local Upgrade Approval DEP has provided this form for use by local Boards of Health. Other forms may be used, but the information must be substantially the same as that provided here. Before using this form, check with your local Board of Health to determine the form they use. Form 9A is to be submitted to the Local Board of Health for the upgrade of a failed or nonconforming septic system with a design flow of less than 10,000 gpd, where full compliance, as defined in 310 CMR 15.404(1), is not feasible. System upgrades that cannot be performed in accordance with 310 CMR 15.404 and 15.405, or in full compliance with the requirements of 310 CMR 15.000, require a variance pursuant to 310 CMR 15.410 through 15.415. Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. ILEI NOTE: Local upgrade approval shall not be granted for an upgrade proposal that includes the addition of a new design flow to a cesspool or privy, or the addition of a new design flow above the existing approved capacity of an on-site system constructed in accordance with either the 1978 Code or 310 CMR 15.000. A. Facility Information 1. Facility Name and Address: David Higgenbottom Name 250 Farnham Street Street Address No. Andover MA 01845 City/Town State Zip Code 2. Owner Name and Address (if different from above): Same as Above Name City/Town Zip Code 3. Type of Facility (check all that apply): ® Residential ❑ Institutional 4. Describe Facility: Family Dwell 5. Type of Existing System: ❑ Privy ❑ Cesspool(s) Street Address State Telephone Number ❑ Commercial ❑ School ® Conventional ❑ Other (describe below): 6. Type of soil absorption system (trenches, chambers, leach field, pits, etc): Leach Field Form 9A Application for Local Upgrade Approval revised.doc • rev. Application for Local Upgrade Approval* Page 1 of 4 7/06 A f Commonwealth of Massachusetts City/Town of No. Andover o Form 9A - Application for Local Upgrade Approval .�� DEP has provided this form for use by local Boards of Health. Other forms may be used, but the information must be substantially the same as that provided here. Before using this form, check with your local Board of Health to determine the form they use. A. Facility Information (continued) 7. Design Flow per 310 CMR 15.203: Design flow of existing system: Design flow of proposed upgraded system Design flow of facility: B. Proposed Upgrade of System 1. Proposed upgrade is (check one): 440 gpd 440 gpd 440 gpd ❑ Voluntary ❑ Required by order, letter, etc. (attach copy) ® Required following inspection pursuant to 310 CMR 15.301 2. Describe the proposed upgrade to the system: Replace leach field and system components 3. Local Upgrade Approval is requested for (check all that apply): ❑ Reduction in setback(s) — describe reductions: ❑ Reduction in SAS area of up to 25%: SAS size, sq. ft. ❑ Reduction in separation between the SAS and high groundwater: Separation reduction Percolation rate Depth to groundwater Form 9A Application for Local Upgrade Approval revised.doc • rev. 7/06 ft. min./inch ft. Unknown date of inspection % reduction Application for Local Upgrade Approval* Page 2 of 4 Commonwealth of Massachusetts City/Town of No. Andover Form 9A - Application for Local Upgrade Approval DEP has provided this form for use by local Boards of Health. Other forms may be used, but the information must be substantially the same as that provided here. Before using this form, check with your local Board of Health to determine the form they use. B. Proposed Upgrade of System (continued) ❑ Relocation of water supply well (explain): ❑ Reduction of 12 -inch