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Miscellaneous - 333 RALEIGH TAVERN LANE 4/30/2018
Lot & Street CONSTRUCTION APPROVAL Has plan review fee been paid: YES NO Permit# Plan Approval: Date: l /� Approved by: Designer: ��j(j Plan Date: Conditions: Water Supply: Well Permit: Well Tests: Chemical Bacteria I Bacteria H Plumbing. Sign -Off: Comments: Town. Form "U" Approval: Date Issued Conditions: Well _ Driller: Da-pproved Date=Ap owed_ Date-Appro d_ -Wiring S Approval to -Issue: By: Final Approval: All Permits Paid? _Well. Construction..Approyal?� Septic System Construction Approval? Certification? Other Any Variance Needed? FINAL BOARD Off' HEALTH APPROVAL: DATE: APPROVED BY: YES \ NO e::�T-S -' NO YES NO YESID CYES'� NO NO NO YES NO SEPTIC SYSTEM INSTALLATION y Is the installer licensed? LOS NO Type of Construction: NEW REPAIR,— New EP.AIR,-New Construction: - _Certified Plot Plan Review YES NO -Floor Plan Review YES NO — Conditions of Approval from Form U YES NO _Issuance of DWC permit:- Ry" ES: NO _DWC Permit Paid?`�' - - -- .S NO. ---DWC-Permit # Installer: Begin.. Inspection:_ _ _ /� YES NO _ _Excavation Inspection: _ - Needed: Construction Inspection: Needed: Plan Satisfactory: _ Approval of Backfill: ---Final Grading Approval Date: By: f Date:,,, By. Final Construction Approval: Date: By: , Certificate of Compliance: Approval: 6.3 Date: North Andover Board of Assessors Public Access µoR7y Drt j7��e ,�ry0 »�> y ;. C HU��°' Return to the Home page click on logo New Search Sales Summary Residence Detached Structure Condo Commercial Comparable Sales Town of I4orth Andover Ekoard of Assossors Parcel ID: 210/107.A-0125-0000.0 SKETCH Click on Sketch to Enlarge Page 1 of 1 Property Record Card Community: North Andover PHOTO Location: 333 RALEIGH TAVERN LANE Owner Name: SHEA, THOMAS F MARYBETH L SHEA Owner Address: 333 RALEIGH TAVERN LANE City: NORTH ANDOVER State: MA ZIP: 01845 Neighborhood: 7 - 7 Land Area: 1.12 acres Use Code: 101 - SNGL-FAM-RES Total Finished Area: 1388 sqft ASSESSMENTS CURRENT YEAR PREVIOUS YEAR Total Value: 449,900 431,300 Building Value: 212,400 215,500 Land Value: 237,500 215,800 Market Land Value: 237,500 Chapter Land Value: LATEST SALE Sale Price: 223,500 Sale Date: 12/30/1997 Arms Length Sale Code: Y -YES -VALID Grantor: M ELAINE MICHAUD Cert Doc: Book: 04930 Page: 0284 http://csc-ma.us/NandoverPubAcc/jsp/Home.jsp?Page=3&Linkld=991543 7/18/2007 f� r Deed Notice 333 Raleigh Tavern Lane, North Andover, Massachusetts, further described at the Essex North Registry of Deeds BookrQ Page -M, has a Micro FAST septic system which was installed in October of 1998. C This system is manufactured by: Bio-Microbics 8271 Melrose Drive Lenexa, KS 66214 and is distributed by: CA J & R Sales & Service, Inc. 44 Commercial Street Raynham, MA02767 Regulations governing the use and maintenance of the above -referenced system are pursuant to Title V of the Massachusetts General Laws, 310 CMR 15.00 and through the North Andover Board of Health. i -$sect r,7/?j acvIlckde 1 � CSS ber gee oc� O;lj A&M -k('411) sha l� jy rr c � 140V 5 198 -m'2:18 �aej-'3-om It Y ESSEX NORTH REGI.' RY D� L AIVRENCE, MASS. A TRUE COPY: ATTEST: w Postal ServiceTM CERTIFIED M!TI 2 M.R, -■ (Domestic Mail Only; Coverage Provided) C3 OFFIC�AL USE Postage $ 147 ri C3 Certified Fee �16 C3 C3 Return Receipt Fee (Endorsement Required) . Postmaric HereVl C3 Restricted Deliver' Fee r=1 (E.d.ent Required) .. Ln is ru Total Postage & Fees O Sent To F C3 !Cz, or PO Box No. --------- --------- State.City - A/M Certified Mail Provides: r�(es�ensy)'�ooZeunp'aotiE�o�sd ■ A mailing receipt. s A unique Identifier for your maiipiece ■ A record of delivery kept by the Postal Service for two years Important Reminders: ■ Certified Mail may ONLY be combined with First -Class Mail® or Priority Mail®. ■ Certified Mail is not available for any class of International mail. m NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables, please consider Insured or Registered Mail. o For an additional fee, a Return Receipt may be requested to provide proof of delivery. To obtain Return Receipt service, please complete and attach a Return Receipt (PS Form 3811 to the article and add applicable postage to cover the fee. Endorse maiipiece 'Return Receipt Requested". To receive a fee waiver for a duplicate return receipt, a USPS® postmark on your Certified Mail receipt is required. s For an additional fee, delivery may be restricted to the addressee or addressee's authorized agent. Advise the clerk or mark the mailpiece with the endorsement "Restricted Delivery" n If a postmark on the Certified Mail receipt is desired, please present the arti- cle at the post office for postmarking. If a postmark on the Certified Mail receipt is not needed, detach and affix label with postage and mail. IMPORTANT: Save this receipt and present it when making an inquiry. Internet access to delivery information isnot available on mail addressed to APOs and FPOs. ■ Complete items 1, 2, and 3. Also complete item 4 if Restricted Delivery is desired' ■ Print your name and address on the reverse so that we can return the card to you. ■ Attach this card to the back of the mailpiece, or on the front if space permits. Article Addressed to: ,�.z,�s� G r A. Sig ur Aant ddressee B. Received by (Printpt( l*me) C_ pate qf_Delivery D., 1; d ddress different from item 1? ❑ A(e: / I . E 46livery address below: ❑ No '3. a. m Q`c i Ob�d Mail ❑ Express Mail ❑ Registered ❑ Return Receipt for Merchandise ❑ Insured Mail ❑ C.O.D. 4. Restricted Delivery? (Extra Fee) ❑ Yes 2. Article Number t 7004. 2510 0001 6602 2800 (Pansfer from service labeq l l l• t l 1 '. t PS Form 3811, February 2004 Domestic Return Receipt 102595-02-M-1540 UNITED STATES PQ1YtYbE EX.,E5r S; _. 14 y mail a ,yes Paid • Sender: Please print your name, address, and ZIP+4 in this box • NORTH ANDOVER HEALTH DEPT:. 1600 Osgood StrZK6�, Building 20, Suite _ North Andover, MA 01845 MAR 2 1 2007 ��r` C PUBLIC HEALTH DEPARTMENT Community Development Division March 12, 2007 Mr. Thomas Shea Or Current Homeowner 333 Raleigh Tavern Lane North Andover, MA 01 845 Re: Wastewater Treatment Services Dear Current Homeowner, This correspondence is in regards to the Micro FAST septic system that is servicing the property at 333 Raleigh Tavern Lane. The North Andover Health Department has been notified, and have since confirmed, with Wastewater Treatment Services, Inc. that there is currently no contract for services for this property with their company. If you have switched service companies, please contact the Health Department, within seven days of receipt of this letter, with a copy of your current contract. Operation of this septic system without a maintenance contract is a violation of the MA Department of Environmental Protection code, 310 CMR 15.287. (see attached information and documentation) Your prompt response to rectify this violation, without the need of further action by this office, will be greatly appreciated. Thank u, usa Sawyer, REHS/RS7 Public Health Director Encl. Letter dated February 2, 2007 Copy 310 15.287 I/A fact sheet Deed notice 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 918.688.9540 Fax 918.688.8416 Web www.townofnorthandover.com PUBLIC HEALTH DEPARTMENT Community Development Division March 12, 2007 Mr. Thomas Shea Or Current Homeowner 333 Raleigh Tavern Lane North Andover, MA 01 845 Re: Wastewater Treatment Services Dear Current Homeowner, This correspondence is in regards to the Micro FAST septic system that is servicing the property at 333 Raleigh Tavern Lane. The North Andover Health Department has been notified, and have since confirmed, with Wastewater Treatment Services, Inc. that there is currently no contract for services for this property with their company. If you have switched service companies, please contact the Health Department, within seven days of receipt of this letter, with a copy of your current contract. Operation of this septic system without a maintenance contract is a violation of the MA Department of Environmental Protection code, 310 CMR 15.287. (see attached information and documentation) Your prompt response to rectify this violation, without the need of further action by this office, will be greatly appreciated. Thank u, usa Sawyer, REHS/RS7 Public Health Director Encl. Letter dated February 2, 2007 Copy 310 15.287 I/A fact sheet Deed notice 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 918.688.9540 Fax 918.688.8416 Web www.townofnorthandover.com February 2, 2007 Mr. Thomas Shea 333 Raleigh Tavern Lane North Andover,MA 01845 44 Commercial Street Raynham, MA 02767 Tel: (508) 880-0233 Fax: (508) 880-7232 Re: Serial Number: MCF156 Location: 333 Raleigh Tavern Lane, North Andover, MA Dear Mr. Shea: We understand you do not wish to continue your maintenance contract with our company. Please be advised the Massachusetts Department of Environmental Protection requires a maintenance contract be in place for the life of the alternative septic system. Also, we are required to inform both the state and local agency of your decision. If you have any questions or need additional information please call our office at (508) 880-0233. Sincerely, Donna L. Callahan Copy to: Massachusetts DEP North Andover Board of Health 1600 Osgood Street North Andover, MA 01845 310 CMR DEPARTMENT OF ENVIRONNEEWAL PROTECTION 15.286: continued (10) Should the Department disapprove general use of the alternative system which was provisionally approved, any person wishing to use such system may file a permit application for use of the alternative system pursuant to 314 CMR 5.00 (groundwater permitting). Disapproval under 310 CMR 15.286 shall not prejudice any action on an application pursuant to 314 CMR 5.00. (11) The conditions established in 310 CMR 15.287 apply to any use of a provisionally approved alternative system. (12) If at any time the local Approving Authority or the Department determines that an alternative system that has been installed pursuant to a provisional approval is failing or has failed, enforcement action may be taken. (13) It shall be a violation of310 CMR 15.000 to make a false representation that an alternative system has been approved for provisional use. 15.287: General Conditions for Use of Alternative Systems Pursuant to 310 CMR 15.294 through 15.286 The following conditions shall apply to all uses of alternative systems pursuant to 310 CMR 15.284 through 15.286: (1) All plans and specifications shall be designed in accordance with 310 CMR 15.220 (2) Any required operation and maintenance, monitoring and testing plans shall be submitted to the Department and approved prior to initiation of the use. Monitoring and sampling shall be performed in accordance with a Department approved plan. Sample analysis shall be conducted by an independent U.S. EPA or Commonwealth of Massachusetts approved testing laboratory, or an approved independent university laboratory, unless otherwise provided in the Department's written approval. It shall be a violation of 310 CMR 15.000 to omit from a report or falsify any data collected pursuant to an approved testing plan. (3) The facility served by the alternative 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) The Department and/or the local Approving Authority may require the owner or operator ofthe system to cease operation ofthe system and/or to take any other action necessary to protect public health, safety, welfare and the environment. (5) The owner or