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HomeMy WebLinkAboutMiscellaneous - 326 FOREST STREET 4/30/2018ZIA +t« r Permit NO: Date Issued: BUILDING PERMIT TOWN OF NORTH ANDOVER ° APPLICATION FOR PLAN EXAMINATI N - Date Receiv°4 ed <•�•-K- 0 02 `7 ��SsgCHUS �y IMPORTANT: Applicant must all items on this LOCATIONS Co res. Print PROPERTY OWNER t�t,�`; •> Print MAP NO: ©G A PARCEL: ZONING DISTRICT: Historic District yes Cno Machine Shop Village yes TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑ Addition [I Two or more family ❑Industrial [I Alteration No. of units: 11 Commercial ❑ Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑ Well D Floodplain D Wetlands 0 Watershed District ❑ Water/Sewer I — � I Identification Please Type or Print Clearly) OWNER: Name: M�-r� ' �., Phone: to - 79q - o -t 7 Address: CONTRACTOR Name: Phone: 791-9,1q-94 u IL Q Address: Supervisor's Construction License: Home Improvement License: ��w Date: Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE: BULDING PERMIT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost: $ `'-1 FEE: $ Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of An I- IcAl is vvalved U TYPE OF SEWE GE DISPOSAL Public Sewer e]] ❑ Private (septic tank, etc. Certified Plot Plan ❑ Stamped flans ❑ TaRD-iRVMassage/BodyArt ❑ Tobacco Sales ❑ Permanent Dumpster on Site El Swllnlmimg Pools Food Packaging/Sales THE FOLLOWING SECTIONS FOR OFFICE USE O INTERDEPARTMENTAL SIGN ®FF m U F®Rf I NLY i PLANNING & DEVELOPMENT COMMENTS CONSERVATION COMMENTS HEALTH COMMENT Reviewed Reviewed o Reviewed On e us x Zoning Decision/receipt submitted yes Planning Board Decision: -- Comm Conservation Decision: WIter & Sewer Connection/sr natu Comments_ re � Date DPW Town Engineer: Signature: FIRE�DEPq o -9 edjat -J,24 Ma 5N et _ Te►T!P}Dumpster on.. ,yep `Fire{pep�rtment ��gnafure/date CO�IVTS SUMMARY OF' VERTS SEWER 0 FDTN. 94.47 6'OFF SEPTIC TANK IN SEPTIC TANK OUT 96.81 PUMP TANK IN 96.74 DIST. BOX IN 98.77 DIST. BOX OUT 98.59 INV. IN CHAMBER 98.50 BOTT. CHAMBER 98.22 wL N/F MILLER BUILDING TIES LDG. CORNER A' B C SEPTIC TANK OUT 38.0 24.7 — PUMP TANK OUT 40.3 34.4 - DIST. BOX 23.7 35.8 — D NO THIS THIS PLAN & CERTIFICATION IS NOT — A WARRANTY OF THE SUBSURFACE DISPOSAL — SYSTEM. IT IS A RECORD OF THE LOCATION — AND ELEVATION OF THE -.EXISTING SYSTEM COMPONENTS. "I HEREBY 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." APPROVED DESIGNS PLANS. SIGNATURE OF DESIGNER DATE i, �i, � • r � / I r TOWN LOT 13 r I Lia INSP. •,'�; PORT i0 GAL TIC TANr 40 N/F BIELIK �I�UMP T/IWK - D -80X l r-2 54.72' _ -- - �,�y 11930' FOR ES s�� WW/ACH FIELD 40 INFILTRATOR CHAMBERS AS BUILT PLAN OF SUBSURFACE DISPOSAL SYSTEM LOCATED IN NORTH ANDOVER, MASS. /326 FOREST STREET AS PREPARED FOR MARK BIONDI TM: 106A 8-18-14 TL: 13 SCALE: 1"=40' 0 20 40 80 MERRIMACK ENGINEERING SERVICES 66 PARK STREET ANDOVER, .MASSACHUSETTS 01810 PUBLIC HEALTH DEPARTMENT Town of North Andover Community Development Division CERTIFICATE OF COMPLIANCE Installation: 8/22/14 (Final grade inspection on 4/23/15) This is to certify that the individual subsurface disposal system received a SATISFACTORY INSPECTION of the: Complete Repair and Construction of an ®n -Site Sewage Disposal System By: John Butt At: 326 Forest Street Map 106A Lot 13 ,I, North Andover, MA 01845 The Issuance of this certificate-11all not be construed as a guarantee that the system will function satisfactorily. Michele Grant Public Health Agent 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com e NORry' ti P s i s �S$^CHUSEZ 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: Jo �,L) F. Name) Located at: "q,� �(J�/IfL (Installation Address) Was installed in conformance with the North Andover Board of Health approved plan, originally dated and last revised on za , with a design flow of —T 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. 112 ssJJ Bottom of Bed Inspection Date: Engineer Representative (Signature) And - Print Name (� e Final Construction Inspection Date: il'1 ` �. ifs Engineer Representative (Signature) �v And - Print Name (Signature) Date: Z -15 -lig' JOE110 -Caj--r-F And - Print Name Enginer: 1�fRIA(I (Signature) Date: And - Print Name 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web http://www.townofnorthandover.com Blackburn, Lisa From: Isaac Rowe <irowe@mill riverconsulting.com> Sent: Friday, August 22, 2014 3:44 PM To: Blackburn, Lisa; Sawyer, Susan Cc: 'Pam Lally'; 'Isaac Rowe' Subject: RE: 326 Forest Street Attachments: 326 Forest St - final inspection form.doc Susan, Attached is the final inspection form for the above referenced property. Everything looked and all risers/manhole covers were in place. John did a great job and had all components exposed and ready for inspection. I hope he does more work in town. Let me know if you have any questions. Thanks, Isaac M. Rowe, R.S. Project Manager Mill River Consulting 6 Sargent Street Gloucester, MA 01930-2719 Phone: 978-282-0014 ext.804 Fax: 978-282-1318 irowe(@miliriverconsultina.com www. millriverconsulting.com From: Blackburn, Lisa[mailto:LBlackburn(atownofnorthandover.com] Sent: Thursday, August 21, 2014 10:28 AM To: Dan Ottenheimer; Isaac Rowe; Pam Lally Subject: 326 Forest Street Good Morning, Please contact John Butt, 978-815-5754 for final construction inspection at 326 Forest St. Thank you. Lisa Blackburn Health Department Town of North Andover 1600 Osgood Street, Suite 2035 North Andover, MA 01845 Phone 978-688-9540 Fax 978-688-8476 Email IblackburnCa@townofnorthandover.com Web www.TownofNorthAndover.com 1 North Andover Health Department (ommunity Development Division ONSITE WASTEWATER SYSTEM CONSTRUCTION NOTES LOCATION INFORMATION ADDRESS: 326 Forest St. INSTALLER: John Butt MAP: 106A LOT: 13 DESIGNER: Merrimack Engineering PLAN DATE: 6/25/14 BOH APPROVAL DATE ON PLAN: 7/28/14 INSPECTIONS TANK INSPECTION: 8/11/14 DATE OF BED BOTTOM INSPECTION: 8/14/14 DATE OF FINAL CONSTRUCTION INSPECTION: 8/22/14 DATE OF FINAL GRADE INSPECTION: q 015 SITE CONDITIONS - Ok'd by B.D. X Contractor reports any changes to design plan X Existing septic tank properly abandoned X Internal plumbing all to one building sewer X Topography not appreciably altered Comments: 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 ® Weep hole plugged ® 1500 gallon tank has been installed H-10 loading ® Monolithic tank construction ® Water tightness of tank has been achieved by visual testing ® Inlet tee installed, centered under access port Z Outlet tee installed, centered under access port (effluent filter) ® 24" inch cover to within finish grade installed over outlet access port ® Neoprene boots around inlet & outlet Comments: PUMP CHAMBER ❑ Bottom of tank hole has 6" stone base ® Weep hole plugged ® 1000 gallon Pump Chamber installed ® H-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 ® 24" cover at final grade installed over pump access port ® Water tightness of tank has been achieved by Visual testing ® Neoprene boots around inlet & outlet Comments: CONTROL PANEL ® Alarm & Pump are on separate circuits ® Alarm sounds when float is tripped ® Location of control panel: basement ® Alarm signal