separation between inlet and outlet tees and high groundwater ❑ Use of only one deep hole in proposed disposal area ® Use of a sieve analysis as a substitute for a perc test ❑ Other requirements of 310 CMR 15.000 that cannot be met— describe and specify sections of the Code: If the proposed upgrade involves a reduction in the required separation between the bottom of the soil absorption system and the high groundwater elevation, an Approved Soil Evaluator must determine the high groundwater elevation pursuant to 310 CMR 15.405(1)(h)(1). The soil evaluator must be a member or agent of the local approving authority. High groundwater evaluation determined by: Randy Burley Evaluator's Name (type or print) C. Explanation Signature 3/24/08 Date of evaluation Explain why full compliance, as defined in 310 CMR 15.404(1), is not feasible. (Each section must be completed) 1. An upgraded system in full compliance with 310 CMR 15.000 is not feasible: No other location on the lot 2. An alternative system approved pursuant to 310 CMR 15.283 to 15.288 is not feasible: An alternative system is not cost prohibitive. Form 9A Application for Local Upgrade Approval revised.doc • rev. Application for Local Upgrade Approval• Page 3 of 4 7/06 w Commonwealth of Massachusetts City/Town of No. Andover Form 9A - Application for Local Upgrade Approval DEP has provided this form for use by local Boards of Health. Other forms may be used, but the information must be substantially the same as that provided here. Before using this form, check with your local Board of Health to determine the form they use. C. Explanation (continued) 3. A shared system is not feasible: No other adiacent is available 4. Connection to a public sewer is not feasible: Public sewer is not available in the area. 5. The Application for Local Upgrade Approval must be accompanied by all of the following (check the appropriate boxes): ❑ Application for Disposal System Construction Permit ❑ Complete plans and specifications ❑ Site evaluation forms ❑ A list of abutters affected by reduced setbacks to private water supply wells or property lines. Provide proof that affected abutters have been notified pursuant to 310 CMR 15.405(2). ❑ Other (List): D. Certification "I, the facility owner, certify under penalty of law that this document and all attachments, to the best of my knowledge and belief, are true, accurate, and complete. I am aware that there may be significant. consequences for submitting false information, including, but not limited to, penalties or fine and/or imprisonment for deliberate violations." Facility Owner's Signature Benjamin C. Osgood Jr. P.E. (Agent for Owner) Print Name New England Engineering Services; Inc. 1600 Osgood Streeet Preparer's address 01845 State/ZIP Code Form 9A Application for Local Upgrade Approval revised.doc • rev. 7/06 Date 6/5/08 Date No. Andover, MA City/Town (978)686-1768 Telephone Application for Local Upgrade Approval* Page 4 of 4 O C. U) A® }W}�� V/ V, U) L O N N v � N A V' � + .0 �.+ cn O P C E F E U U L1• CNSC PET�C 7 ❑ O O C O U +` C' O O(m U Fo > O Z tC � E L 4-^-0 C Y O O � � (2) E m z C: n m m m U C 0 U 7 El M, ON a) E m z ro E m z 'ri ❑ 19 E o Z Z c m J a) E m z ro E m z 'ri El C C 7 O O O L L L) >' > O O 7 LO LO 0 U � � 0 � O 0 0 LL a) E m z ro E m z 'ri M F- 0 0 Z 0 0 m El m E `o z [G, L OC 0 MW -o a� 3 N a� aa) U C N w (D Q) L Lel a� a� L Fl - Lo L U m Q� (J o - v �m U a '0 o �0 a. N d d C O LIE d .Q E m z 0 2 c 0 m � C y O S U O O CL J 0 d � r [0 ❑ Z L) 0 ❑ � a� cn m } ❑ C U N O N � C N O � U N O 0 (0 L co N El c N T J n 0 J J E J � � LL C O � t6 .. 