operator shall provide written notice to any new owner or operator that the system is an alternative system. Such notice shall include notice of the general conditions and any special conditions applicable to the system and its owner. (6) The owner or operator, or the proponent ofthe alternative system, shall obtain and provide the Department with a determination from the board of certification of operators of wastewater treatment facilities established pursuant to M.G.L. c. 21, § 34A as to whether a certified operator is required for operation of the alternative system. The Department shall waive this requirement if it has on file a determination for the alternative system, and shall notify the owner, operator, or proponent of the determination. (7) It is a violation of 310 CMR 15.000 to install, construct, or operate an alternative system except in full compliance with the written approval and 310 CMR 15.287. (8) The Department may require the issuance of a groundwater discharge permit pursuant to 314 CMR 5.00 (groundwater discharge program) for any alternative system. (9) The system owner shall maintain an operation and maintenance contract with a Massachusetts certified operator where one is required by 257 CMR 2.00, or otherwise with a person qualified to operate and maintain the system in accordance with the Department's written approval. Ma s s a c h u s e t t s D e p a r t m e n t ENVIRONMENTAL P R O T E C T 1 0 N fact sheet Innovative and Alternative (I/A) On -Site Septic Systems For most Massachusetts homes without access to municipal sewers, septic systems provide for on-site wastewater treatment and disposal. However, site limitations can make it difficult to replace a failing cesspool or septic system with a conventional septic system that will meet state standards. Innovative/Altemative (1/A) on-site systems can help address these situations: • They are generally better than conventional septic systems at removing solids and other pollutants from wastewater before it goes to the soil absorption system (SAS). • The SAS following an I/A technology can be expected to have a longer life. • I/A technology can also provide advanced treatment to reduce the wastewater's nitrogen content. For this reason, nitrogen reducing systems may be required for new home construction near a private or public water supply well or other nitrogen - sensitive areas. Whether your home already has an I/A system or you are thinking about installing one, it's important to get acquainted with the basics: what your alternatives are, how they work, what they cost to install and maintain, what is required to stay in compliance with Title 5 (the State Environmental Code), and who you can tum to for additional information and assistance. VA Systems: the Basics Before any I/A technology can be used in Massachusetts, it must be reviewed and approved by the Department of Environmental Protection (DEP). Before it can be installed at a particular site in a given community, the local board of health needs to review and approve plans prepared by a qualified designer who is either a registered professional engineer or a registered sanitarian. In certain instances, the site-specific local approval must then be sent to DEP for concurrence and final authorization. Both local and state environmental officials involved in the approval process are responsible for ensuring that the proposed system meets local requirements, which may be more stringent than DEP's; that the selected I/A technology will perform at least as well as, if not better than, a conventional septic system; and that the installation is done in accordance with all the requirements of Title 5. As of June 2001, DEP had approved nearly 50 different I/A on-site technologies for use in Massachusetts, and DEP and local boards of health had approved more than 1,350 individual installations across the state. DEP's website has detailed information on approved technologies (see last page of this brochure for web addresses). Have an I/A on-site system already? You need to know what kind of technology it employs, keep good records on the system's location, and be sure to operate and maintain it properly. DEP requires that owners of I/A systems have a maintenance contract with a specifically licensed individual or company. ------- A--- 4 -11 Want to investigate I/A on-site technologies? Your first stop should be the office of your local board of health. There, you will learn about local requirements for on-site systems, possible restrictions on the use of I/A on- site technologies, background information about environmental conditions in your community, and information on qualified on-site wastewater system design professionals. No matter what type of system you want to install for on-site wastewater treatment and disposal, you will need to work with a qualified system designer to make the right decisions and to produce plans that can be submitted to obtain local and, if necessary, DEP approval. Here are some initial questions to ask the designer. • Should I install an I/A system? • What are my technology options? • What are the local and state approval requirements? • How much will it cost me to install, operate and maintain an I/A technology as opposed to a conventional septic system? Mmmadwseft Department of Once you have identified one or more specific technologies to consider, you should Environmental Protection ask additional questions of the designer. One Winter street • How many of these systems are operating in Massachusetts? What does the Boston MA 021 Oa -4746 performance data show? What is the warranty? • What type of DEP approval does this system have? Will DEP approval be required to install the system on my lot? commonwealth of . What are the sampling and testing requirements? What will the operation and ^'"'seft maintenance service contract cover? .>ene Swift, Governor • Is there any information available on equipment or operating problems? Executive office of Buying a home? Environmental Affairs If you are thinking of purchasing a previously -owned home that is not connected to a Bob DuraW, secretary sewer, you should request a copy of the inspection report that is required by Title 5 when a house is to be sold. This is a requirement whether the house has a Department of conventional septic system or an I/A system. Environmental Protection Lauren A. Liss, Commissioner For either new or existing homes, you should inquire about the on-site system and whether it employs I/A technology. If it does, you should ask the owner or real estate Produced by the agent the same questions that you would ask a designer. If they can't answer your Bureau of Strategic questions, you should require that they either do the necessary research and get back Office of Innovative Technology to you or put you in contact with the designer of the system. Don't sign a purchase - and -sale agreement until you are fully informed about the type of I/A system in use on and Green B"s'n� n Business the property, as well as the related maintenance contract requirements, annual and the ng and rgy operating energy costs, and maintenance history. Bureau of Resource Protection Division of watershed Want to learn more? management For additional information about I/A on-site technologies for wastewater treatment and Title 5 Program, disposal, call DEP's Title 5 Hotline at (800) 266 -1122 or contact the DEP Regional November 2001. Printed on Service Center that covers your part of the state (the local board of health can tell you recycled paw. which DEP regional office serves your community): This information is available in Western alternate format by calling our (Springfield) (413) 775-2214 ADA coordinator at Central (617)57 72' (Worcester) (508) 792-7683 Massachusetts Department of Environmental Protection One Winter Street Boston, MA 02106.4746 commonwealth of Massachusetts Jane Shrift, Governor Executive Office of Environmental Affairs Bob Durand, Secretary Department of Environmental Protection Lauren A. Liss, Commissioner Produced by the Bureau of Strategic Planning Office of Innovative Technology and Green Business and the Bureau of Resource Protection Division of Watershed Management Title 5 Program, November 2001. Printed on recycled paper. This infomratim is available in alternate format by calling our ADA Coordinator at (617) 574-6872. Metro/Northeast (Wilmington) (978) 661-7677 Southeast (Lakeville) (508) 946-2714 On the Web: Massachusetts Department of Environmental Protection: Basic consumer information on septic system maintenance, inspection, repair and financing: hftp://www.state.ma.us/dei)/consumer/consumer.htm Frequently asked questions about the agency's I/A on-site technology approval program: http://www.state.ma.us/der)/brp/wwm/t5Dubs.htm Technical information on I/A technologies approved for use in Massachusetts: hftp://www.state.ma.us/deD/bri)/Wwm/t5r)ubs.htm Massachusetts Altemative Septic System Test Center hftp://www.buzzardsbay.org/etimain.htm Small Flows Clearinghouse: http://www.nesc.wvu.edu/nsfc/nsfc index htm Deed Notice 333 Raleigh Tavern Lane, North Andover, Massachusetts, further described at the Essex North Registry of Deeds Book30 Page, has a Micro FAST septic system which was installed in C October of 1998. This system is manufactured by: Bio-Microbics 8271 Melrose Drive Lenexa, KS 66214 and is distributed by: G J & R Sales & Service, Inc. 1j 44 Commercial Street Raynharn, MA02767 Regulations governing the use and maintenance of the above -referenced system are pursuant to Title V of the Massachusetts General Laws, 310 CMR 15;00 and through the North Andover Board of Health. C oynmcY, Guto I4- / A1C1J�GC�(, S f �cS. ;� a.ur14y 04 his ' C!cc,, , � /14' eirr �t') �( �V1c� << � q�Pecjv-ec 1/Uv �ybali - 'ea anJ Qc.knavle lae( -fftie ��'rfq(_)mcj as her ��e e ocf cr;,)j deiA , 333 (�c�e,i9l,'JN� 010S �zU�erv, �n �j _"' d Y U rr Contingency Flan for 333 Raleigh Tav= Lane I. • • . ' ..Y %J•A• • : t • • �• t : • is TYPE 1: �fiure of vnmg xY&tem indicated h� an. alarm in th4 pump chAxtrxber In the event of an in the pump chamber the following procedure should bo followed Z, Silence the audiblo alarm in the basement. 2. If not an external power outage proceed to step # 3 3. Open pump control box in the basement of the dwolling, 4, Locate On/Off&to switch and switch to manual On mode. 5• If alp goes off switch back to Auto and wait to sec if problem is fficed. 6. If alarm comes bade ori there is a problem with the pump and.a, aeptio system setvice company should be contacted ir=cdiately to repair the pumps, 7. ThoN. A, oad OfErpidth and tho Stxtc %F4X- must be notified within V }urs. TYPE 2 Yai arc of Ynst Svstem,gr l'a>Zure of the IcAch field, I. Contact the N_,!