located inside: basement Comments: DISTRIBUTION -BOX ® Installed on stable stone base ® H-20 D -Box ® Inlet tee (if pumped or >0.08'/foot) ® Hydraulic cement around inlet & outlets ® Observed even distribution ® Speed levelers provided (not required) ® Schedule 40 PVC Pipe Comments: 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 N/A Retaining wall (boulder / concrete / timber/ block) ❑ Final cover as per plan Comments: 51x48 SOIL ABSORPTION SYSTEM (Gravel -less Chambers) ® Brand and Model of Chamber: Standard Quick 4 Infiltrator Chambers Low Profile ❑ Number of chambers per row: 10 ❑ Number of rows (trenches): 4 Comments: Total Chambers = 40 FINAL GRADE Loamed %Seeded Q Cover per plan Comments: DOCUMENTS NEEDED Certification of Installation Form submitted By engineer and signed and dated by Engineer and installer As -Built Plan BM = 100.00 HR= 2.82 HI = 102.82 SYSTEM ELEVATIONS ROD ELEVATION AS -BLT INVERT ELEV DESIGN INVERT ELEV Benchmark Building Sewer OUT 5.05 ; 97.42 97.5 Septic Tank IN 5.44 97.03 97.00 Septic Tank OUT 5.69 96.78 96.75 Pump Chamber IN 5.75 96.72 96.70 2" Pump Chamber OUT 5.62 97.03 ------ 2") Distribution Box IN 3.90 98.75 98.70 Distribution Box OUT 3.90 98.57 98.53 Lateral 1 TOP 4.02 Lateral 1 INVERT 98.45 98.48 Lateral 2 TOP 4.02 Lateral 2 INVERT 98.45 98.48 Lateral 3 TOP 4.01 Lateral 3 INVERT 98.46 98.48 Lateral 4 TOP 4.00 Lateral 4 INVERT 98.47 98.48 Top of Chamber 98.87 98.87 Bottom of Bed/Chamberl 4.62 98.20 98.20 CRITICAL SETBACK DISTANCES Mark those distances checked in the field against the design plan and regulatory setback ' Suction line 222(2) z 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) z 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 BUILT CHECKLIST 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) `/ Lot number, Street Name, Assessors Map and Parcel Number 4) ✓ Lot Lines and Location of Dwellings served by the system 5) Z—Locations, Elevations and Dimensions of system, including reserve (if applicable) 6) Ties to dwelling or Permanent Structure & Wells a. From Septic Tank & istribution (D) Box b. From Leach Area / Ties to Lot Lines from leach area Locations of Deep Holes & Peres Top of Foundation Elevation T/ Locations of Wells, Drains, Watercourses within 150 feet of system 11) /Location of water, gas, electric lines, cable 12) " Location of Structures within 6 Inches of Finished Grade 13) '/ Original Stamp & Signature 14) Location and holder of any easements which could impact the system 15) ✓ Impervious Areas; Driveways, etc 16) '/ North Arrow 1' V Location & Elevations of Benchmark used 18) / STATEMENT ON PLAN (NA 5.3) a. "I certify the locations, elevations, ties, cover material; exposed component covers etc., shown on this as -built substantially agree with the approved plan and ha ve determined that the break out elevations, ifapplicable, 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 any manufacturer's ,,5pecifications." Signature of Designer Date As of: Tuesday, July 30, 2D13 Commonwealth of Massachusetts BOARD OF HEALTH North Andover P.I. F.I. Map-Block-Lot 106.A0013 ----------------------- Permit No BHP -2014-0728 ----------------------- FEE $250.00 ----------------------- DISPOSAL WORKS CONSTRUCTION PERMIT Permission is hereby granted John -Butt ------------------------------------------------------------------------------------------------- to (Construct) an Individual Sewage Disposal System. at No 326 FOREST STREET as shown on the application for Disposal Works Construction Permit No. B11P-20 A0 ----r— t ated August O1, 2014 FILE COPS Issued On: Aug -01-2014 BOARD OF HEALTH ---------------------------------------------------------------------------------- Telephone Number 3. Installer Information U0)►1 Q A)unttA s onit (ons r Name Name of Company r��3 t.As�l���r�►,,l ,� Address 13p)AA-P MA City/Town StateZip Code 176 81� S7s L/ Telephone Number (Cell Phone # if possible please) 4. Designer Information OIL( DV14ACkOsti MifA4fttilA( fN(frNlfjAi)W7 Name Name of Company 66 NAA li r Address M00 f," & AA l� %k City/Town State Zip Code Telephone Number (Best # to Reach) Application for Disposal System Construction Permit • Page 1 of 2 Application for Septic Disposal System W-/- / `I Construction Permit —TOWN OF TODAY'S DATE NORTH ANDOVER, MA 01845 $ 250.00 — Full Repair $125.00 - Component Important: Application is hereby made for a permit to: When filling out ❑ Construct a new on-site sewage disposal system* forms on the computer, use ❑ Repair or replace an existing on-site sewage disposal system* only the tab key to move your E]Repair or replace an existing system component —What? cursor - do not use the return A. Facility Information key. !� -32(m I;AdSr 91— Address or Lot # �0©:ri Jj01� �ICity/Town 2.- *TYPE OF SEPTIC SYSTEM*: AUGG 0 12014 ➢ ❑ Pump ❑ Gravity (choose one) ***If TOWN OF NORTH ANDOVER pump system, attach copy of electrical permit to application*** HEALTH DEPARTMENT ➢ ❑ 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) ➢ ❑ Pressure Dosed (D -Box Present) S.A.S. ➢ ❑ Does the system require an effluent filter? Yes No If yes, does plan specify make and model of filter? YES = (no further info, needed) NO = (installer must specify brand of filter before DWC issuance) What is the Make? What is the Model. 2. Owner Information Name 326 /v)Atfsr Address (if different from above) &AIK ANjbUI{r` /VLA ()/b 4,S City/Town State Zip Code Telephone Number 3. Installer Information U0)►1 Q A)unttA s onit (ons r Name Name of Company r��3 t.As�l���r�►,,l ,� Address 13p)AA-P MA City/Town StateZip Code 176 81� S7s L/ Telephone Number (Cell Phone # if possible please) 4. Designer Information OIL( DV14ACkOsti MifA4fttilA( fN(frNlfjAi)W7 Name Name of Company 66 NAA li r Address M00 f," & AA l� %k City/Town State Zip Code Telephone Number (Best # to Reach) Application for Disposal System Construction Permit • Page 1 of 2 p • •. Application for Septic Disposal System Construction Permit - TOWN OF TODAY'S DATE NORTH ANDOVER, MA 01845 $ 250.00 -Full Repair $125.00 -Component PAGE 2OF2 A. Facility Information continued.... 5. Type of Building: ❑Residential Dwelling or ❑Commercial B. Agreement The undersigned agrees to ensure the construction and maintenance of the afore -described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code, as well as the Local Subsurface Disposal Regulations for the Town of North Andover. I understand that until a final Certificate of Compliance has been issued by this Board of Health, the installed system is not approved. o cNr _3-1-1 zI Name Date Application App o d By: (Boar of Health Representative) Y///y 11 �t'Tf Name Date Application Disapproved for the following reasons: For Office Use Only: 1. Fee Attached? Yes No 2. Project Manager Obligation Form Attached? Yes No 3. Pump S sy tem? If so, Attach copy ofElectrical Permit Yes No 4. Reviewed approval letter, all paperworkreceived.? Yes No 5. Foundation As -Built? (new construction only): Yes_ No (same scale as approved plan). 