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N 0) to t/) e N N N N m •ems cn '� c� cn o to ca , a� o �. c E0 E E 0 o O U U LL. M5� ILI" Soil and Plant Nutrient Testing Lab West Experiment Station University of Massachusetts Amherst, MA 01003 413.545.2311 http://www.umass.edu/plsoiWsoi ltest TEXTURAL ANALYSIS RESULTS Customer Name: New England Eng. Services 1600 Osgood Street, Suite 2-64 N. Andover, MA 01845 Sample ID: 75595 Customer Designation: 250 Farnum St, N. Andover, MA USDA SIZE FRACTIONS Main Fractions Size (mm) Percent Sand 0.05-2.0 70.3 Silt 0.002-0.05 23.9 Clay < 0.002 5.8 Total < 2.0 100.0 Sand Fractions Size (mm) Percent Very Coarse 1.0-2.0 4.7 Coarse 0.5-1.0 8.2 Medium 0.25-0.5 13.7 Fine 0.10-0.25 26.2 Very Fine 0.05-0.10 17.4 0.05 #270 70.3 Silt Fractions Size (mm) Percent Coarse 0.02-0.05 11.5 Medium 0.005-0.02 9.6 Fine 0.002-0.005 2.8 23.9 USDA Textural Class = fine sandy loam Gravel Content = 6.7% COMMENTS: 03/28/08 PERCENT OF WHOLE SAMPLE PASSING Size (mm) Sieve # 2.00 #10 93.3 1.00 #18 88.9 0.50 #35 81.2 0.25 #60 68.4 0.10 #140 44.0 0.05 #270 27.7 0.02 20 um 17.0 0.005 5 um 8.0 0.002 2 um 5.4 SEPTIC TANK EFFLUENT LOADING RATE WITH PRESSURE DISTRIBUTION gpd/sq.ft (cm/day) PERC. RATE SOIL CLASS (min./inch) CLASS I CLASS II CLASS III CLASS IV 10 - 0.63(2.6) - - 15 - 0.61(2.5) 0.41(1.7) - 20 - 0.58(2.4) 0.37(1.5) - 25 - 0.44(1.8) 0.36(1.4) - 30 - 0.38(1.6) 0.33(1.3) - 40 - 0.29(l.2) - 50 - - 0.25 (1.0) 0.25 (1.0) 60 - - 0.20 (0.8) 0.20 (0.8) 15.243: Types of Soil Textural Classes (1) The following soil textural classes apply to soil types of which they are composed: CLASS I Sands, Loamy Sands CLASS II Sandy Loams, Loams CLASS III Silt Loams, Sandy Clay Loams with less than 271/o clay, Silt CLASS IV Clays, Silty Clay Loams,_ Sandy Clay Loams with 27% or more Clay, ClayLoams and Silty Clays (2) Textural Classifications are made based on the relative proportion of sand, silt and clay in the soils and in accordance with the following textural triangle: t SOIL TEXTURAL TRIANGLE percent sand W* M Page 1 of 1 DelleChiaie, Pamela From: Marianne Peters[mpeters@millriverconsulting.com] Sent: Tuesday, March 25, 2008 3:29 PM To: 'Daniel Ottenheimer'; dobrzut@millriverconsulting.com; Grant, Michele; DelleChiaie, Pamela; 'Randy Burley'; Sawyer, Susan Subject: Soil Results -250 Farnum Street -March 24th Attached please find the soil eval results done yesterday @ 250 Farnum Street; please call if any questions. Thanks, MARIANNE PETERS OFFICE MANAGER MILL RIVER CONSULTING 2 BLACKBURN CENTER GLOUCESTER, MA O 1930 978-282-0014 PH 978-282-0012 FX WWW.MILLRIVERCONSULTING.COM 3/25/2008 YS 00 V) V) oz) \01 Q9, fs q DOM14. i 'tz4 RECEIVED _ T qq p j + i . (.)- 1 8LUU8 y i,U !:i :.1. tti li C j`� !� i% r_. .,'Ii;i:=.`� MAR i r 3 r N L.. ,_r!� p€ NORTH ANDOVER Q" ,_ < _. „! - . 1_ "_ _ .. . 20 9' - ? CONSERVATION COMMISSION ` '_ �1 F.i . ` ,..,. _ :` , r..._r.`-r �: I rs < > ^ _; 3 ; r : , _ !`3� :; : � �. i . I''�i =. '•fl : ��ri .. : ..+ (�' � 3 ' fj . _.e'?i„_r. ."it=. S:. s`�ii") =.i ?. v�y !,�.•h=m s:%: !`k:<j%�(; eT` ry.._. n r i.,.. ,o'il..,oi?orn ._._ .... ,. , Wnlull ( APPL I CAT! ON FOR SUI L TESTS I DATE.' �� pC� MAP PARCEL.- ID E' & i -,n,1 "F., !1:. 