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Miscellaneous - 443 BOSTON STREET 4/30/2018 (2)
443 BOSTON STREET 2101107.D-0109-0000-0 A rfjaSr Y 3 11 4 `" .5` t Zs i.�.f3`f"x-R! y e*(k 4 l; y r Y".1. ' ,tRf�'S . .•sem .t.; . �7'SSh �. 4-at k'�' e .`•�..! � :�11. ; 5� zc3 y C.Y-LQT # ��Z` 1 h r �. STREET t __ ..._ .._.__.... ONSTRUCTI.ON APPROVA.. -✓ Q -VIEW FEE .BEEN PAID? YES � NO JVAL: DATE ��9 APP. BY_ - �� PLAN DACE: (5,)//L'�J�� INS SUPPLY: TOWN WELL WELL PERMIT DRILLER WELL TESTS: CHEMI DA'l E APPROVED,_.___.-__..__._.____ BACTERIA I UA I E f1I tPRUVED BACTERIA II D APPROVEllY._-_-___ f COMMENTS: FORM U APPROVAL:: APPROVAL TO ISSUE YES NO DATE ISSUED BY CONDITIONS: FINAL APPROVAL: . ALL PERMITS PAID YES NO WELL CONSTRUCTION APPROVAL YES NO SEPTIC SYSTEM CONSTRUCTION APPROVAL YES NO OTHER YES NU ANY VARIANCE NEEDED YES NO FINAL BOARD OF HEALTH APPROVAL: I �PTIaZEM- NSIfl4tI QN Jy:xr 'ISTHE INSTALLER LICENSED? :.�ES _ ; NO TYPE OF CONSTRUCTION: NEW REPAIR ;' NEW CONSTRUCTIDN: CERTIFIED PLOT PLAN REVIEW YES NO CONDITIONS OF..APPROVAL YES NO 4 i r (FROM FORM r '.,ISSUANCE OF `DWC PERMIT YES NO ' . DW C PERMIT NO. ~'INSTALLER: ` ' BEGIN INSPECTION YEIS10: i \ •`:_ ..:. EXCAVATION ` INSPECTION: ; NEEDED: ,SASSED / BY .:CONSTRUCTION INSPECTIONS NEEDED: AS BUILT PLAN SATISFACTORY: YES APPROVAL TO BACKFILL: DATE:- - c / 't' BY 1 .FINAL . GRADING APPROVAL: DATE F�� BY - FINAL CONSTRUCTION APPROVAL: DATE: BY y,« t !t � ,A,. �;rl'''�- 3'l XSck!'r c{'`"� 't>n'f YM t aHlwR r ,a�YR �' •.. .1 - l ?"*a.:"�...« µ�o+ta+� „t� y � Fi('Twr klyy7 —v "' + s �i:, t• r w a f�^r•cs-s t.a.. {L, #� -,� \js z.4 •S.' ,L .#i��'3 ++L s. •. tj ..`gk, '(�yy`'¢ r .a n*.e�+ *. sx".y9�y,,. fi,; ` ` t. f.. viift - yG7 _.b!w 'Nr r r �. §fit.r -!.'✓. ^.}:�f ( i. MAP # ` per' T;4 # t�,• z r _ _ PARCEL # �� ' STREET • �ONSTRUCTLO,N-APPRO.VA.L., • HAS PLAN REVIEW FEE .BEEN PAID? YES NO PLAN APPROVAL: DATE ���� APP. BY DESIGNER: PLAN DATE. CONDITIONS WATER SUPPLY: TOWN WELL WELL PERMIT DRILLER WELL TESTS: CHEMI DAZE AF'F�RUVED BACTERIA I DA fE (IPPRUVED BACTERIA II D APPROVED - - COMMENTS: FORM U APPROVAL: APPROVAL TO ISSUE YES NU DATE ISSUED BY CONDITIONS: FINAL APPROVAL: . ALL PERMITS PAID YES NO WELL CONSTRUCTION APPROVAL YES NU SEPTIC SYSTEM CONSTRUCTION APPROVAL YES NO OTHER YES NU ANY VARIANCE NEEDED YES NO FINAL BOARD OF HEALTH APPROVAL: DATE: BY: - E� GY��EM�NSI94L$T�QN '-', .;IS THE INSTALLER LICENSED?.., 1 + • _ :YES NO • ;_ t 7. ` TYPE. OF CONSTRUCTION: ? NEW I.-- REPAIR -NEW CONSTRUCTION: CERTIFIED PLOT PLAN REVIEW YES NO 1 _ . CONDITIONS OF.-APPROVAL YES NO (FROM FORM U) :.. _ISSUANCE OF DWC PERMIT YES NO DWC PERMIT N0. r _ _ - INSTALLER: 17 BEGIN INSPECTION YES 0: - ."EXCAVATION . INSPECTION: _ ; NEEDED: PASSED :CONSTRUCTION INSPECTIONS NEEDED: rwi AS BUILT PLAN SATISFACTORY: YES_z- /71 APPROVAL. TO BACKFILL: DATE: � / � `A � BY mFINAL . GRADING APPROVAL: DATE `� �« BY FINAL CONSTRUCTION APPROVAL: DATE: BY Commonwealth of Massachusetts ExecLftive Office of Environmental Affairs Department .of Environmental Protection- Willlaen F.Weld Governor Trudy Coxe Secretary,EOEA David B. Sttuhs Commissioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION UU Property Address: '�' / � � Address of Owner: Date of Inspection: ,1 (If different) Name of Inspector: Company Name, Address and Telephone Number: t p CERTIFICATION STATEMENT 9ta4 ,,i., _�, I certify that I have personally inspected the sewage disposal system at this address and that the in-formation reported below is true, aceturate and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: asses Conditionally Passes Needs Further Evaluation By the Local Approving Authority Fails Inspector's Signature: Date..: The System Inspector :,b)111bmit a copy of this inspection report to the Approving Authority within thirty (30) days of completing tfris inspection If the system � 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 Department of Environmental Protection. The original should be sent tc, thn system owner and copes sent to the buyer, if applicable and the approving authoeil�. INSPECTION SUMMARY: Check A, B, C, or D A] SYSTEM SES: I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR $5.303. Any failure criteria not