�, Qgr4 of He it �aUi-a 24 AM, for authority to, A. Turd off gate valve between the Fast Septic Wank and th© Pump Chamber. B. For instructions ou system operation - 2. Notify Now England a6noci* Services, Inc., tho design en&eer. OF -f TAItiGf�RD %. o Oka- COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION TITLE 5 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 333 Raleigh Tavern Lane R.ECEIVED OCT - 3 2006 TOWN OF NORTH ANDOVER HEALTH DEPARTMENT CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000). The system: X_ Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority F- — -Fails Inspector's Signature: 41 Date: g-15-0( The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP) within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Notes and Comments ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. NOTE: This Title 5 is NOT a guarantee/warranty of the future function of the septic system. North Andover, MA 01845 Owner's Name: Marybeth Shea Owner's Address: Same Date of Inspection: 09-15-2006 Name of Inspector: (please print) John Soucy Company Name: Soucy Sewer Service, Inc. Mailing Address: 830 Livingston Street Tewksbury, MA 01876 Telephone Number: 978-851-8839 R.ECEIVED OCT - 3 2006 TOWN OF NORTH ANDOVER HEALTH DEPARTMENT CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000). The system: X_ Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority F- — -Fails Inspector's Signature: 41 Date: g-15-0( The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP) within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Notes and Comments ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. NOTE: This Title 5 is NOT a guarantee/warranty of the future function of the septic system. i Page 2 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 333 Raleigh Tavern Lane North Andover, MA 01845 Owner's Name: Marybeth Shea Date of Inspection: 09-15-2006 Inspection Summary: Check A,B,C,D or E / ALWAYS complete all of Section D A. System Passes: X I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Answer yes, no or not determined (Y,N,ND) in the for the following statements. If "not determined" please explain. The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if (with approval of Board of Health): broken pipe(s) are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if (with approval of the Board of Health): broken pipe(s) are replaced obstruction is removed ND explain: Page 3 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 333 Raleigh Tavern Lane North Andover, MA 01845 Owner's Name: Marybeth Shea Date of Inspection: 09-15-2006 C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b) that the system is not functioning in a manner which will protect public health, safety and the environment: _ Cesspool or privy is within 50 feet of surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: _ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. — The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. — The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. _ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance "This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: Page 4 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 333 Raleiah Tavern Lane North, Andover, MA 01845 Owner's Name: Marvbeth Shea Date of Inspection: 09-15-2006 D. System Failure Criteria applicable to all systems: You must indicate "yes" or "no" to each of the following for all inspections: Yes No X Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool _ X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool X Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/2 day flow X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped X Any portion of the SAS, cesspool or privy is below high ground water elevation. _ X Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. X Any portion of a cesspool or privy is within a Zone 1 of a public well. X Any portion of a cesspool or privy is within 50 feet of a private water supply well. X Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.] No (Yes/No) The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd• You must indicate either "yes" or "no" to each of the following: ("The following criteria apply to large systems in addition to the criteria above) yes no ____ _ the system is within 400 feet of a surface drinking water supply T _ the system is within 200 feet of a tributary to a surface drinking water supply _ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area — IWPA) or a mapped Zone II of a public water supply well If you have answered "yes" to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. Page 5 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 333 Raleigh Tavern Lane North Andover, MA 01845 Owner's Name: Marvbeth Shea Date of Inspection: 09-15-2006 Check if the following have been done. You must indicate "yes" or "no" as to each of the following: Yes No x _ Pumping information was provided by the owner, occupant, or Board of Health x Were any of the system components pumped out in the previous two weeks ? x _ Has the system received normal flows in the previous two week period ? x Have large volumes of water been introduced to the system recently or as part of this inspection ? x Were as built plans of the system obtained and examined? (If they were not available note as N/A) x Was the facility or dwelling inspected for signs of sewage back up ? X _ Was the site inspected for signs of break out ? x T Were all system components, excluding the SAS, located on site ? x _ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum ? x_ Was the facility owner (and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems ? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: Yes No x _ Existing information. For example, a plan at the Board of Health. _ x Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [3 10 CMR 15.302(3)(b)] Page 6 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 333 Raleieh Tavern Lane North Andover, MA 01845 Owner's Name: Marybeth Shea Date of Inspection: 09-15-2006 FLOW CONDITIONS RESIDENTIAL Number of bedrooms (design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x # of bedrooms): 330_ Number of current reside ts:_4_� Does residence have a ar �nd� es or noOno.age gr (Y ) Is laundry on a separate sewage system (yes or no): no [if yes separate inspection required] Laundry system inspected (yes or no): no Seasonal use: (yes or no): no Water meter readings, if available (last 2 years usage (gpd)): See Attached. Sump pump (yes or no): no Last date of occupancy: recent COMMERCIAL/INDUSTRIAL N/A Type of establishment: Design flow (based on 310 CMR 15.203): gpd Basis of design flow (seats/persons/sgft,etc.): Grease trap present (yes or no): _ Industrial waste holding tank present (yes or no): _ Non -sanitary waste discharged to the Title 5 system (yes or no): Water meter readings, if available: Last date of occupancy/use: OTHER (describe): GENERAL INFORMATION Pumping Records Source of information: Home Owner Was system pumped as part of the inspection (yes or no):en_ (Micro -Fast Tank System) If yes, volume pumped: 1500 gallons -- How was quantity pumped determined? Gage on truck Reason for pumping:Inspection and Maintenance . TYPE OF SYSTEM X Septic tank, Pressure Dosing System, soil absorption system _ Single cesspool Overflow cesspool Privy _ Shared system (yes or no) (if yes, attach previous inspection records, if any) _ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract (to be obtained from system owner) _ Tight tank _ Attach a copy of the DEP approval Other (describe): Approximate age of all components, date installed (if known) and source of information: 1998 Were sewage odors detected when arriving at the site (yes or no): No Page 7ofII OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 333 Ralei¢h Tavern Lane North Andover, MA 01845 Owner's Name: Marvbeth Shea Date of Inspection: 09-15-2006 BUILDING SEWER (locate on site plan) Depth below grade: 24" Materials of construction: X cast iron _40 PVC _other (explain): Distance from private water supply well or suction line: 75' Comments (on condition of joints, venting, evidence of leakage, etc.): SEPTIC TANK: x (locate on site plan) Depth below grade: 18" Material of construction: X concrete _metal _fiberglass polyethylene _other (explain) If tank is metal list age: _ Is age confirmed by a Certificate of Compliance (yes or no): _ (attach a copy of certificate) Dimensions: 10'.5" x 6' Sludge depth: 2" Distance from top of sludge to bottom of outlet tee or baffle: 36" Scum thickness: 1" Distance from top of scum to top of outlet tee or baffle: 6" Distance from bottom of scum to bottom of outlet tee or baffle: 14" How were dimensions determined: Tarte & Sludge Tool Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): NOTE: Micro -Fast System: (See Fast Maintenance Schedule for more details) GREASE TRAP: (locate on site plan) N/A Depth below grade: _ Material of construction: concrete metal fiberglass _polyethylene other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Page 8 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 333 Ralei¢h, Tavern Lane North Andover, MA 01845 Owner's Name: Marybeth Shea Date of Inspection: 09-15-2006 TIGHT or HOLDING TANK: _ (tank must be pumped at time of inspection)(locate on site plan) N/A Depth below grade: Material of construction: concrete metal fiberglass _polyethylene other (explain): Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present (yes or no): Alarm level: Alarm in working order (yes or no): Date of last pumping: Comments (condition of alarm and float switches, etc.): DISTRIBUTION BOX: N/A (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: n/a Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): (Pressure Dosing Sy tem) PUMP CHAMBER: X (locate on site plan) Pumps in working order (yes or no): yes Alarms in working order (yes or no): -es Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Components in alarm worked properly. Secondary floats are in working order. Page 9 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 333 Raleieh Tavern Lane North Andover, MA 01845 Owner's Name: Marybeth Shea Date of Inspection: 09-15-2006 SOIL ABSORPTION SYSTEM (SAS): X (locate on site plan, excavation not required) If SAS not located explain why: Type leaching pits, number: leaching chambers, number: leaching galleries, number: leaching trenches, number, length: X leaching fields, number, dimensions: 30'x 30' overflow cesspool, number: _ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): No Sign of Hydraulic Failure. (Pressure Dosing System) CESSPOOLS: (cesspool must be pumped as part of inspection)(locate on site plan) N/A Number and configuration: Depth — top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow (yes or no): Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): PRIVY: (locate on site plan) N/A Materials of construction: Dimensions: Depth of solids: Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Page 10 of 11 OFFICIAL INSPECTION FORM -- NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 333 Raleigh Tavern Lane North Andover, MA 01845 Owner's Name: Marybeth Shea Date of Inspection: 09-15-2006 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. NF STAP ES © Cc) C,5 O zxa2 DECK I at G e -- \ MIT OF SAI ER t4 TE eA '4 w j cfocy GA11 500 SGA O!V AST TAW jt + + i co co s CC ELECTRIC EASEMENT RAL _-` � per' A VERN N-��-6;z a - Page 11 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: Owner's Name: Date of Inspection: SITE EXAM Slope Surface water Check cellar x Shallow wells 333 Raleiah Tavern Lane North Andover, MA 01845 Marvbeth Shea 09-15-2006 Estimated depth to ground water 2.83 Please indicate (check) all methods used to determine the high ground water elevation: x Obtained from system design plans on record - If checked, date of design plan reviewed: Observed site (abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health -explain: Checked with local excavators, installers- (attach documentation) Accessed USGS database -explain: You must describe how you established the high ground water elevation: Test Pit performed on 04/01/1998 on design plans Summary Record Card generated on 9/13/2006 2:55:48 PM by