6. Floor Plans? (new construction only): Yes No Application for Disposal System Construction Permit • Page 2 of 2 SEPTIC SYSTEM INSTALLER PROJECT MANAGEMENT OBLIGATIONS As the North Andover licensed installer for the construction for the septic system for the property at: 3 G � FoA 0s i 5T' (Address of septic system) Relative to the application of -John aifl, (Installer's name) Dated ej - U 1 - J It o ay s date For plans by V t—AP/ iR NCZM CMaNOK (Engineer) And dated 6-175- / � (Original ate With revisions dated 7-f (Last revis I understand the following obligations for management of this project: -/?,EQEIVE� date) AUG 01 2014 TOWN OF NORTH ANDOVER 1. As the installer, I am obligated to obtain all permits and Board of Health approved p HP iOr�E R.� TMENT 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 (1'� inspection unless there is a retaining wall, which should be done first. The installer must request the inspection but does not have to be present. b. Final Construction Inspection — Engineer must first do their inspection for elevations, ties, etc. As -built of verbal OK (or e-mail to: healthdel2t(@townofnorthandover.co from the engineer must be submitted to the Board of Health, after which installer calls for an inspection time. Installer must be present for this inspection. With a pump system, all electrical work must be ready and able to cause pump to work and alarm to function. c. Final Grade — Installer must request inspection when all grading is complete. Installer does not have to be on-site. 4. As the installer, I understand that only I may perform the work (other than simple excavation) and I am required to complete the installation of the system identified in the attached application for installation. I further understand that work done by others unlicensed to install septic systems in North Andover can constitute reasons for denial of the system and/or revocation or suspension of my license to operate in the Town of North Andover, significant fines to all persons involved are also possible. 5. As the installer, I understand that I must be on-site during the performance of the following construction steps: a. Determination that the proper elevation of the excavation has been reached. b. Inspection of the sand and stone to be used. c. Final inspection by Board of Health staff or consultant. d. Installation of tank, D -Box, pipes, stone, vent, pump chamber, retaining wall and other components. 6. As the installer, I understand that I am solely responsible for the installation of the system as per the approved plans. No instructions by the homeowner, general contractor, or any other persons shall absolve me of this obligation. Undersigned Licensed Septic Installer: 6.0(,/(( J OhA Ourr (Name — Print �) V-, 0 (Nark e igne (Today's Date) Commonwealth of Massachusetts Department of Fire Services BOARD OF FIRE PREVENTION REGULATIONS Official Usemy Permit No. Occupancy and Fee Checked [Rev. 1/071 (leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00 (PLEASE PRINT ININK OR TYPE ALL INFORMATION) Date: F , Ly I City or Town of. NORTH ANDOVER To the Inspector of *Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street & Number) idol A&C>'T Owner or Tenant O 0 V 7 Telephone No. Owner's Address s Is this permit in co nju ction with a building permit? Yes ❑ No ,n (Check Appropriate Box) Purpose of Building W ELf otAS d Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters p� New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed EIectrical Work:��� '�mlan�ftho,/��Z�u» --able may be waived by the Inspector of Wires. Date... `...1 ................... A O� NORTH °�a s3�CHU5E This certifies that !....0 TOWN OF NORTH ANDOVER has permission to perfor -- wiring in the buildin t .....,.� 2-.....z:�.s-�: ee .......... 0 .... ..�."'.,....... ic. No — ... Check #2—%-10 CHECK ONE: INSURANCE Icertify, cinder the s and FIRM NAME: _ AMA,< PERMIT FOR WIRING ;o. of Total ransformers KVA generators KVA o. of Emergency Lighting attery Units IRE ALARMS No. of Zones o. of Detection and Initiating Devices 0. of Alerting Devices b. of Self -Contained etection/Alertin Devices Kcal ❑ Municipal ElOther Connection ;curity Systems:* . No. of Devices or Equivalent ita Wiring: No. of Devices or Equivalent :lecommunications Wiring: . No. of Devices or E uivalent ............... or •` `'!r ad, or asrega�iredbythe Inspector of Wires. ELEC AL INSPECTOR V policy.) Rule 10, and upon completion. ace of electrical work may issue unless lge or its substantial equivalent. The I if ermit issuing office. peso ofperju , that�Infoorniation this Zication is true and complete. 0U2Ft0443,:1AQ 676 C7L AW LIC. NO.:�E- 16ig Licensee:l ),.I••t L -S Oyoy h I -_7;4Kj Signatufe'�-7_., LIC. NO.: � _ (If applicable, enter " xempt" in the Z' nse rber me.) Bus. Tel. No. - Iat �d '�� eA Address: 66" �W,—, . � , tl`� � f�E,rJ,:f-.U6 PA. (3 y Alt. Tel. No.: *Per M.G.L c. 147, s. 57-61, security work requires Department of Public Safety "S" License: Lic. No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent. Owner/Agent PERMIT FEE: $ !� Signature Telephone No. P-0. rEDI- COPY BRAT rL1R�,v North Andover Health Department (ommunity Development Division July 31, 2014 Mark Biondi 326 Forest Street North Andover, MA 01845 Re: Subsurface Sewage Disposal System Plan for 326 Forest St. Man 106A lot 13 Dear Mr. Biondi: The proposed wastewater system design plan for the above site dated June 25, 2014 with a final revision date July 28, 2014 and received on July 30, 2014 has been approved. The design has been approved for use in the construction of a replacement onsite septic system for a 4 -bedroom (max 9 -room) home. This plan is generally good for 3 -years from the date of approval however, as this is for a repair system, this is reduced to 2- years. The plan received the following local upgrade approval. 1) Use of only one deep hole as opposed to the two required 2) The use of a reduction of the distance from the SAS to the foundation from 20 to 15 feet. During this time, a licensed septic system installer must obtain a permit and complete this work, and a Certificate of Compliance be endorsed by the installer, designer and the Town of North Andover. In the event an imminent health problem, such as sewage backup into the dwelling is occurring, the North Andover Board of Health may reduce the time period for which this plan is valid. This approval is also subject to the following conditions: 1. Please keep the attached DEP Form 9b for your records (attached) 2. This system utilizes an infiltrator system and the owner has certified the understanding of this system, as found in the document submitted (see attached) 3. 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 Page 1 of 2 North Andover Health Department, 1600 Osgood Street, Suite 2035 North Andover, MA 01845 Phone: 978.688.9540 Fax: 978.688.8476 ti r - 326 Forest Street July 31, 2014 Permit is void, installation shall stop, and the applicant shall reapply for a new Disposal Systems Construction Permit (3 10 CMR 15.020(1)). 