1 •:" . i', !' ! r LOCATION OF SOIL TESTS: A56 rG o haoi St, OWNER: N1i)_0 [6110b0thM Contact# q79 -LP -L,9-73 0V APPLICANT: Contact ADDRESS: ENGINEER: CERTIFIED SOIL EVALUATOR: I Intended Use of Land: Re identi2J Subdivision yl milyliorr Commercial IsThis: Repair Testing: L,�Undeveloped Lot Testing: Upgradefor Addition: In the Lake Cochichewick Watershed? Yes No THE FOLLOWING MUST BE INCLUDED WITH THISFORM `r Proof of land ownership (Tax bill, or letter from owner permitting test) A 8.5__x 11 —Plot plan & Location of Testing (pleaseindicatetest pit sites on the plan) Fee of $425.00 per lot for new construction. This coversthe minimum two deep holes and two percolation tests required for each disposal area Fee of$360,0 per lot for repairs or upgrades. GENERAL INFORMATION > Only Certified Soil Evaluators may perform deep hole inspections > Only Mass. Registered Sanitarians and Professional Engineers can design septic plans. v At least two deep holes and two percolation tests are required for each septic system disposal area Repairs requi re at leasttwo deep holes and at least one percof ati on test, I the discretion of the BOH representative. Full payment will berequired for ail additional testswithin two weeks of testing, Within 45 days of testing, a scsi ed pian (no smsi ler than 1 _ 100..) s3si l be submitted to the Board of Heath showing the location of all tests (including aborted tests). e Within 60 days of testing soil evaluation for ms shall be submitted, Please Do Not Write Below This Line N.A. Conservation Commission Approval Date: 3 (25 C o Signature of Conservation Agent: Date back to Health Department: (stamp in): Dale, )b b J,K �4 % X4 ,Jelle6hiaie, Pamela From: DelleChiaie, Pamela Sent: Tuesday, March 18, 2008 3:10 PM To: Daniel Ottenheimer (E-mail); Marianne Peters (E-mail); Randy Burley (E-mail) Cc: Wedge, Donna Subject: Soil Test Application - 250 Farnham Street -----Original Message ----- From: noreply@yourcopier.com [mai Ito:noreply@yourcopier.com] Sent: Tuesday, March 18, 2008 4:06 PM To: DelleChiaie, Pamela Subject: Message from KMBT_600 SKMBT_600080318 15050. pdf !j 3203 O 'wwwW Town of North Andover `�,••e,-;,; ;:•°h' HEALTH DEPARTMENT ,SSACHUSt4 ! %� CHECK #: �/� Xal DATE: 114e-- CHECK LOCATION: _ H/O NAME: _ CONTRACTC 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 SEPTLC"Sustems: CEJ' S/eptic - Soil Testing ❑ Septic - Design Approval ❑ Septic Disposal Works Construction (DWC) ❑ Septic Disposal Works Installers (DWI) ❑ Title 5 Inspector ❑ Title 5 Report .I CLjOV ER MOW Try �!Y �11••lD S"-R��1!�-E- E�} Ot .C� 3W 6t PN _ O 1 _ _ TOHEAOF NORTH In7• $. j6e• ems' ❑ Other: (Indicate) $ Health Agent Initia White - Applicant Yellow - Health Pink - Treasurer 91, &l{ :9510 Phone .�...�++ 97/8.688.8 47'6 F,4'\X1 RECEIVED vo'vw town.of r!Oihan'dov r., om MAR 17 2008 TOHEAOF NORTH In7• LTH DEPARTMENT RII,,CEL: hal), tact#. q79- 6 25 ,tact #. ntact - Commercial Upgrade for- Addition,.- No r nitti ng test) test pit sites on the plan) ,e mi ni mum two deep hol es and 3KOOper lot for repairsor upgrades. ATION tions. s can desi gn sept i c pl ans. I for each septic system disposal area ation test, at the di scret i on of the BOH vo weeks of testing. 00) shad I be submitted to the Board of Health bmitted Thisi-ine -� he c6� 0 PO added � 1 � � '•fir--- ��' f �� o � �hu� � /af , N..• 00 3 D 7 ° o� 0 jj7 o Q b d 0 F .�Q00 (� 61 rr • S S 60 c'cc �l v / TOWN OF SYSTEM PUMPING RECORD D DATE: t - ` -6)s SYSTEM OWNER & ADDRESS SEP 16 2005 I TOIWE QTH DEPART TER SYSTEM LOCATION (example: left front of house) M&I)se DATE OF PUMPING: �l QUANTITY PUMPED: CESSPOOL: NO YES SEPTIC TANK: NO YES NATURE OF SERVICE: ROUTINE OBSERVATIONS: GOOD CONDITION HEAVY GREASE ROOTS EXCESSIVE SOLIDS SOLIDS CARRYOVER EMERGENCY FULL TO COVER BAFFLES IN PLACE LEACHFIELD RUNBACK FLOODED OTHER (EXPLAIN) SYSTEM PUMPED BY: Bateson Enterprises, Inc. COMMENTS: CONTENTS TRANSFERRED TO: G.L.S.D Lowell Waste GALLONS