Lisa Warren Page 1 Town of North Andover Tax Map # 210-107.A-0125-0000.0 • 333 RALEIGH TAVERN LANE SHEA, THOMAS F 333 RALEIGH TAVERN LANE N. ANDOVER, MA 01845 Class 101 Single Family Property Type 1 Residential Size Total 1.12 Acres FY 2007 UB Mailing Index Name/Address Type Loan Number SHEA, THOMAS F Payor 333 RALEIGH TAVERN LANE N. ANDOVER, MA 01845 Active/Inact. From UB Account Maint. Account No Cycle Occupant Name Bldg Id. 14114.0 - 333 RALEIGH TAVERN LANE Last Billing Date 9/7/2006 2100095 02 Cycle 02 UB Services Maint. Service Code Rate Charge MISCFEE ADMIN FEE 0.635/8 7.82 WTR WATER 01 ALL METER SIZE 394.64 UB Meter Maintenance Active/Inactive Active Multiplier/Users 1/ /1 Serial No Status Location Brand Type 0022305416 a Active ENC F.L. ? w Water Date Reading Code Consumption Posted Date 8/21/2006 4533 a Actual 90 9/13/2006 Trouble Code:03 5/4/2006 4443 a Actual 14 6/20/2006 Trouble Code:03 2/2/2006 4429 a Actual 14 3/13/2006 11/2/2005 4415 a Actual 71 12/14/2005 Trouble Code:03 8/11/2005 4344 a Actual 122 9/12/2005 Trouble Code:03 5/9/2005 4222 a Actual 13 6/8/2005 2/14/2005 4209 a Actual 20 3/15/2005 Trouble Code:03 11/16/2004 4189 a Actual 69 12/17/2004 Trouble Code:03 8/10/2004 4120 a Actual 103 9/20/2004 Trouble Code:03 5/17/2004 4017 a Actual 30 6/14/2004 2/17/2004 3987 a Actual 22 4/16/2004 Size 0.63 0.63 Until YTD Cons 0 Variance 437% 1% -82% -34% 739% -30% -68% -42% 264% 56% 0% Please complete all items marked + mail signed original contract to: J&R Sales & Service Inc 44 Commercial Srr_ Ra_MA 02767 DU On Copy ----------------- ) & R SALES & SERVICE, INC. INSPECTION& EFFLUENT TESTING AGREEMENT This Inspection Agreement is entered into by MR Sales & Service,Inc. System OWNER (herein called OWNER), for the (herein call MR) and the FAST® J&R's obligations to inspect OWNER?s equipment listed below.g forth terms and conditions governing Upon acceptance of this agreement, MR will render the following services only: Equipment will be inspected at least _L times per Year that this inspection beginning . These inspection will include:Agreement remains in effect, with the first 1) Testing of the sludge depth in the septic tank 2) Inspection, Power testing and clean/repkce intake filter of the air blower. 3) Inspection of the alarm system. 4) Inspect over-all condition of FAST® System. S) Notify OWNER of any problems encountered 6) Service other than routine maintenance will be billed at an hourly rate plus travel and material. J&R shall notify the local board of health and the Department of EnvirotunentaI Protection in writing within 24 hours of a system failure or alarm event including corrective measures that have been taken. It is understood that by this Agreement MR is not obligated to supply any Parts. Any additional labor time will be billed to the OWNER at standard labor rates of S. 00 —�-� Per hour. Emergency service between regular inspections will be provided at standard rates for labor d business hours, after 5:00 PM and on Saturdays time and one- acingnormal minimum four (4) hour plus standard c � and double time on Sundays and holidays, not include expenses to byes for parts plus mileage and travel charges. This agreement does or alt repair a caused by abuse, accident, theft, acts of a third person, farces of nature, Bring the equipment. MR shall not be responsible for failure to render the service for causes beyond its control, including strikes and labor disputes. 44 Commeipal Si. RdY'MIOm, MA 02767 fel: 508 823-9566 Fay :506-88&1232 ucL iZ) l� ic:Z)5p i&K tngineereo rrooucts bUa 88U -72J2 p.3 OWNER understands and agrees that MR is not responsible for special or consequential damages, in in loss of time, injury to person or property unit or equipment failure. g This agreement is not assignable without the consent ofJ&R and will remain in force until canceled by either Party through written notice. This is a two Year service contract to be billed annually in compliance with State regulations. will result in cancellation and nullification of any warranties. Failure to comply A TURER M QU NO. Bio-Microbics Home FAST E ILt MENT OWNER *Signed by:-Ek'6'— *Address: th L. Shea 333 Raleigh Tavern Lane North Andover, MA 01845 '`City: State: .Zip: 978-686-0626 *Telephone: SERIAL NO. CATIO An TE Boxford, MA $350.00 d&R Sats & Sexvicel Inc. Signed by: C lXj. , 44 Commerc' Street / Raynham, MA 02767 Tel: (508) 823-9566 Fax: (508) 880-7232 Effect Date of Agreement Effluent Testing Effluent sample taken 4 times per year, delivered to a qualified testing lab for evaluation and with results being sent to State and local Agencies as well as the owner. Owner is responsible for providing access to effluent to enable a grab sample to be taken for laboratory test' p g acceptable Pte: rY ing Performed: *(PLEASE CHECK ONE) ( ) GENERAL, ( X) REMEDIAL () PROVISIONAL *SPECIAL CONDITIONS PER LOCAL BOARD OF HEALTH (y) or (N) If YES, please attached copy of permit (X) BODS, TSS, pH ( ) pH, BOD5 , TSS, TKN, NO3 -N, Ammonia ( ) Other Cost for testing 150.00/vis4 Operator assigned: William Everett Telephone: 508 82 -9566 *Engineer: *Approval for Effluent Testing ' 3 � AVAL,naturl— Homeowne m 0 tAORTIi O�tt�ae c61�� 6 H ... , �t �• G1_ c«wiru.nc.. �• PUBLIC HEALTH DEPARTMENT Community Development Division March 12, 2007 Mr. Thomas Shea Or Current Homeowner 333 Raleigh Tavern Lane North Andover, MA 01845 Re: Wastewater Treatment Services Dear Current Homeowner, This correspondence is in regards to the Micro FAST septic system that is servicing the property at 333 Raleigh Tavern Lane. The North Andover Health Department has been notified, and have since confirmed, with Wastewater Treatment Services, Inc. that there is currently no contract for services for this property with their company. If you have switched service companies, please contact the Health Department, within seven days of receipt of this letter, with a copy of your current contract. Operation of this septic system without a maintenance contract is a violation of the MA Department of Environmental Protection code, 310 CMR 15.287. (see attached information and documentation) Your prompt response to rectify this violation, without the need of further action by this office, will be greatly appreciated. Thank . u, usa Sawyer, REHS/RS' Public Health Director Encl. Letter dated February 2, 2007 Copy 310 15.287 I/A fact sheet Deed notice 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 918.688.9540 Fax 918.688.8416 Web www.townofnorthandover.com 21 February 2, 2007 Mr. Thomas Shea 333 Raleigh Tavern Lane North Andover, MA 01845 44 Commercial Street Raynham, MA 02767 Tel: (508) 880-0233 Fax: (508) 880-7232 e t i FEB 0 6 2001 j TONAIN' OF Re: Serial Number: MCF156 Location: 333 Raleigh Tavern Lane, North Andover, MA Dear Mr. Shea: We understand you do not wish to continue your maintenance contract with our company. Please be advised the Massachusetts Department of Environmental Protection requires a maintenance contract be in place for the life of the alternative septic system. Also, we are required to inform both the state and local agency of your decision. If you have any questions or need additional information please call our office at (508) 880-0233. Sincerely, Aot� 01-/ e4a-l�� Donna L. Callahan Copy to: Massachusetts DEP North Andover Board of Health 1600 Osgood Street North Andover, MA 01845 310 CMR: DEPARTMENT OF ENVIRONMENTAL PROTECTION 15.286: continued (10) Should the Department disapprove general use of the alternative system which was provisionally approved, any person wishing to use such system may file a permit application for use of the alternative system pursuant to 314 CMR 5.00 (groundwater permitting). Disapproval under 310 CMR 15.286 shall not prejudice any action on an application pursuant to 314 CMR 5.00. (11) The conditions established in 310 CMR 15.287 apply to any use of a provisionally approved alternative system. (12) If at any time the local Approving Authority or the Department determines that an alternative system that has been installed pursuant to a provisional approval is failing or has failed, enforcement action may be taken. (13) It shall be a violation of310 CMR 15.000 to make a false representation that an alternative system has been approved for provisional use. 15.287: General Conditions for Use of Altematiye Systems Pursuant to 310 CMR 15.294 through 15.286 The following conditions shall apply to all uses of alternative systems pursuant to 310 CMR 15.284 through 15.286: (1) All plans and specifications shall be designed in accordance with 310 CMR 15.220. (2) Any required operation and maintenance, monitoring and testing plans shall be submitted to the Department and approved prior to initiation of the use. Monitoring and sampling shall be performed in accordance with a Department approved plan. Sample analysis shall be conducted by an independent U.S. EPA or Commonwealth of Massachusetts approved testing laboratory, or an approved independent university laboratory, unless otherwise provided in the Department's written approval. It shall be a violation of 310 CMR 15.000 to omit from a report or falsify any data collected pursuant to an approved testing plan. (3) The facility served by the alternative 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) The Department and/or the local Approving Authority may require the owner or operator of the system to cease operation ofthe system and/or to take any other action necessary to protect public health, safety, welfare and the environment. (5) The owner or operator shall provide written notice to any new owner or operator that the system is an alternative system. Such notice shall include notice of the general conditions and any special conditions applicable to the system and its owner. (6) The owner or operator, or the proponent of the alternative system, shall obtain and provide the Department with a determination from the board of certification of operators of wastewater treatment facilities established pursuant to M.G.L. c. 21, § 34A as to whether a certified operator is required for operation of the alternative system. The Department shall waive this requirement if it has on file a determination for the alternative system, and shall notify the owner, operator, or proponent of the determination. (7) It is a violation of 310 CMR 15.000 to install, construct, or operate an alternative system except in full compliance with the written approval and 310 CMR 15.287. (8) The Department may require the issuance of a groundwater discharge permit pursuant to 314 CMR 5.00 (groundwater discharge program) for any alternative system. (9) The system owner shall maintain an operation and maintenance contract with a Massachusetts certified operator where one is required by 257 CMR 2.00, or otherwise with a person qualified to operate and maintain the system in accordance with the Department's written approval. 