4. It is the responsibility of the applicant and/or the applicant's septic system designer, septic system installer or other representative to ensure that all other state and municipal requirements are met. These may include review by the Conservation Commission, Zoning Board, Planning Board, Building Inspector, Plumbing Inspector and/or Electrical Inspector. The issuance of a Disposal System Construction Permit shall not construe and/or imply compliance with any of the aforementioned requirements. Please feel free to contact the office with any questions you may have. We look forward to working with you to obtain a wastewater treatment and dispersal system which will be in compliance with all regulations and assure protection of public health and the environment of North Andover. Sincerely, Susan Y. Sawyer, REHS/RS Public Health Director Encl. Form 9B Owner Certification Local Installers List cc: Merrimack Eng. Services File Page 2 of 2 North Andover Health Department, 1600 Osgood Street, Suite 2035, North Andover, MA 01845 Phone: 978.688.9540 Fax: 978.688.8476 Commonwealth of Massachusetts City/Town of North Andover a Local Upgrade Approval Form 913 O 4M 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. Important: When filling out forms on the computer, use only the tab A. Facility Information 1. Facility Name and Address Mark Biondi key to move your Name cursor - do not use the return 326 Forest Street key. Street Address North Andover MA 01845 City/Town State Zip Code 2. Owner Name and Address (if different from above): Name Street Address City/Town State Zip Code Telephone Number 3. Type of Facility (check all that apply): x Residential ❑ Institutional ❑ Commercial ❑ School 4. Design flow per 310 CMR 15.203: 440 gpd 5. System Designer: Vladimir NemchenokName PE 15 66 Park Street Andover NH 01810 Address City/Town State, ZIP B. Approval 1. Local Upgrade Approval is granted for: ® Reduction in setback(s) — specify: Setback from the SAS to the foundation; from 20 feet to 15 feet ❑ Reduction in SAS area of up to 25%: SAS size, sq. ft. % reduction 326 Forest Street Local Upgrade Approval* Page 1 of 2 Commonwealth of Massachusetts City/Town of North Andover N �Y a Local Upgrade Approval Form 9B 4M 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): List variances granted requiring DEP approval: North Andover Health Dept Approving Authority Susan Sawyer July 31, 2014 Print or Type Name and Title Signature Date 326 Forest Street Local Upgrade Approval* Page 2 of 2 v 0 N r M ti z z I O � � O C> o 00 C:) N N N O� ,� d 01 ,� O ^, M 00 00 O ,-a O '-r �' O .--i O M 00 '� - N O O Q r� 0�0 M O 00 O 00 00 00 '"( N � 00 O 00 O? z 00 M O W4 O Q� O O O O CD Q x z O Q d Q w z z Q O z a W �O z z Z a Z w ¢ H H H Q O w w O O O >x O H w c), w w w w >xx O H H 'zo Uz O WO OzQQ� 9zZHzO1 Oz O Q� O O°O zz w -1f�dr�iT �lddcn Q1WrnQ T�g'z O M V) M kn 00 N ',O om= V) ID knlzj- M V) O 00 O O oo O N O y O N M M 01 �p r N N a1 �O " [-- d a\ - d 00 GO - N M O \O N 00 M M M O to — M d d O N'n N 00 O d-O� �O 00 O �O �O 00 � � �D d- l- M Ln � al O "0N � 00 V)Q1 M kn Ln t--00 M 4A M a\ l-- � kn A 4 �,O N d = � 01 = V) N t t 00 "O \O 00 00 00 00 M 00 .-i 00 00 M 00 00 DD 00 M 00 00 00 00 00 00 M M 00 00 00 00 M C1 c1 O\ c \O O1 t- O\ Vl \,D O> C1 O\ C', �c V) C1 O\ Q, 01 C1 \,c �'O O\ Cl C\ D\ W J LUJ Q N O cl) N N .3CL =~N m= ct Co OZ0 WD > W ° = m o 0 a U' N U y C O = O U O�=d .0 O LL � a1�...coDn >NU U) csUa: Z�W cd Q O W W b4 cd .c G > > m 0 0 0 0 m O O Q. 0: ¢maavQQQtitititititititi•� 0 00 aa�wxr���HH3 3 July 29, 2014 Susan Sawyer Director of Public Health 1600 Osgood Street Building 20, Suite 2035 North Andover, MA 01845 RE: 326 Forest Street Dear Ms. Sawyer, RECD IVO JUL 3U 2014 TOWN OF NORTH ANDOVER HEALTH DEPARTMENT As owner of the above referenced property, I hereby certify to the following: 1.) I have been provided with a copy of the Title 5 UA technology Approval letter dated May 22, 2014, the Owner's Manual, an the Operation and Maintenance Manual for Infiltrator Chambers and I agree to comply with all the terms and conditions. 2.) I understand and accept this approval does not allow use of a garbage grinder. 3.) I understand the requirement to repair, replace, modify or take any action required by D.E.P. or the Local Approving Authority if the D.E.P. or the Local Approving Authority determine the system to be failing to protect health, safety, or the environment. I hereby certify to the above. 7 36 ZIt prop rty owner: Mark Biondi date: Bill Dufresne Merrimack Engineering Services, Inc. •66 Park Street • 907 Ocean Blvd. -Andover, MA 01810 • Hampton, NH 03842 •(978) 475-3555 Ext. 20 • Cell: (978) 502-6206 Fax: (978) 475-1448 Email: brdufresne@comcast.net LETTER OF TRANSMITTAL RECEIVED 30 2014 TOWN OF NORTH ANDOVER HEALTH DEPARTMENT TO: Susan Sawyer DATE: 7-29-14 North Andover BOH RE: 326 Forest Street NO. DESCRIPTION 3 Revised 7- 28-14 WE ARE SENDING YOU: ( ) PRINTS (x ) PLANS ( ) SPECIFICATIONS ( )COPY OF LETTER COPIES DATE NO. DESCRIPTION 3 Revised 7- 28-14 Subsurface Sewage Disposal System Plan THESE ARE TRANSMITTED as checked below (x ) FOR APPROVAL ( ) FOR YOUR USE ( ) AS REQUESTED ( ) FOR REVIEW AND COMMENT ( ) APPROVED AS SUBMITTED ( ) RESUBMITTED REMARKS Plans have been revised to address all comments in letter dated 7-22-14 Please note that the approval letter for Infiltrators specifically states that notification is not required at time of property transfer as mentioned in 6. d (2) of your review letter. Thanks, SIGNED: i North Andover Health Department (ommunity Development Division July 22, 2014 Vladimir Nemchenok Merrimack Engineering Services 66 Park Street Andover, MA 01810 Re: Subsurface Sewage Disposal System Plan for 326 Forest Street, Man 106A, Lot 13 Dear Mr. Nemchenok: The proposed wastewater system design plan for the above site dated June 25, 2014 and received on June 26, 2014 has been reviewed. Unfortunately, the plan cannot be approved until the following items are corrected. The specific section in Title 5: 310 CMR 15.000, or North Andover regulation that is not met by this design follows each item. Please provide for the brand and model effluent filter which you propose to have used and indicate the need for annual maintenance (3 10 CMR 15.227(7)). 2. Please indicate the outlets for the distribution box are to be at the same elevation (3 10 . / CMR 232(3)) V 3 Please provide greater clarity for the site contractor regarding the inlet tee inside the distribution box including dimensions of piping, distances from top and bottom of box and other relevant features t,,4. Please provide a performance curve for the pump specified (3 10 CMR 15.220(4)) Please indicate the grade over the soil absorption system is to be at a minimum 2% slope (3 10 CMR 15.240(10)) Since the Infiltrator Chamber system is proposed as an alternative soil absorption system c/ the "Standard Conditions for Alternative Soil Absorption Systems with General Use Certification and/or Approved for Remedial Use" will apply. Please provide the following as required by the approval conditions: Section II(7): e) The record drawings, approved by the LAA, must clearly indicate an area for the best feasible replacement system that could be installed in the event that the Page 1 of 2 North Andover Health Department, 1600 Osgood Street, Suite 2035, North Andover, MA 01845 Phone: 978.688.9540 Fax: 978.688.8476 