evaluated are indicated below. B] SYSTEM CONDITIONALLY PASSES: One or more system components need to be replaced or repaired. The system, upon completion of the replacement or repair, passes inspection. Indicate yes, no, or not determined (Y, N, or ND). Describe basis of determination in all instances. If"not determined"., explain why not) The septic tank is metal, cracked, structurally unsound, shows substantial infiltration or exfiltration, or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. (revised 8/15/95) $ One Winter Street • Boston,Massachusetts 02108 • FAX(617)556-1049 • Telephone(61:)292-5500 i1 Printed on Recycled Paper ti SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) a Property Address: �d �� 1 S A '4j Owner: Date of Inspection / — B] SYSTEM CONDITIONALLY PASSES (continued) Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health): broken pipe(s) are replaced obstruction is removed distribution box is levelled or replaced The system required pumping more than four 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 C] FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health, safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, IF.APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: the system has a septic tank and soil absorption system and is within 100 feet to a surfat-e water supply or tributary, to a surface water supply. The'system ha, a septic tank and soil absorption system and is within a Zone I of a public water supply well. The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well. The sy>lem hay a septic tank and soil absorption system and is less than 100 feet but 50 feet or more from a private water supply well, unless a well water analysis 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. D] SYSTEM FAILS: I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. (revised 8/15/95) 2 c �M SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) ,f Property Ad res,: Owner: Pr)Q)C Date of Inspection: D] SYSTEM FAILS (continued): Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/2 day flow. Requiredr pumping mop:than 4 times in the last year NOT dine to clogged or obstructed pipe(s). Number of times"pumped ' Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone I of a public well. Any portion of a cesspool or privy is within 50 feet of a private water supply well. Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. E] LARGE SYSTEM FAILS: The following criteria apply to large systems in addition to the criteria above: The design floe% of system is 10,000 gpd or greater (Large System) and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area (IWPA) or a mapped Zone II of a public water supply well's The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the (owl regional office of the Department for further information. (revised 8/15/95) 3 �4 L SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART S CHECKLIST Property Address: ! y� 1'01,5 eoAl Owner: /W/v c V- Date of Inspection: 6 _'t E.^S Check if the following have been done: 10101 __(oAL'mpin information Was requested of the owner, occupant„ and Board of'Health. Gone of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates duri that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. _As t plans have been obtained and examined. Note if they are not available with N/A. e" he facility or dwelling was inspected for signs of sewage back-up. he s em does not receive non-sanitary or industrial waste flow he 'e was inspected for signs of breakout. L � P g /All tern components, excluding the Soil Absorption System, have been located on the site. i he septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or tee aterial of construction, dimensions, depth of liquid, depth of sludge, depth of scum. zfacilit) d location of the Soil Absorption System on the site has been determined based on existing information or ed by non-intrusive methods. _ o„c c, (and occupants, if d:ffcrcn! frcm owner) were provided with information on the proper maintenance of Sub- Surface Disposal System. (revised 8/15/95) 4 s SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: y� �6$ �� SJ 'xv ,/(ham r Owner: '.,f"'& Date of Inspection: 6 , FLOW CONDITIONS