0 Massachusetts D e p a r t m e n t ENVIRONMENTAL P R O T E C T I O N fact sheet Innovative and Alternative (I/A) On -Site Septic Systems For most Massachusetts homes without access to municipal sewers, septic systems provide for on-site wastewater treatment and disposal. However, site limitations can make it difficult to replace a failing cesspool or septic system with a conventional septic system that will meet state standards. Innovative/Aitemative (I/A) on-site systems can help address these situations: • They are generally better than conventional septic systems at removing solids and other pollutants from wastewater before it goes to the soil absorption system (SAS). • The SAS following an VA technology can be expected to have a longer life. • I/A technology can also provide advanced treatment to reduce the wastewater's nitrogen content. For this reason, nitrogen reducing systems may be required for new home construction near a private or public water supply well or other nitrogen - sensitive areas. Whether your home already has an 1/A system or you are thinking about installing one, it's important to get acquainted with the basics: what your alternatives are, how they work, what they cost to install and maintain, what is required to stay in compliance with Title 5 (the State Environmental Code), and who you can tum to for additional information and assistance. VA Systems: the Basics Before any I/A technology can be used in Massachusetts, it must be reviewed and approved by the Department of Environmental Protection (DEP). Before it can be installed at a particular site in a given community, the local board of health needs to review and approve plans prepared by a qualified designer who is either a registered professional engineer or a registered sanitarian. In certain instances, the site-specific local approval must then be sent to DEP for concurrence and final authorization. Both local and state environmental officials involved in the approval process are responsible for ensuring that the proposed system meets local requirements, which may be more stringent than DEP's; that the selected VA technology will perform at least as well as, if not better than, a conventional septic system; and that the installation is done in accordance with all the requirements of Title 5. As of June 2001, DEP had approved nearly 50 different I/A on-site technologies for use in Massachusetts, and DEP and local boards of health had approved more than 1,350 individual installations across the state. DEP's website has detailed information on approved technologies (see last page of this brochure for web addresses). Have an VA on-site system already? You need to know what kind of technology it employs, keep good records on the system's location, and be sure to operate and maintain it properly. DEP requires that owners of I/A systems have a maintenance contract with a specifically licensed individual or company. ---�--• ^--- . -84 Want to investigate VA on-site technologies? Your first stop should be the office of your local board of health. There, you will learn about local requirements for on-site systems, possible restrictions on the use of I/A on- site technologies, background information about environmental conditions in your community, and information on qualified on-site wastewater system design professionals. No matter what type of system you want to install for on-site wastewater treatment and disposal, you will need to work with a qualified system designer to make the right decisions and to produce plans that can be submitted to obtain local and, if necessary, DEP approval. Here are some initial questions to ask the designer: • Should I install an I/A system? • What are my technology options? • What are the local and state approval requirements? • How much will it cost me to install, operate and maintain an I/A technology as opposed to a conventional septic system? Mwsadwse is Department of Once you have identified one or more specific technologies to consider, you should Environmental Protection ask additional questions of the designer. • How many of these systems are operating in Massachusetts? What does the One VArder street performance data show? What is the warranty? Boston, MA 02108-4746 • What type of DEP approval does this system have? Will DEP approval be required to install the system on my lot? conwriormweab of • What are the sampling and testing requirements? What will the operation and Niessachuseft maintenance service contract cover? Jar* swift, Governor • Is there any information available on equipment or operating problems? Executive ofte of Buying a home? EnMronmental Affairs If you are thinking of purchasing a previously -owned home that is not connected to a Bob Durand, spry sewer, you should request a copy of the inspection report that is required by Title 5 when a house is to be sold. This is a requirement whether the house has a Dent of conventional septic system or an I/A system. Environmental Protection Lauren A. Un, Commissioner For either new or existing homes, you should inquire about the on-site system and whether it employs I/A technology. If it does, you should ask the owner or real estate agent the same questions that you would ask a designer. If they can't answer your Produced by the questions, you should require that they either do the necessary research and get back Bureau of k '" to to you or put you in contact with the designer of the system. Don't sign a purchase - Office innovative Technology agreement until you are fully informed about the type of I/A system in use on and Green Business the property, as well as the related maintenance contract requirements, annual and� operating and energy costs, and maintenance history. Bureau of Resource Protection Division of watershed Want to learn more? manage,nent For additional information about VA on-site technologies for wastewater treatment and Title 5 Program, disposal, call DEP's Title 5 Hotline at (800) 266 -1122 or contact the DEP Regional November 2001. Printed on Service Center that covers your part of the state (the local board of health can tell you recycled . which DEP regional office serves your community): This infomudion is available in Western awe format by calling our (Springfield) (413) 775-2214 ADA coordinator at Central (617) 5746872. (Worcester) (508) 792-7683 Metro/Northeast (Wilmington) (978) 661-7677 Southeast (Lakeville) (508) 946-2714 On the Web: Massachusetts Department of Environmental Protection: Basic consumer information on septic system maintenance, inspection, repair and financing: http://www.state.ma.us/dep/consumer/consumer.htm Frequently asked questions about the agency's VA on-site technology approval program: http://www.state.ma.us/dep/brp/wwm/t5r)ubs.htm Technical information on I/A technologies approved for use in Massachusetts: http://www.state.ma.us/dep-/brp/Wwm/t5r)ubs.htm Messadmelft Deperhent of Massachusetts Alternative Septic System Test Center. Ermronmen Protection http://www.buzzardsbay.o[g/etimain.htm One Wmter street Boston, MA 02108-4746 Small Flows Clearinghouse: http://www.nesc.wvu.edu/nsfe/nsfc index.htm Comrnonwealth of Jane swift, Governor Executive Office of Ernironmentai Affairs Bob Durand, secretary Department of Environmental Protection Lauren A. hiss, commissioner Produced by the Bureau of strategic Planning Office of Innovative Technology and Green Business and the Bureau of Resource Protection Division of Watershed Management Title 5 Program, November 2001. Printed on recycled Paper. This information is available in alternate format by calling our ADA Coordinator at (617) 574-8872. Deed Notice 333 Raleigh Tavern Lane, North Andover, Massachusetts, further described at the Essex North Registry of Deeds BookPage 3", has a Micro FAST septic system which was installed in C October of 1998. This system is manufactured by: Bio-Microbics 8271 Melrose Drive Lenexa, KS 66214 and is distributed by: C4 J & R Sales & Service, Inc. 44 Commercial Street Raynharn, MA02767 Regulations governing the use and maintenance of the above -referenced system are pursuant to Title V of the Massachusetts General Laws, 310 CMR 15.00 and through the North Andover Board of Health. C. o 11 r rbn alleo l+k 0� I `CIJJGC6AS� CG'1,',,4y 04 TV' C� of fe'are)A IUaryl gCi -'�ect and cuekncwle l8e c�_ -bhp- py�qom(l as her ye e 0cr f oocl dei. cl. , X33 �cLe,�9G,7�iVnn Ln ,ti. �»�oJ�v ,,�114 oi84s ti I v NOV 5 MO Pm12;1E .1411 h : "� j Y (&� rr North Andover Board of Health 27 Charles Street North Andover, MA 01845 Attention: Ms. Sandy Starr Dear Ms. Starr: -rN ml'owu�November 1998 n, HEALTH 25 la0 Enclosed please find a copy of the deed notice we discussed for the septic installation at 333 Raleigh Tavern Lane. As the stamp indicates, this notice was recorded at the Registry of Deeds on November 5, 1998. It is my understanding that we are now eligible for a Certificate of Compliance. If you have any questions, please do not hesitate to call me at 686-0626. Sincerely, AVVV_'_ Marybeth Shea cc: Timothy Felter, LSB John Soucy Ben Osgood, New England Engineering V Deed Notice 333 Raleigh Tavern Lane, North Andover, Massachusetts, further described at the Essex North Registry of Deeds Book 93Q Page a2l, has a Micro FAST septic system which was installed in October of 1998. This system is manufactured by: Bio-Microbics 8271 Melrose Drive Lenexa, KS 66214 and is distributed by: J & R Sales & Service, Inc. 44 Commercial Street Raynharn, MA02767 Regulations governing the use and maintenance of the above -referenced system are pursuant to Title V of the Massachusetts General Laws, 310 CMR 15.00 and through the North Andover Board of Health. /�c1r�1� � �Sheci �.i�ze�je �o�r►�V�� V ��r� c /1r / '+ !� II NOV 5' 00 rm12:I grfCPUr �-�eQ G7nd as he rPe e 0C J,)d /qjLA_�t� Skja X33 �e�.ei l,'�UPrn �i1 .119 0105 v, mg�e, ac knacle 18e 1 xe p4�K,sCM It Y -*-C- fiyrqc),�(] TOWN OF NORTH ANDOVER BOARD OF HEALTH CERTIFICATE OF COMPLIANCE DATE OF COMPLIANCE: 1/13/99 This is to certify that the individual subsurface disposal system constructed ( ) or repaired ( X ) by John Soucy a North Andover Licensed Installer at 333 Raleigh Tavern Lane, No. Andover, MA 01845 has been installed in accordance with the provisions of Title V of the State Sanitary Code and with the North Andover Board of Health regulations as described in the Design Approval Site System Permit # 986.5 dated 7/23/98. The Issuance of this certificate shall not be construed as a guarantee that the system will function satisfactorily. Board of Health Inspector TOWN OF NORTH AND.' BOARD OF HEALT'-i i G 1 51996 TOWN OF NORTH ANDOVER ;SEWAGE DISPOSAL SYSTEM INSTALLATION CERTIFICATION i The undersigned hereby certify that the Sewage Disposal System (:?$ constructed; ( ) repaired; by ccA located at _33 �v was installed in conformance with the North Andover Board of Health approved plan, System Design Permit # dated with an approved 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.. Bed inspection date: /obo 8 L & Engi er Represen t e Final in Installe Design CtviL r/ 7 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Address of property *333 QAI,EtU 14 -Mv652� LlA�E , K10. A"DOVe-e, H.OL94S Owner's name M- ELAujE MtC_HAVD Date of Inspection S- IS =CtS PART A CHECKLIST Check if the following have been done: Pumping information was requested of the owner, occupant, and Board of Health. I// None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. 