proposed Alternative Soil Absorption System fails or it is determined that it is not capable of providing equivalent environmental protection; Section II(18): a) proof that the Designer has satisfactorily completed any required training by the Company for the design and installation of the Technology; c) certification by the Designer that the design conforms to the Approval, any Company Design Guidance, and 310 CMR 15.000; and d) a certification, signed by the Owner of record for the property to be served by the Technology, stating that the property Owner: 1. has been provided a copy of the Title 511A technology Approval, the Owner's Manual, and the Operation and Maintenance Manual, and the Owner agrees to comply with all terms and conditions,- 2. onditions;2. for Systems installed under a Remedial Use Approval, the owner agrees to fulfill his responsibilities to provide written notification of the Approval to any new Owner, as required by 310 CMR 15.287(5); 3. if the design does not provide for the use of garbage grinders, the restriction is understood and accepted; and 4. whether or not covered by a warranty, the System Owner understands the requirement to repair, replace, modify or take any other action as required by the Department or the LAA, if the Department or the LAA determines the System to be failing to protect public health and safety and the environment, as defined in 310 CMR 15.303. Please feel free to contact the office 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. Sawv , REHS/RS Public He cc: Mark Biondi File Page 2 of 2 North Andover Health Department, 1600 Osgood Street, Suite 2035, North Andover, MA 01845 Phone: 978.688.9540 Fax: 978.688.8476 Blackburn, Lisa From: Dan Ottenheimer <dano@millriverconsulting.com> Sent: Tuesday, July 22, 2014 2:54 PM To: Sawyer, Susan; Grant, Michele; Blackburn, Lisa Cc: 'Isaac Rowe'; Pam Lally Subject: Plan Disapproval, 326 Forest Street Attachments: Disapproval Letter - 326 Forest Street.docx Attached please a plan disapproval letter associated with the design plan for the wastewater system at this property. Please let me know if you have any questions. Dan Mill River consulting !';vd tnp�nx^_nn� .�, Cne!ronmmn4al Pae r+ytte.ng W =+nr�3�nAP {pvupomrnCe! I!eaP1h Cnnt4rit�n� Daniel Ottenheimer, President Mill River Consulting, Inc. 6 Sargent Street Gloucester, MA 01930-2719 978-282-0014 x 802 www.millriverconsulting.com dano@millriverconsulting.com Member: Massachusetts Association of Onsite Wastewater Professionals, Massachusetts Environmental Health Association, Cape Ann Chamber of Commerce, Gloucester Rotary Club, New England Water Environment Association 1 TOWN OF NORTH ANDOVER �' `�• Office of COMMUNITY DEVELOPMENT AND SERVICES r HEALTH DEPARTMENT' A'p.tritif a'Yr'� 1600 OSGOOD STREET; SUITE 2035 NORTH ANDOVER, MASSACHUSETTS 01845 978.688.9540 — Phone Susan Y. Sawyer, REHS/RS 978.688.8476— FAX Public Health Director E-MAIL: healthdept(a�townofnorthandover.com WEBSITE: http://www.townofnorthandover.com SEPTIC PLAN SUBMITTAL FORM Date of Submission: Site Location: & {2,E �T �� e7r Engineer: i' {1�1 � �� 1,Pfg -t00 New Plans? Yes___Z_$225/Plan Check # (includes 1St submission and one re- review only) Revised Plans?Yes $75/Plan Check # Site Evaluation Forms Included? Yes Vl/ No Local Upgrade Form Included? Yes / No Telephone #:(13 0) '4?2- -`2 5e, S Fax #:_ E-mail: I,-1 f, 0 U N YCE l j 2g ,g-1 CAM Homeowner Name: HAK4 ID DPh, OFFICE USE ONLY When the submi ion is complete (including check): ➢ _Date stamp plans and letter ECEIVED ➢ L/ Complete and attach Receipt ➢ Copy File; Forward to Consultant ➢ Enter on Log Sheet and Database UN 2 6 2014 OF NORTH ANDOVEf� [HEALTHDEPARTMENT _ Commonwealth of Massachusetts City/Town of North 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. Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. �JQI 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. 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: Mark Biondi Residence Name 326 Forest Street Street Address North Andover City/Town 2. Owner Name and Address (if different from above): SAME Name City/Town Zip Code 3. Type of Facility (check all that apply): ® Residential ❑ Institutional 4. Describe Facility: 4 BDRM House 5. Type of Existing System. ❑ Privy ❑ Cesspool(s) L0 State Street Address State (617) 794-0972 Telephone Number ❑ Commercial ❑ School 01845 Zip Code ® Conventional ❑ Other (describe below): 6. Type of soil absorption system (trenches, chambers, leach field, pits, etc): Field t5form9a.doc • rev. 7/06 Application for Local Upgrade Approval* Page 1 of 4 Commonwealth of Massachusetts City/Town of North 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. 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): Unknown 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: Total Replacement (see plan) 3. Local Upgrade Approval is requested for (check all that apply): ® Reduction in setback(s) — describe reductions: S.A.S. to the fdtn. from 20' to 15' ❑ 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 ft. min./inch ft. date of inspection % reduction t5form9a.doc • rev. 7/06 Application for Local Upgrade Approval* Page 2 of 4 Commonwealth of Massachusetts City/Town of North Andover o Form 9A - Application for Local Upgrade Approval wM 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: Evaluator's Name (type or print) Signature Date of evaluation C. Explanation Explain why full compliance, as defined in 310 CMR 15.404(1), is not feasible. (Each section must be completed) 1. An upgraded system in full compliance with 310 CMR 15.000 is not feasible: Limited space given all the site constraints 2. An alternative system approved pursuant to 310 CMR 15.283 to 15.288 is not feasible: NA t5forrn9a.doc • rev. 7/06 Application for Local Upgrade Approval* Page 3 of 4 Commonwealth of Massachusetts City/Town of North 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. C. Explanation (continued) 3. A shared system is not feasible: NA 4. Connection to a public sewer is not feasible: None Available 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." /W'w &/ 6-26-14 Facili y Owner's Signature Date Mark Biondi Print Name Bill Dufresne/Merrimack Engineering Services Name of Preparer 66 Park Street Preparer's address MA / 01810 State/ZIP Code 6-26-14 Date Andover Citylrown (978) 475-3555 Telephone t5form9a.doc • rev. 7/06 Application for Local Upgrade Approval* Page 4 of 4 O v 0 OD w o z 3 G) � m O O cQ N m O D v v� CD •J CD CID z O c Q N 0 CD v cn 9 IMP -o c R N c s Q CD =- x CD O Q O O C m ❑ vz m n J j cn C 7G El 0 v cn v CL m m cn co w v v 0 O 0 co c c > D ?t > - m 3 0 OG 3 m cD O =r CD O CL o \ O 0 O > . m 0 D CA CD (D O.�o m r+ m N m �CrIl O O =Dh N n N (D N OCD O N ar O. N N 0) JIM C) N N a1 m 7 Q 1 0 n� z o m m Z a a N E] CL o v 0 0 v � O m = c c ai a v a o. m O_ N 7 J J 0 ❑ ❑ (D C O — ❑ O O (nN :3G) � a -G -! 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CD m CA (A G m c m 0 r CID �CD<im u,n v0 o o c - . Q� CD �N QocL3 o �3m o � CD M N CL cr 7 O O a v CD (D O 3 ;L N Q- 3 N cr < N c C-) (OD v M a cn XZ (CD 0 V1 3 CD 71 OfD r CD 0 o a, CD3 c c m m tQ Q7 ::r N o' < O `< =i CD 3 O 0 0 N tv < ,N► M CD O E = :E0 o .-: O 3 j t0/! CD C 7 @ a CL C n O N rt CD Q. 0 Q 0 s O X Z7 � N O7 Q NO Cl) cD -4 °• w o mOL o O X Z. CDD 0 =3 7 O T7 0 — O CD 3 ,7 o o O �3 0 0 0 CD (n O S 0. 3 O D h = o (AA CID c) Cr CD y Y/ O 1 O V+ (D SCl) 0) to _v N� .a O U) 0) Commonwealth of Massachusetts City/Town of North Andover Percolation Test Form 12 �M Percolation test results must be submitted with the Soil Suitability Assessment for On-site Sewage Disposal. DEP has provided this form for use by local Boards of Health. Other forms may be used, but the information must be substantially the same as that provided here. Before using this form, check with the local Board of Health to determine the form they use. Important` A. Site Information When filling out forms on the i computer, use Lz only the tab key Owner Name to move your ?9& cursor - not Street Address or Lot # use the return _ t ,� � key. 1 � A+ Citylrown St to rip Code Contact Person (if different from Owner) Te phon—ewer B. Test Results Date Time Date Time 1. Observation Hole # 1 O Depth of Perc10-o Start Pre -Soak. t End Pre -Soak Time at 12" Time at 9" +� Time at 6" Time (9"-6") Rate (Min./Inch) Test Passed: Test Passed: ❑ Test Failed: ❑ Test Failed: ❑ Test Performed By: , Witnessed By: Comments: t5form12.doc• 06/03 Perc Test • Page 1 of 1 A lCommonwealth of Massachusetts Executive Office of Energy & Environmental Affairs Department of Environmental Protection One Winter Street Boston, MA 02108.617-292-5500 DEVAL L. PATRICK RICHARD K. SULLIVAN JR. Governor Secretary DAVID W. DASH Commissioner APPROVAL FOR GENERAL USE Pursuant to Title 5, 310 CMR 15.000 Name and Address of Applicant: Infiltrator Systems, Inc. P.O. Box 768 6 Business Park Road Old Saybrook, CT 06475 Trade name of technology and model: High Capacity chamber, Quick4 High Capacity chamber, Quick4 High Capacity HD chamber, Quick4 Plus High Capacity chamber (8 -inch invert), Quick4 Plus High Capacity chamber (13 -inch invert), Standard chamber, Quick4 Standard chamber, Quick4 Standard HD chamber, Quick4 Plus Standard chamber (5.3 -inch invert), Quick4 Plus Standard chamber (8.0 -inch invert), Quick4 Plus Standard LP (Low Profile) chamber (3.3 -inch invert), Quick4 Plus Standard LP (Low Profile) chamber (8 -inch invert), Infiltrator 3050 (Storm Tech SC -740) chamber, Equalizer 24 chamber, Quick4 Equalizer 24 chamber, Equalizer 36 chamber, Quick4 Equalizer 36 chamber, Quick4 Equalizer 24 LP (Low Profile) chamber (6 inch invert), and Quick4 Equalizer 24 LP (Low Profile) chamber (2 inch invert) (hereinafter the "System"). Schematic drawings of the System and a design and installation manual are a part of this Certification. This approval allows the installation of the above identified chambers without aggregate. Transmittal Number: X259183 Date of Revision: May 22, 2014 Authority for Issuance Pursuant to Title 5 of the State Environmental Code, 310 CMR 15.000, the Department of Environmental Protection hereby issues this Certification to: Infiltrator Systems, Inc., P.O. Box 768, 6 Business Park Road, Old Saybrook, CT 06475 (hereinafter "the Company"), for General Use of the System described herein. The sale, design, installation, and use of the System are conditioned on compliance by the Company, the Designer, the Installer and the System Owner with the terms and conditions set forth below. Any noncompliance with the terms or conditions of this Approval constitutes a violation of 310 CMR 15.000. ojd--� May_ 22, 2014 David Ferris, Director Date Wastewater Management Program Bureau of Resource Protection This information is available in alternate format. Call Michelle Waters-Ekanem, Diversity Director, at 617-292-5751. TDD# 1-866-539-7622 or 1-617-574-6868 MassDEP Website: www.mass.gov/dep Printed on Recycled Paper Infiltrator Chamber, Infiltrator Inc. Approval for General Use — May 22, 2014 Page 2 of 6 I. Design Standards 1. The models listed in Table 1 are covered under this Certification. Table 1: Chamber Dimensions Model Dimensions W x L x H Inches Invert Height Inches Equalizer 24 15 x 100 x 1.1 6 Quick4 Equalizer 24 1.6 x 48 x 1.1 6 Quick4 Equalizer 24 LP 6 -inch invert 16 x 48 x 8 6 Quick4 Equalizer 24 LP (2 -inch invert) 1.6 x 48 x 8 2 Equalizer 36 22 x 1.00 x 13.5 6 Quick4 Equalizer 36 22 x 48 x 12 6 Standard Chamber 34 x 75 x 12 6.5 Quick4 Standard 34 x 48 x 12 8 Quick4 Standard HD 34 x 48 x 12 8 Quick4 Plus Standard 5.3 -inch invert 34 x 48 x 12 5.3 Quick4 Plus Standard 8 -inch invert 34 x 48 x 12 8 Quick4 Plus Standard LP 3.3 -inch invert 34 x 48 x 8 3.3 Quick4 Plus Standard LP 8 -inch invert 34 x 48 x 8 8 Infiltrator 3050 or StormTech SC -740 51 x 85.4 x 30 22.25 High Capacity Chamber 34 x 75 x 16 11 Quick4 High Capacity 34 x 48 x 16 11.5 Quick4 High Capacity HD 34 x 48 x 16 11.5 Quick4 Plus High Capacity 8 -inch invert 34 x 48 x 14 8 Quick4 Plus High Capacity 13 -inch invert 34 x 48 x 14 13 1 Includes Infiltrator MultiportTM invert adapter attached to the side of the end cap. 2Includes Quick4 Plus Periscope adapter attached to the top of the Quick4 Plus All -in - One 8 Endcap. 3 Only systems installed with this invert height shall be allowed to use the effective leaching area associated with this model in Table 2 4Includes Quick4 Plus Periscope adapter attached to the top of the Quick4 Plus All -in - One 12 Endcap. 2. The System is an open -bottom leaching unit molded from polyolefin resin. It can be installed without aggregate or distribution pipe as an absorption trench or as a bed or field. If the System is installed with stone aggregate then the "Effective Leaching Area" in Tables 2 and 3 is not applicable, and must be designed in accordance with the provisions of 310 CMR 1.5.000. 3. The total effective leaching area for any Chamber Model shall be calculated by multiplying the Effective Leaching Area per square foot of chamber times the total length of chamber from end cap to end cap including end caps. Infiltrator Chamber, Infiltrator Inc. Approval for General Use — May 22, 2014 Page 3 of 6 4. For new construction or upgrades, the applicant can size the System in a trench configuration, using the effective leaching areas presented in Table 2. Table 2: Effective Leaching Area in Trench Configuration for New Construction and Remedial Sites Model Effective Leaching Area SF/LF Effective Leaching' Area SF/LF Equalizer 24 3.76 N/A Quick4 Equalizer 24 3.90 N/A Quick4 Equalizer 24 LP 6 -inch invert 3.90 N/A Quick4 Equalizer 24 LP 2 -inch invert) 2.78 N/A Equalizer 36 4.73 N/A Quick4 Equalizer 36 4.73 N/A Standard Chamber 6.53 N/A Quick4 Standard 6.96 N/A Quick4 Standard HD 6.96 N/A Quick4 Plus Standard 5.3 -inch invert) 6.20 N/A Quick4 Plus Standard (8 -inch invert) 6.96 N/A Quick4 Plus Standard LP (3.3 -inch invert) 5.65 N/A Quick4 Plus Standard LP 8 -inch invert 6.96 N/A Infiltrator 3050 or StormTech SC -740 N/A 6.71 High Capacity Chamber 7.79 N/A Quick4 High Capacity 7.93 N/A Quick4 High Capacity HD 7.93 N/A Quick4 Plus High Capacity 8 -inch invert 6.96 N/A Quick4 Plus High Capacity (13 -inch invert) 7.93 N/A '. Effective April 21, 2006, 310 CMR 15.251(1)(b) maximum trench width is 3 feet. 6 Effective leaching area is equal to 1.67 (bottom width + (2x invert height)) for Systems 3 feet or less in width. '. Effective leaching area is equal to 1.0 (3 + (2x invert Height)) for Systems with a width greater than 3 feet. 8. The maximum trench width allowed to calculate effective leaching area is 3 feet. 5. Systems installed on remedial sites shall be allowed to utilize the effective leaching areas presented in Tables 2 or 3, or additional reductions in soil absorption system may be allowed. In no instance shall the reduction in the soil absorption system required in 310 CMR 15.242 exceed the maximum reduction allowed for alternative systems approved in accordance with 310 CMR 15.284. 