11_ As built plans have been obtained and examined. Note if they are not / available with N/A. V The facility or dwelling was inspected for signs of sewage back-up. i/ The site was inspected for signs of breakout. All system components, excluding the SAS, have been located on the site. The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or tees, material of construction, dimensions, depth of liquid, depth of / sludge, depth of scum. The size and location of the SAS on the site has been determined based on existing information or approximated by non -intrusive methods. ✓ The facility owner (and occupants, if different from owner) were provided with information on the proper maintenance of SSDS. 0 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B SYSTEM INFORMATION FLOW CONDITIONS If residential ' 1- number of bedrooms Z number of current residents �40 garbage grinder, yes or no \1�� laundry connected to system, yes or no N.40 seasonal use, yes or no If nonresidential, calculated flow: Water meter readin s, if available: 18Z 6, P- i), AV6, 7�c2or-1 Lt-ZI -q H1 (-'Uue -F Last date of occupancy GENERAL INFORMATION Pumping records and source of information: \\ t�fbi A�t�P� I1. bAST zY2S. �RS X62 Owl fE-z System pumped as part of inspection, yes or no if yes, volume pumped 1000 6Ar Reason for pumping: TLS I Q fPEc. i Coles �, .� o OF TA kl I C , GA EF(.'F�- S C —16 ) K11 P(5c'i- Focz- Ty of system Septic tank/distribution box/soil absorption system Si::gle cesspool Overflow cesspool Privy ` NL Shared system (yes or no) (if yes, attach previous inspection records, if any) Other (explain) Approximate age of all components. Date installed, if known. Source of information: Sewage odors detected when arriving at the site, yes or no 9 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B SYSTEM INFORMATION continued SEPTIC TANK:z (locate on site plan) depth below grade: 2 Z. material of construction: V concrete metal FRP other(explain) Fwz,q 9AF� S dimensions: L= g' W = S t 1 148` 6 sludge depth Z&" distance from top of sludge to bottom of outlet tee or baffle 4." scum thickness 7" distance from top of scum to top of outlet tee or baffle IZ" distance from bottom of scum to bottom of outlet tee or baffle Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, recommendations for repairs, etc.) /-10,'10 C�5v5C, C ou-r �T - tLV6z7t-. S (iZoe- -uiulL I!-tV!E6etT11 1S GOceL7 , c o E Vt oQu c� p G ►tea G L(I ptt� c,a S i �� E � I �c Srwcc.aTi o r OF SeN Ifo -V-C. -r>��S 1.S f c�r��-�E���E� oar fucJE:T-c 0u-7CJ5—oETAj-(V-. DISTRIBUTION BOX: i/ (30" gaoL,) 6P -A L-) (locate on site plan) depth of liquid level above outlet invert Comments: (note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box, recommendation for repairs, etc.) '7_U 1, x i2o" 6 -out CU I COTS A ����� L. DJI s i 2� %v i vtit 06S9a\-/,'=-Q OL-T�-+'-i WO �vr �>_tC o Point 6' . Sot + SaL-SDS GA2a2 O $S =iZ\/ d5Q (C(6- rlv—T i — r^ A -c 6F::2--) PUMP CHAMBER: WA (locate on site plan) pumps in working order, yes or no Comments: (note condition of pump chamber, condition of pumps and appurtenances, recommendations for maintenance or repairs,etc.) 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B SYSTEM INFORMATION continued SOIL ABSORPTION SYSTEM (SAS): (locate on site plan, if possible; excavation not required, but may be approximated by non -intrusive methods) If not determined to be present, explain: S A•<Z1�jFoopTN JAZ Fdt.vr-j "PIAkf SNowI):(6 koP6S9-L s�a3s�2F✓+c, �E,.�G, Di SPoSAL S,/S-a5M A ut- , Pz,PoSEn &, i GMDi/..rG^ AArF� 7_17-7/_ ` ETIA S • RA75ACIAL&O O i FI S v i i H TF+ F i�cv2i-F+ i� �c Ove iZ 13oA RD o H P:A L j Type leaching pits and number leaching chambers and number leaching galleries and number leaching trenches, number, length leaching fields, number, dimensions overflow cesspool, number 3 9NtA1,LoLJ P17 -s Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, recommendations for maintenance or repairs,etc.) ll a poxibl i6G 605. /)--j D--t�OX '/'J0 OF Ogg, Ply F09- CESSPOOLS (locate on site plan): number and configuration depth -top of liquid to inlet invert depth of solids layer depth of scum layer dimensions of cesspool materials of construction indication of groundwater inflow (cesspool must be pumped as part of inspection) Comments: (note condition 'of soil, signs of hydraulic- failure, level of ponding, condition of vegetation, recommendations for maintenance or repairs,etc.) PRIVY: (locate on site plan) materials of construction dimensions depth of solids Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, recommendations for maintenance or repairs,etc.) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B SYSTEM INFORMATION continued SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent referendes landmarks or benchmarks locate all wells within 100' �vus� � 3�3 tri N I Goo G A 1.. ---�'; I I5S O .�•-'�r-� �� (v�rc�—r� � � � ' 31.3' P,T�t loot DEPTH TO GROUNDWATER depth to groundwater (moo WAT15e) method of determination or approximation: 11 12 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C FAILURE CRITERIA Indicate yes, no, or not determined (Y, N, or ND). Describe basis of determination in all instances. If "not determined", explain why not) WO Backup of 'sewage into facility? Wo Discharge or ponding of effluent to the surface of the ground or surface waters? 'O Static liquid level in the distribution box above outlet invert? UIL Liquid depth in cesspool <6" below invert or available volume< 1/2 day flow? N6 Required pumping 4 times or more in the last year? number of times pumped f4b Septic tank is metal?.cracked? structurally unsound? substantial infiltration? substantial exfiltration? tank failure imminent? Is any portion of the SAS, cesspool or privy: --NQ below the high groundwater elevation? Q within 50 feet of a surface water? WO within 100 feet of a surface water supply or tributary to a surface water supply? K.0 within a Zone I of a public well? _ within 50 feet of a bordering vegetated wetland or salt marsh (cesspools and privies only, not the SAS)? KiO within 50 feet of a private water supply well? NO less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis? If the well has been analyzed to be acceptable, attach copy of well water analy: for coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. 13 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART D CERTIFICATION Name of Inspector P• 60 D I Q Company Name F�Ee�1 ��Ac IC �NG,uEE�Z► uG ��2�(e�S Company Address 66 PAP CT- . A�,JDOVC-p I "A . D1 61O Certification Statement I certify that I have personally inspected the sewage disposal system at this address and that the information reported is true, accurate and complete as of the time of inspection. The inspection was performed and any recommendations regarding upgrade, maintenance and repair are consistent with my training and experience in the proper function and manitenance of on-site sewage disposal systems. Ch ck one: V I have not found any information which indicates that the system fails to adequately protect public health or the environment as defined in 310 CMR 15.303. Any failure criteria not evaluated are as stated in the FAILURE CRITERIA section of this form. - I have determined that the system fails to protect public health and the environment as defined in 310 CMR 15.303. The basis for this determination is provided in the FAILURE CRITERIA section of this form. /� p i Inspector's Signature Date S - 2f- q�;_ Original to system owner Copies to: K10V_ 1_H /� l-J�D GV6"12- (D(-1 f�-L OF J- digC T14 Buyer (if applicable) Approving authority T c� cn N D #,« row _•! cco c� �O~, ji � o N iCU 0 O n Cal O w •� * ti3�o � � S N D � Q un. G m c� 3 °Q a w � Ln (D = o i NO O O O N Q W O Z S V) C` D o � tA oma � D Z m o D � m d� w D '� N co p C) o� z ° p = a m D N r O QJ _ Ln O r- m r o O zp • = m w APPLICATION FOR DISPOSAL WORKS CONSTRUCTION PERMIT DATE: ��' CURRENT INSTALLER'S LICENSE# LOCATION: TL_. LICENSED INSTALLER: SIGNATURE: CHECK ONE: TELEPHONE#) Q :7 ? -39,6- - q 19 REPAIR: �4_ NEW CONSTRUCTION: IF NEW CONSTUCTION, PLEASE ATTACH FOUNDATION AS -BUILT. Administrative Use Only $75.00 Fee Attached? Yes No Foundation As -Built? Yes No Floor Plans? Yes No Approval Date: APPLICATION FOR DISPOSAL WORKS CONSTRUCTION PERMIT DATE: C� �'f- CURRENT INSTALLER'S LICENSE# ---- LOCATION: LICENSED INSTAL R: SIGNATURE: 4ELEPHONE# CHECK ONE: REPAIR: NEW CONSTRUCTION: IF NEW CONSTUCTION, PLEASE ATTACH FOUNDATION AS -BUILT. it Administrative Use Only $75.00 Fee Attached? Yes No Foundation As -Built? Yes No Floor Plans? Yes No Approval Date Aug -07-98 11:20A Paul D_ Turbide, PE/PLS 508-465-0313 P_02 August 7, 1998 Sandra Starr North Andover Board of Health Administrator Office of Community Development and Services 30 School St. North Andover, MA 01845 RE: Title V review for 333 Raleigh Tavern Lane Dear Sandra, Enclosed find the "Checklist for North Andover Septic System Plans" for the above- mentioned site. The following is a list of all the `Problem' areas and deficiencies Port Engineering has found. General Information • No deed references are shown on the plan. 220(3) • Plan does not contain designer's certification statement. The applicant need not resubmit the plans to include the above information as this information has been waived in the past. If you have any questions or comments please feel free to contact us. Paul D. Turbide, PE/PLS PODiti ENGINEERING, Civil Engineers & Land Surveyors One Harris Street Newburyport, MA 01950 (978)465-8594 Town of North Andover OFFICE OF COMMUNITY DEVELOPMENT AND SERVICES WILLIAM J. SCOTT Director August 13, 1998 Ben Osgood, Jr. New England Engineering 33 Walker Road North Andover, MA 01845 30 School Street North Andover, Massachusetts 01845 RE: 333 Raleigh Tavern Lane Dear Ben: This letter is to inform you that the proposed septic plans for 333 Raleigh Tavern Lane, dated 7/23/98 have been approved. Please note that because this is an alternative innovative system, a signed maintenance contract, binding on all future owners of the property must be submitted to the North Andover Health Department prior to construction of the system. In addition, before the Certificate of Compliance can be issued, evidence shall be submitted to the Health Department that a recording has been made in the appropriate registry of deeds that discloses the existence of this system and its maintenance requirements. If you have any questions, please do not hesitate to call the Board of Health office at the number below. Sincerely, Sandra Starr, R.S. Health Administrator cc: Wm. Scott, Dir. CD&S Property owner File CONSERVATION - (978) 688 9530 • HEALTH - (978) 688-9540 • PLANNING - (978) 688-9535 *BUILDINGOFFICE - (978) 688-9545 0 *ZONING BOARD OF APPEALS - (978) 688-9541 0 *146 MAIN STREET NEW ENGLAND ENGINEERING SERVICES lk INC July 28, 1998 Sandra Starr, Administrator North Andover Board of health Osgood Street North Andover, MA 01845 Re: 333 Raleigh Tavern Lane septic design Dear Sandra: Enclosed are the following: 1. 3 Copies of the design plans for 333 Raleigh Tavern Lane 2. 3 Copies of the soil evaluator sheets. 3. 3 Copies of the Fast System approval issued by DEP for remedial use. This design does not incorporate any Local upgrade approvals or DEP variances. The Fast system has been specified in order to overcome the fact that their is less than four feet of naturally occurring soil in the area of the proposed leach bed. The use of the Fast system allows the naturally occuring soil to be reduced to 24" without the need for a hearing by the local Board of Health or DEP approval. If you have any questions regarding this plan please do not hesitate to contact this office. Sincerely, --� Benj C. Osgood, fir., EIT President 33 WALKER ROAD -SUITE 23- NORTH ANDOVER, MA 01845 - (978) 686-1768 - (888) 359-7645- FAX (978) 685-1099 MERRIMACK - ENGINEERING SERVICES INC. Engineers • Surveyors 9 Planners 66 Park Street ANDOVER, MASSACHUSETTS 01810 (508) 475-3555 Fax (508) 475-1448 TO 664M 12t;1 s� WE ARE SENDING YOU ❑ Attached ❑ Under separate cover via ❑ Shop drawings ❑ Prints ❑ Plans ❑ Copy of letter ❑ Change order ❑ DATE JOB NO. ATTENTION RE: ❑ Samples COPIES DATE NO. DESCRIPTION THESE ARE TRANSMITTED as checked below: ❑ For approval ❑ Approved as submitted ❑ For your use ❑ Approved as noted ❑ As requested ❑ Returned for corrections ❑ For review and comment ❑ ❑ FORBIDS DUE 19 REMARKS 3 the following items: ❑ Specifications ❑ Resubmit copies for approval ❑ Submit copies for distribution ❑ Return corrected prints ❑ PRINTS RETURNED AFTER LOAN TO US COPY TO SIGNED: if enclosures are not as noted, kindly notify us at once. Town of North Andover, Massachusetts BOARD OF HEALTH ah, 19 / DESIGN APPROVAL FOR SOIL ABSORPTION SEWAGE DISPOSAL SYSTEM Applicant s 1, Q b,00 i LI!'C .Test No Site Location a 2 .