6. For new construction or an upgrade, the applicant can size the System in bed or field configuration, using the effective leaching areas presented in Table 3. OP Infiltrator Chamber, Infiltrator Inc. Approval for General Use — May 22, 2014 Page 4 of 6 Table 3: Effective Leaching Area for Bed or Field Configuration New Construction and Remedial Sites Model Effective Leaching Area SF/LF Equalizer 24 2.09 Quick4 Equalizer 24 2.23 Quick4 Equalizer 24 LP 6 -inch invert 2.23 Quick4 Equalizer 24 LP 2 -inch invert 2.23 Equalizer 36 3.06 Quick4 Equalizer 36 3.06 Standard Chamber 4.73 Quick4 Standard 4.73 Quick4 Standard HD 4.73 Quick4 Plus Standard 5.3 -inch invert) 4.73 Quick4 Plus Standard 8 -inch invert 4.73 Quick4 Plus Standard LP 3.3 -inch invert 4.73 Quick4 Plus Standard LP 8 -inch invert 4.73 Infiltrator 3050 or StormTech SC -740 7.10 High Capacity Chamber 4.73 Quick4 High Capacity 4.73 Quick4 High Capacity HD 4.73 Quick4 Plus High Capacity (8 -inch invert) 4.73 Quick4 Plus High Capacity (13 -inch invert) 4.73 9. Effective Leaching area is equal to 1.67 times bottom width only. 7. When the System is used with a secondary treatment unit approved in accordance with 310 CMR 15.284 or 15.288, additional reductions in soil absorption system may be allowed. In these situations the reduction in the SAS cannot exceed the maximum allowed under the secondary treatment units approval. In no instance shall the reduction in the soil absorption system area required in 310 CMR 15.242 exceed the maximum reduction allowed for alternative systems approved in accordance with 310 CMR 15.284. II. Special Conditions 1. The System is an approved Alternative Chamber for use as an Alternative Soil Absorption System. In addition to the Special Conditions contained in this Approval, the System shall comply with the "Standard Conditions for Alternative SAS with General Use Certification and/or Approved for Remedial Use" (the 'Standard Conditions'), except where stated otherwise in these Special Conditions. 2. New Construction This Certification is for the installation of a System to serve new construction or an existing facility with a proposed increase in flow, for Infiltrator Chamber, Infiltrator Inc. Approval for General Use — May 22, 2014 Page 5 of 6 which a site evaluation in compliance with 310 CMR 15.000 has been approved by the Approving Authority and the site meets the siting requirements for new construction, as provided in Paragraph 6 in section II Design and Installation Requirements of the Standard Conditions. 3. Remedial Site This General Use Certification also applies to the installation of a System for the upgrade or replacement of an existing failed or nonconforming system, provided that the facility meets the siting requirements for upgrades, as provided in Paragraph 7 in section II Design and Installation Requirements of the Standard Conditions 4. The System shall be exempt from the minimum inlet spacing requirements of 310 CMR15.253. 5. The System shall have a minimum of one inspection port through the top of one of the chambers. The inspection port shall be capped with a screw type cap and accessible to within three inches of finish grade. 6. When the System is installed in trench configuration, then the system shall comply with these requirements: a) Length (each trench) 100 feet maximum (310 CMR 15.251(1)(a)); b) Width (each trench) 2 feet minimum to 3 feet maximum (310 CMR 15.251(1)(b)). - Chambers greater than 3 feet wide, when specifically approved, are subject to other Special Conditions and limitations; c) The minimum separation distance between any two trenches shall be two times the effective width or depth of each trench, whichever is greater, or where the area between trenches is designated as reserve area, three times the effective width or depth of each trench, whichever is greater (310 CMR 15.251(1)(d)); d) The effective leaching area shall be calculated using the bottom area and a maximum of two feet (per side) of side wall area for each trench (3 10 CMR 15.251(1)(e)); e) Trenches shall be situated, where possible, with their long dimension perpendicular to the slope of the natural soil. Where possible they shall follow the contour lines (3 10 CMR 15.251(2)); f) Trenches constructed at different elevations shall be designed to prevent effluent from the higher trench(es) flowing into the lower trench(es) (310 CMR 15.251(3)); g) The area between trenches may be designated as system reserve area only where the separation distance between the excavation sidewalls of the primary trenches is at least three times the effective width or depth of each trench, whichever is greater (3 10 CMR 15.251(4)) - Chambers greater than 3 feet wide, when specifically approved, shall be separated by three times the actual width and are subject to other Special Conditions and limitations; and Infiltrator Chamber, Infiltrator Inc. Approval for General Use — May 22, 2014 Page 6 of 6 h) Effluent distribution lines exceeding 50 feet in length shall be connected and venting provided in accordance with 310 CMR 15.241 (3 10 CMR 15.251(11)). 7. When installed in trench configuration, approved Alternative Chambers greater than 3 feet wide: a) shall be installed with a minimum separation distance between any two trenches of two times the actual width of the chamber, or where the area between trenches is designated as reserve area, three times the actual width of the chamber; and b) shall only be entitled to a maximum effective width of 3 feet for the purposes of calculating total effective leaching area. 8. When installed in a bed or field configuration, the System may be installed without distribution piping, but must comply with the following requirements in 310 CMR 1.5.252: a) the use of leaching beds or fields is restricted to systems with a calculated design flow of less than 5,000 gpd per leaching bed or field (3 10 CMR 1.5.252(1)); b) the maximum length of chambers in series shall be 1.00 feet (310 CMR 15.252(2)(b)); c) separation distance between adjacent beds/fields shall be ten feet (310 CMR 15.252(2)(f)); and d) the effective leaching area shall include only the bottom area, not the sidewalls (3 10 CMR 15.252(2)(1)). 9. For Systems constructed in fill and installed, the System shall be installed as specified in 310 CMR 15.255- Construction in Fill, except the minimum 15 foot horizontal separation distance to be provided between the soil absorption area and the adjacent side slope shall be measured horizontally from the top of the chamber. 10. The System is exempt from 310 CMR 15.287, specifically items: (5) requiring written notification of alternative system prior to property transfer; (6) need for a certified operator, (9) need for an operation and maintenance contract with an operator and (10) deed notice requirement. Project: Customer: Material Source: Material Location: Bentley Warren Bentley Warren Dayton Sand & Gravel Stockpile Dayton Sand & Gravel Co., Inc. 928 Goodwin Mills Road, Dayton, Maine 04005.7352 1.800.339-2700 or 1.207.499.2306 Fa>c1.207.499.7102 Date: Tested By: Material Description: Specification: Wednesday, July 16, 2014 Marco Stone Washed Sand C33 (Ell) Fine Aggregate (Modified) 11 aiR��+�n�f���1►�cawii�...+ItiRffRice���inR��sl.aii����ifn�fl�f��1 if R:fl�f�lff�ff.lfffi�H'i M1a Ham. i' ffflfifH���ifNfHfn���� ■fflfl/ffl=�i:�Qfl�fi�L33•�1�1��ilIR� �fH'f•��■f���f�ff�� .1 i�f[flailftfH�1��H7�i1>•}EO��'Mfffl��nR111111111111 IUMMUS ii=Hz='.��� ■f/ft�ff3s����IriHiI�1�'RO��.���iH■t�f•�(� �i�if'Hft» itiflfl��[ti��p'�'�� �`(iG�■AH'!f/�t� ■f'f[�. �� fMffMff/IlNM:M�iff�ltt�YlHiQQHfffffi�A%tdlill'nft!�•l:ii1Iafttl�=f���ff�ifiDlaf��fif�►�i!�'f.��Ai`ltl.���t i�■iitt7�QH�FfRi�7flf�fH�flYSof�MMUIM_W�`tw�Mtl 01 111111111111111 t■1Rmf• Nit �f���f�f'�����i���� iii�i■Riff�fHHiHH� �=f=�f�����ff�=�if�f�f••f[fiffi•ff�•f�A<'�.����� �W110 9[w"MfK�1� ■�A�1•ff'�� ■■� in HEM �l��Hi!•■IfRIiOf�ff�ifviL�ftt�fs''��itilr�f•fff��;� �w�Vil'fRi�'�fff•��if '�f•'���� ■- ff)tifff�lA�f■H■il,fllfl#�7�■N9RkYi1[fflfff■�f�i'f�'f•�� ■'fH����nYnt ntl<tY1•���!'�i;���n:'��'.<II� 1 �fZOnnMM FYrti1f01sas=_=_��� ■iHnnt'�.1Rf��� �tlnt�s`��� Rt�'ff �)t'ff=� Q�i1fRl�ftf�f •i7 ■R�� iftt���>,�tYf=ilml�ftff��inrla,� ��■�s'i�ntffin•I�ff�'� 1 fftSM�1t1�71�H=Rf1=it��CHf�f,\'f1��i� �yflfi�ffRi1�1�Q■ff fflt=i:�� fla;�l.�ff�'� ���_�� ■1•frfi�IMMUN m\ffl�Hf�fiff�'��.�� f•►Vf,7Hff���■ n��sf���� ommmf 1[Y<igltl��.ffH■��iH�flfff•Hfifff� �■fH�i/t'�� "ftp ���� QYaYt=:�� iA [YA � �\�■�OiRR��=f�i�� 1■fltr���nfrfn�nf��ni��r��ri.���rn��fn�ff�■����u���f��f�ff� ifff•��ffl�»7��NMMUiM41 WIN 1 iiH,tel!=I��:�Qi'Ritf••[tltSa�i]nA(�f�f<!f!>.7d1ifR f1 ntin�� Win) ff 1 t Htf1 ��f� iNRntIMMEN man tOil- - IM iStan MMM11 1 illi= �� Nei ,�fBHt � MUIR" 8�11��111110■0iil�i� �- �■ S�ff1=��i��N'iRil� ��ltf•��f•ftilPlt�f•�f��■fHt����� �1QIiin'M1�=f�l'i��+a 1 iitfl�ffH•f�H��Iff illt��iff��iHiflfffNMEMIMMEM lfff■�1•.Y 11 Gradation Analysis Sieve Size Inch mm Passing Specification 1/2" 12.5 100.0 7/16" 11.2 100.0 3/8" 9.5 100.0 100 1/4" 6.3 100.0 #4 4.75 99.7 95 100 #8 2.36 89.3 80 100 #16 1.18 70.3 50 - 85 #20 0.85 58.5 #30 0.6 45.9 25 60 #50 0.3 20.5 5 30 #100 0.15 5.6 0-10 #200 0.075 1.2 0 - 2 TOWN OF NORTH ANDOVER Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT 1600 OSGOOD STREET; SUITE 2035 NORTH ANDOVER, MASSACHUSETTS 01845 Susan Y. Sawyer, RENS, RS Public Health Director 978.688.9540 — Phone 978.688.8476 — FAX www.townofnorthandover RECEIVED MAY 21 2014 APPLICATION FOR SOIL TESTS LN OF NORTH ANDOVER 'HEALTH DEPARTMENT DATE: � �?�� — � MAP &PARCEL: � D LOCATION OF SOIL TESTS: .,9 OWNER: Contact #: 77 c — L0 9 7Z APPLICANT: 1--1 Contact #: ADDRESS: 32,& *Kz f? � ENGINEER: NCr f&l,I4CIC rP6,10i t/V t4 Contact#: C0—/a,) 4f 7�� ����� X-ZP CERTIFIED SOIL EVALUATOR: N (.t,2b i" //C G 5is 1 6 2az) Intended Use of Land: Residential Subdivision Single Family Ho Commercial / Is This: Repair Testing: V Undeveloped Lot Testing: t Upgrade for Addition: In the Lake Cochichewick Watershed? Yes No THE FOLLOWING MUST BE INCLUDED WITH THIS FORM ➢ Proof of land ownership (Tax bill, or letter from owner permitting test) ➢ 8.511x 11 " Plot plan &c Location of _Testing (please indicate test nit sites on the Plan ➢ Fee of $425.00 per lot for new construction. This covers the minimum two deep holes and two percolation tests required for each disposal area. Fe of $360 .00 per. lot for repairs or upgrades. GENERAL INI ATION ➢ Only Certified Soil Evaluators may perform deep hole inspections. ➢ Only Mass. Registered Sanitarians and Professional Engineers can design septic plans. ➢ At least two deep holes and two percolation tests are required for each septic system disposal area. ➢ Repairs require at least two deep holes and at least one percolation test, at the discretion of the BOH representative. ➢ Full payment will be required for all additional tests within two weeks of testing. ➢ Within 45 days of testing, a scaled plan (no smaller than 1"-100') shall be submitted to the Board of Health showing the location of all tests (including aborted tests). ➢ Within 60 days of testing soil evaluation forms shall be submitted. Please Do Not Write Below This Line N.A. Conservation Commission Approval Datyl: 0-- t q Signature of Conservation Agent.VU I Date back to Health Department: (stamp in): res Form LCE -)2. 1M ID44A7990"i enj 33531A PLAN OF LAND IN NORTH ANDOVER Brasseur Associates, Sarveyors av1.y 1964 x ,axS�4&&kyplfi rt aar �Q�s CLOCI C€MM 01)—A:.1a--- �Oa R'tt�11 bOt7A'.�.�P-- Copy Ifo 4p an LAN!D,Rf /� s OFFICE Scale offh)s plan 6v fret fo an inch C.M. Anderson, bWowr &Court✓.q Blackburn, Lisa From: Blackburn, Lisa Sent: Tuesday, May 27, 2014 5:49 PM To: Dan Ottenheimer; Isaac Rowe; Pam Lally Cc: Bill Dufresne Subject: 326 Forest Street Attachments: 20140S271754.pdf Good Afternoon, Attached is an application for soil testing at 326 Forest Street. Please contact Bill Dufresne to set up a date. Thank you. -----Original Message ----- From: noreply@townofnorthandover.com [mailto:noreply@townofnorthandover.comj Sent: Tuesday, May 27, 2014 5:55 PM To: Blackburn, Lisa Subject: Message from "ComDev-Health-Ricoh" This E-mail was sent from "ComDev-Health-Ricoh" (Aficio MP C3002). Scan Date: 05.27.201417:54:58 (-0400) Queries to: noreply@townofnorthandover.com Please note the Massachusetts Secretary of State's office has determined that most emails to and from municipal offices and officials are public records. For more information please refer to: http://www.sec.state.ma.us/pre/preidx.htm. Please consider the environment before printing this email. 1 SUMMARY OFANVERTS SEWER ® FDTN. 94.47 6'OFF SEPTIC TANK IN SEPTIC TANK OUT 96.81 PUMP TANK IN 96.74 DIST. BOX IN 98,77 DIST. BOX OUT 98.59 INV. IN CHAMBER 198.50 BOTT. CHAMBER 1 98.22 BUILDING TIES LDG. CORNER _A B C SEPTIC TANK OUT 38.0 24.7 - PUMP TANK OUT 40.3 34.4 - DIST. BOX 23.7 35.8 - D, -NOTE: THIS PLAN & CERTIFICATION IS NOT - A WARRANTY OF THE SUBSURFACE DISPOSAL - SYSTEM. IT IS A RECORD OF THE LOCATION - AND ELEVATION OF THE . EXISTING SYSTEM COMPONENTS. "I HEREBY 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." APPROVED DESIGNS PLANS. 11-"401wz d�10 &6� a /�' SIGNATURE OF DESIGNER DATE 0 ry�0 C �( N/F \ N/F MILLER BIELIK tp oi . ry. dust. f rp.100. C . ZO INSP. VENT PORT 1$00 GAL. SEPTIC TANr +� X000 GA� 40 D—BOX N PUMP T#fNK T `119.30' 54.72 POI M T STRW l LEACH40 INFILTRATOR CHAMBERS AS BUILT PLAN OF SUBSURFACE DISPOSAL SYSTEM LOCATED IN NORTH ANDOVER, MASS. /326 FOREST STREET AS PREPARED FOR MARK BIONDI TM: 106A 8-18-14 TL: 13 SCALE: 1"=40' 0 20 40 80 MERRBUCK ENGINEERING SERVICES 66 PARK STREET ANDOVER, MASSACHUSETTS 01810