`;:; fQ Reference Plans and Specs. _ bLnn C)Z:2c� . . Qn _ ; I /°J/w ENGINEER U DESIGN . DATE Permission is granted for an individual soil absopgion sewage disposal system to be installed in accordance with regulations of the State and the Board of Health. BOARD OF HEALTH Fee s , Site System Permit No. TO: NORTH ANDOVER, MASS c` 1 q 19 BOARD OF HEALTH FROM: DESIGN ENGINEER Re: Soil Absorption Sewage System Inspection This is to certify ;;t--�hat I have inspected the construction of the said disposal system at ot 32 R,0,-�a 7-1�� North Andover, Mass. The grades and construction are as specified in my plans and specifications dated 1�k OF )li, t--�:n:r 1q fJf 4�,� R g. Pro it eg. Wi. urian / P;o, a54 V /J SEPTIC PLAN SUBMITTALS' LOCATION: 93 3 NEW PLANS: YES $125.00/P1an�T� REVISED PLANS: YES $ 45.00/Plan SITE EVALUATION FORMS INCLUDED: YES NO DATE: I DESIGN ENGINEER: /Ve-%.I, 1 , ["29E—', -:2i vt ee v1-7,,•, Ski QS rL st C ., DATE TO CONSULTANT: When the submission is all in place, route to the Health Secretary o NORTIy BOARD OF HEALTH 30 SCHOOL STREET TEL. 688-9540 NORTH ANDOVER, MASS. 01845 APPLICATION FOR SOIL TESTS DATE: 3 - M -- q 0 LOCATION OF SOIL TESTS: 3,3,3 Lyi Assessor's map & parcel number: r e ( jav;- OWNER: TEL. NO.: .. 1- ADDRESS:/// . ADDRESS:/// 9 rys Gc Sjf-, ltcav e-- LY ENGINEER: /Vey E.L CvA�nc� TEL. NO.: X178- CERTIFIED SOIL EVALUATOR: _2�c�n (', T,..�jclz_a Intended use of land: residential subdivision, single family home, commercial THE FOLLOWING MUST BE INCLUDED WITH THIS FORM: Proof of land ownership (Tax bill, deed, or letter from owner permitting tests) 2. Piot plan 3. Fee of $175.00 per lot for new construction. This covers the minimum two deep holes and two percolation tests required for each disposal area. Fee of $75.00 per lot for repairs or upgrades. GENERAL INFORMATION 1. Only Certified Soil Evaluators may perform deep hole inspections. 2. Only Mass. Registered Sanitarians and Professional Engineers can design septic plans. 3. At least two deep holes and two percolation tests are required for each septic system disposal area. 4. Repairs require at least two deep holes and at least one percolation test, at the discretion of the BOH representative. 5. Full payment will be required for all additional tests within two weeks of testing. 6. 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). 7. Within 60 days of testing soil evaluation forms shall be submitted. Town of North Andover, Massachusetts Form No. 1 0ORTl1 �L BOARD OF HEALTH v/�Cjy O/g2'61 19 752 APPLICATION FOR SITE TESTING/INSPECTION TeD y�SSacHus���y Applicant NAME Site Location Engineer�-^r' NAME Test/Inspection Date and Time Fee 7. 7 LADDRESS TELEPHONE AIX j /1q9-0 CH MAN, BOARD OF HEALTH Test No. 46jr;2 S.S. Permit No. D.W.C. No. C.C. Date Plbg. Permit No. NoA165 3 FORM 11 - SOIL EVALUATOR FORM Page 1 of 3 Date: e -1 11—W Commonw Ith of Massachusetts Massachusetts Soil Suitability Assessment for On-site Sewage Dis osal Performed B L='�� C' y• Date: Witnessed B D...........TZ........................... ........................................... !.Dation Addrasyyor� 5 1 3�/3�//"�7�� n Owna's Nam, LDC 1i0�1G Ll dew Construction ❑ Repair N 97,E Office Review Published Soil Survey Available: No ❑ Yes R1 Year Published lQ�.. Publication Scale % i4 Soil Ma Unit �............ % 1 p Drainage Clas�i/it/ Soil Limitations el,�V2' ......��/5,/�5,L..... Surficial Geologic Report Available: No ❑K Yes ❑ Year Published .......,.... Publication Scale _. GeologicMaterial (Map Unit)......................................................................................................... Landform................................................................................................................................................................ Flood Insurance Rate Map: Above 500 year flood boundary No ❑ Yes Q Within 500 year flood boundary No ❑Yes ❑ Within 100 year flood boundary No ❑Yes ❑ Wetland Area: National Wetland Inventory Map (map unit) Wetlands Conservancy Program Map (map unit) Current Water Resource Conditions (USGS): Month. Range :Above Normal RINormal ❑Belciv Normal ❑ Other References Reviewed: -- DEP APPROVED FORM • 12/07/95 FORM I I - SOIL.` ---~ Page 2 of 3 On-site Review � Deep Hole Number '/- _- ' \Neatha 7 Location (identify on site plan) Land Use - Slope A?�7 Surface Stones' -' ' _ Vegetation Londhunn Position onlandscape (sketch onthe back) Distances from: Open Body �c^~`^ feet Drainage vvay ����- feet Possible VVnt Area feet Property Line . . '--. feet Drinking Water Well . feet Other DEEP OBSERVATION HOLE LOG* Depth from Soil Horizon Soil Texture Soil Co [or Soil Other Surface (Inches) (USDA) (Munself) Mottling (Structure, Stones, Boulders, Consistency, % ' m/w.°w=v,Z n"^ Parent Material (geologic) Depth to Groundwater: Standing Water mthe Hole: -- ExVnatau Seasonal *inx Ground Water: � - ~~ DEP APPROVED noPJm'ownm vvuonmofrom Pit Face: -- ----� FORM 11 - SOIL EVALUATOR FORM Page 2of3 Location Address or Lot No On-site Review Deep Hole Number Date: JTime:l Weathet� 1�. —.4 Location (identify on site plan) .. : Land Use Slope {%} Surface Stones /ly.:...... Vegetation%?�1>��7 .:..:... v.:.........: :... ....:...::::..:..::...........: . Landform ..::,•� Position on landscape (sketch on the back) .:.�.:.....` Distances from: o Open Water Body . c7o feet Drainage way. .:. feet Possible Wet Area feet Property Line ............. feet Drinking Water Well ....,- .. feet Other. .....-'_,.,..,.,_., DEEP OBSERVATION HOLE LOG` Depth from Surface (Inches) Soil Horizon Soil Texture (USDA) Soil Color (Munsell) Soil Mottling Other (Structure, Stones, Boulders, Consistency, % Gravel) NK — -- &WAY -0114 (fel u MINIMUM Vr L IIULLA n r-%L%J1".c.,W Mt cv�n In,7v�.,vla�.0 -1 Parent Material (geologic) L Com% 2 s ?� ��—"� OepthtoBedrock: �Z r Depth to Groundwater: Standing Water in the Hole: Weeping from Pit Face: Estimated Seasonal High Ground Water: 4 DEP APPROVED FORM - 12/07/95 FORM 11 - SOIL EVALUATOR FORM Page 2 of 3 Location Address or Lot No. �'�� ��f��/ ,S�^_ / v� �l•�=/�e On-site Review Deep Hole Number' --'- umber Date: Timer �' n Weathe Location (identify on site plan):'' ...:;....:.:...:.::...::..: ..::................. . Land Use Slope M 8: Surface Stones Vegetation .. . ........... . Landform Position on landscape (sketch on the back) Distances from: Open Water Body feet Drainage way. ��a� feet Possible Wet Area feet Property Line .. ... feet Drinking Water Well ....:`- .. feet Other, DEEP OBSERVATION HOLE LOG' Depth from Surface (Inches) Soil Horizon Soil Texture (USDA) Soil Color (Munsell) Soil Mottling Other (Structure, Stones, Boulders, Consistency, % Gravel) o d /� r ' MINIMUM OF 1 HULLS LUUI itu AI tvtnr rhUrUatu uiarUOAL ranch Parent Material (geologic) ��� 7-V DepthtoBedrock: �5 Depth to Groundwater: Standing Water in the Hole: Weeping from Pit Face: r Estimated Seasonal High Ground Water:ki -- � DEP APPROVED FORM . 12/07/95 �Y�7��/%%l� %�/jTi(/C FORM II - SOIL EVALUATOR FORN, I'age 3 of 3 Location Address or Lot No. /A Determinatr'on oreasonaI Hi h Water Table Method Used: ❑ Depth observed standing in observation hole ................... inches ❑ Depth weeping from side 9f observation hole .................. inches Depth to soil mottles ✓: .:. , inches ❑ Ground water adjustment .................. feet'Y6�-'?5 h�-3- Index Well Number .................. Reading Date .................. Index well level .................. Adjustment factor ................... Adjusted ground water level ........................................ Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? If not, what is the depth of naturally occurring pervious material? Certification I certify that on 6 9� (date) I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with the required training, expertise and experience described in 310 CMR 15.017. Signature Date !� DEP APPROVED FORM - 12/07/95 Y f, s�� D 7-1 �-� ib L-5 Mai Q V f72 LJ O-Lp Pr 3 �Y �Sy• i 55����� _ �. i 'tf r,- ACP di 4 LOCATION: ENGINEER: d_� c - BOH WITNESS: 6? _1 PERCOLATION TEST BOTTOM DEPTH OF PERC TEST: T TIME OF SOAK: minutes long) TIME AT 12" f TIME ATC"' TIME AT E" OVEFRNIGHT SOAK TIME STARTED - NEXT DAY SOAK: _ T IME AT 112 T! Irl E AT G° TIME AT E" i (I A lust i minutes) m 4 vAigam F. Wald Ga.m« Trudy C-oxe S+U�ttty• EOEA Thomas 8. Powers AWN Commmama: -NONE N0. : 508 775 3650 Commonweaim of Massochusefts Executive Office of Environmental Affairs Department of Environmental protection Nov. 19 1997 01:44PM P2 REMEDIAL USE APPROVAL Pursuant to Title 5, 310 CMR .15.000 Name and Address of Applicant: Smith & Loveless, Inc. 14040 Santa Fe Trail Drive Lenexa, KS 66215 Trade name of technology and model nuMbers: Smith & Loveless single home FAST and Modular FAST (hereinafter the "System") Date of Application: Transmittal Number: Date of Issuance: Modified: Effective date: Expiration date: December 23, 1994 98300 & 9$299 March 24, 1995 April 26, 1995 March 31, 1995 March 31, 2000 Authority for Issuance Pursuant to Title 5 of the State Environmental Code, 310 CMR 15.000, the Department of Environmental Protection hereby issues this Remedial Use Approval to: Smith & Loveless, Inc., 14040 Santa Fe 'Trail Drive, Lenexa, KS 66215 (hereinafter "the Company"), for Remedial Use in the Commonwealth of Massachusetts of the System described herein. Sale and use of the System are conditioned on and subject to compliance by the Company and the System owner/operator 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. qlgrhn J- *W91-ns/,f sting Director ivision f Wat4 Pollution Control Department of En ironmental Protection One Minter Street • Boston, Massachusetts 02108 0 FAX (677) 556-1049 Da e Telephone (617) 292-5500 .FROM t ROWLAND PHONE NO. 508 775 5650 FAST Remedial use Approval I. Design Standards Nov. 19 1997 01:45PM P3 Page: 2 The system shall be installed in series between the septic tank and the leaching system of a standard Title 5 system in a manner which neither intrudes on, replaces a component of, nor adversely affects the operation of a Title 5 system as constructed in accordance with 310 CMR 15.1.00 - 15.279, subject to the provisions of this Approval.. A. Reduced Soil Absorption system The System may be used in soils with a percolation rate of up to 90 Iain./inch. For soils with a percolation rate of 60 to 90 min./inch, the effluent Loading rate shall be 0.15 gpd / soft. The required soil absorption system area may be. reduced by 50t if all of the following conditions are met: 1. No reduction in required setbacks from public.or private wells, bordering vegetated wetlands, surface waters, salt marshes, coastal banks, certified vernal pools, water supply lines, surface water supplies or tributaries to surface water supplies, or drains which discharge to surface water supplies or their tributaries, is allowed without a variance; 2. No reduction in the required groundwater separation distance is allowed; 3. No reduction in the required four feet of naturally occurring pervious material is allowed. B. Reduction of the Groundwater separation Distance in approving use of the System by a particular owner/operator, the local approving authority may allow a reduction in the required four foot separation (in soils with a recorded percolation rate of more than two minutes per inch) or the required five foot separation (in soils with a recorded percolation rate of two minutes or less per inch) between the bottom of the soil absorption system and the high groundwater elevation, provided that all of the following conditions are met: 1. 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 Jess per inch) between the bottom of the soil absorption system and the high groundwater elevation is maintained; 2. No reduction in the soil absorption system size required by 310 CMR 15.242 or setbacks from public or private wells, bordering vegetated wetlands, surface waters, salt marshes, coastal banks, certified vernal - - .. •� .. _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ .- _ _ _ _ -. FROI ROWLAND PHONE NO. 508 775 3650 Nov. 19 1997 01:45PM P4' FAST Remedial Use Approval Page: 3 pools, water supply lanes, surface water supplies or tributaries to surface water supplies, or drains which discharge to surface water supplies or their tributaries may be allowed without a variance pursuant to 310 CMR 15.410 at seg; 3. No reduction in the required four feet of naturally occurring pervious material is allowed. 8'tt=o-n-o-ftba_RequYrement` for -four --teed- Nat rally, �acurri�Pervia_ �IatexXaY Where the proposed owner/operator of the System has demonstrated that the alternatives of siting an onsite system with four feet of naturally occurring pervious material or connection to a sanitary sewer or to a shared system are not feasible, the local approving authority may allow the repair or replacement of the disposal area with no less than two feet of naturally occurring pervious material, with the use of the System, provided that all of the following conditions are met: 1. the four feet requirement cannot be met anywhere on the site, or on an adjacent property with appropriate easements; �i 2. No reduction in the soil absorption system size required by 310 CMR 15.242 or setbacks from public or private wells, bordering vegetated wetlands, surface waters, salt marshes, coastal banks, certified vernal pools, water supply lines, surface water supplies or tributaries to surface water supplies, or drains which discharge to surface water supplies or their tributaries may be allowed_ without a variance pursuant to 310 CMR 15,410 et pe q; �'3. No reduction in the required groundwater- separation ;. distance is allowed. 11. General -Conditions 1. All provisions of 310 CMR 15.000 are applicable to the use of the system, the owner/operator, and the Company, except those which specifically may be allowed to be varied under the terms of this Approval. 2. An approved Soil Evaluator shall perform the soil evaluation in accordance with 310 CN�R 15.100 et seq. 3. Pressure dosing designed in accordance with Department guidance is required. 4. plans and specifications shall be stamped and signed by either a Massachusetts Registered Professional Engineer or a Massachusetts Registered Sanitarian. 5. Any required operation and maintenance, monitoring and testing shall be performed. Any required sample FROM : ROWLAND PHONE NO. : 508 775 3E50 No-�. 19 1997 01:46PM P5 FAST Remedial 05e Approval Page: 4 analysis shall be conducted by an independent U.S. EPA or Commonwealth of Massachusetts approved testing laboratory, or an approved independent university laboratory. It shall be a violation of this Approval to falsify any data collected pursuant to an approved testing plan, to omit any required data or to fail to submit any report required by such plan. 6. 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. 7. The Department and/or the local approving authority may require the owner/operator of the System 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. 8. The Department has not determined that the performance of the system for remedial use will provide a level of protection to public health and safety and the environment that is at least eVivalent to that of a sewer system. Accordingly, the System shall not be used where it is feasible to connect the facility served by the System to a sanitary sewer. 9. Desian and installation shall be in strict conformance with 3!0 CMR 15.000 and this Approval. 11. Nothing in this Approval authorizes any violation of M.G.L. c. 131, § 40, 310 CMR 10.00, or'any other law. 12. The Company and owner/operator shall furnish the Department within a reasonable time any information which the Department may request to determine whether cause exists for modifying, revoking, reissuing or terminating this Approval or to determine whether the Company and/or the owner/ operator is complying with the terms and conditions of this Approval and 310 CMR 151.000. III. Special conditions applicable to the system Owner/operator 1. The System is approved for remedial use in connection with the -discharge of sanitary wastewater only.' Any non -sanitary wastewater generated and/or used at the facility served by the System shall not be introduced into the system and shall be lawfully disposed of. 2. If the System will be used as a shared system as defined by 15.002, the financial assurance requirements for shared systems as may be required pursuant to 15.290 (2) shall apply. 3. Maintenance agreement: i. Throughout its life, the System shall be under a maintenance agreement. No maintenance agreement shall be for less than two years. FROM ROWLAND PHONE NO. : 502 775 3650 FAST Remedial Use Approval NOV. 19 1997 01:47PM P6 Page: 5 ii. The System shall not be constructed/installed until a maintenance agreement and contingency plan are submitted to and approved by the local approving authority which: provides for the contracting of a person or farm competent in providing services consistent with the System's specifications and the operation and maintenance requirements specified by the design engineer and any specified by the local approving authority; contains procedures for notification of the Department and the local board of health within 24 hours of a system failure or alarm event and for corrective measures to be taken immediately. provides the name of the Massachusetts certified operator or operators that will operate the System in accordance with Massachusetts regulations 257 CMR 2:00. 4. Effluent from the System shall be monitored quarterly. At a minimum the following parameters shall be monitored: pH, BODS, TSS. Every time the System is monitored, the water meter reading also shall be recorded. All monitoring data shall be submitted to the Department by January 31 of each year. After three years of monitoring and at the request of the owner/operator, the local approving authority may reduce or eliminate the monitoring requirements. 5. The owner/operator of the Systen shall at all times properly operate and maintain the System. 6. When a sanitary sewer connection becomes feasible, the owner/operator of the System shall obtain necessary permits and connect the facility served by the System to the sewer within 60 days of such feasibility and shall abandon the System in compliance with 310 CMR- 15.354 MR15.354 unless a later time is allowed in writing by the Department. IV. Special Conditions applicable to the Company 1. The Company annually shall submit to the Department, by January 31 of each year, a report, signed by a corporate officer, general partner or Company owner, stating, for the previous calendar year, the number of units sold for use in Massachusetts including the owner's name and address, address of the facility served by the System and the design flow; all known failures, malfunctions, and corrective actions taken and the location and date of each such event. 2. The Company shall notify the Director of the Division of Water Pollution Control at least thirty (30) days in advance of the proposed transfer of ownership of the FROM : ROWLAND PHONE NO. : 508 775 3650 Nov. 19 1997 01:48P1,1 P3 FAST Remedial Use Approval Page: 6 technology for which this Approval is issued. The notice shall include the name and address of the new owner, the date of transfer, and the respective responsibilities of the parties relative to the System. All provisions of this.Approval applicable to the Company shall be applicable to the successors and assigns of the Company. 3. The Company shall provide any purchaser of the System with a copy of this Approval prior to sale of the System. in any contract for distribution and/or sale of the system, the Company shall require the distributor or seller to provide the purchaser of the System, prior to any sale of the System, with a copy of this Approval. 4. If the Company wishes to use a System installed under this Approval as a piloting or provisional use demonstration site, the Company shall submit to the Department a notice that the Company wishes to use this site as a demonstration site for their piloting or provisional use application. 5. If the Company wishes to continue this Remedial Use 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. V. Reporting All notices and documents required to be submitted to the Department by this Approval shall be submitted to: Director Division of Water Pollution Control Department of Environmental protection One Winter Street 8th floor Boston, Massachusetts 02108 VI. Expiration date Notwithstanding the expiration date of this Approval, any system sold and installed prior to the expiration date of this Approval, and approved, installed and maintained in compliance with this Approval (as it may be modified) and 31.0 CMR 25.000, 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. lFP66 POWLAHD PHONE NO. 518 775 7_,050 NOV. 19 1997 01:47PM P7 FAST Remedial Use Approval Page: 7 VII. Rights of the Department The Department may suspend, modify or revoke this Remedial. Use 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 or the Company. VIIZ.Rigbt of Appeal This Approval is an action of the Department. Any person aggrieved by this action may request an adjudicatory hearing. A request for a hearing must be made in writing and postmarked within thirty (30) days of the date of issuance of this Approval. Under 310 CMR 1.0.(6)(b), the. request must state clearly and concisely the facts which are the grounds for the recruest, and the relief sought. The hearing request along with a valid check payabl.e.to Commonwealth of Massachusetts in the amount of one hundred dollars ($100.00) must be mailed to: Commonwealth of Massachusetts Department of Environmental Protection P.O. Box 4062 Boston, MA 022x1 The request will be dismissed if the filing fee is not paid, unless the appellant is exempt or granted a waiver as described below. The filing fee is not required if the appellant is a city or town (or municipal agency), county, or district of the Commonwealth of Massachusetts, or a municipal housing authority. The Department may waive the adjudicatory hearing filing fee for a person who shows that paying the fee will create an undue financial hardship. A person seeking a waiver must file, together with the hearing request as provided above, an affidavit setting forth -the facts believed to support the claim of undue financial hardship.