RESIDENTIAL: Design flow: rtal o s Number of bedrooms: Number of current residents: Garbage grinder (yes or no): Laundry connected to syste (ves or no): Seasonal use (yes or no): Water meter readings, if available: Last date of occupancy: jy opt COMMERCIAUI N DUSTRIAL: Type of establishment: Design flow: tzallons/day 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: OTHER: (Describe) Last date of occupancy; GENERAL INFORMATION PUMPING RECORDS and source of information: System pumped as part of inspection: (yes or no) �S If yes, volLme pumper! {C3ta� ga ons 7 ; Reason for pumping. ��� D C7– 727 r� TYPE OF S EM -lo— Septic tank/distribution box/soil absorption system Single cesspool Overflow cesspool Privy Shared system (yes or no) (if yes, attach,previous inspection records, if any) Other (explain) APPROXIMATE AGE of all components, date installed (if known) and source of information: Sewage odors detected when arriving at the site: (yes or no) d (revised 8/15/95) $ w SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM.INFORMATION (continued) Property Address: J 6'S j'J,–j Owner: H/Vow Date of Inspection: SEPTIC TANK: (locate on site plan) Depth below grade,5 d t( Material of construction: +. Crete _metal _FRP—other(explain) Dimensions: h ` Sludge depth: Distance from top of Judge to bottom of outlet tee or baffle: Scum thickness: Distance from top of scum to top of outlet tee or baffle:_ r, Distance from bottom of scum to bottom of outlet tee or baffler Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of ligyid leve J in relation to outlet invert, structural integrity, evidence of leaks e, etc.) a'u y'!� !'- 1-40 SrCJC1'Ger i?c� ra � Ge GREASE TRAP:_ (locate on site plan) Depth belov+, grade: Material of construction: _concrete _metal _FRP —other(explain) Dimensions: Scum thickness. Distance from top of scum to top of outlet tee or baffle: Distance from bottom nt cru— 1- hnnnm of outlet tee or battle Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outleE invert,'structural integrity, evidence of leakage. etc.i (revised 8/15/95) 6 c SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Ad(Jress. Owner: N Off' Date of Inspection: /./$ - TIGHT OR HOLDING TANK:_ (locate on site plan) Depth below grade: Material of construction: _concrete_metal _FRP—other(explain) Dimensions: Capacity: gallons Design flow: gallons/day Alarm level: Comments: (condition of inlet tee, condition of alarm and float switches, etc.) DISTRIBUTION BOX: (locate on site plan) / f� Depth of liquid level above outlet invert: d r�`0 L I-ef f " r Comments: (note if Ie,e! and distri' ^~ c , e•.id^nce of"!ids c� n near pvidnnce of leakage into or out of hox, etc 1 PUMP CHAMBER:,t� N (locate on site plan) Pumps in working order:(yes or no) � Comments: (notec dition of pump c m r, condition of pumps and app rtenance}�s,. etc.) © i' (revised 8/15/95) 7 C • k SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address �',�f�� % �/`/ 5%- Owner: 1<"'loe Date of Inspection: SOIL ABSORPTION SYSTEM (SAS):1,.+0-_10, (locate on site plan, if possible; excavation not required, but may be approximated by non-intrusive methods) If not determined to be present, explain: Type. A leaching pits, number:_ ' leaching chambers, number:_ leaching galleries, number: leaching trenches, number,length: leaching fields, number, dimensions: overflow cesspool, number: Comments: (note condik' n of s il, signs of hydra I<ic failure, level of riding, conditio I vegetation,etc.) 41aze 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, conditiori of vegetation, etc.) PRIVY:_ (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) (revised 8/15/95) 8 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: Owner: /,6f ox Date of Inspection: 6 C�-49,i� SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' s � DEPTH TO GROUNDWATER l Depth to groundwater: feet method of determination or approximation: ,,,(((��� (revised 8/15/95) 9 /J :.-. 1. `.� �E S•. - � i <.� SUBSURFACE SEWAGE DISPOSAL SYSTEM: INSPECTION FO NO Address of property 'I y "[O�BO���F HEAI.TN Owner ' s name &I r.'-1 Date of Inspection UM Of 1 PART A CHECKLIST Check if the following have been done: Pumping information was requested of the owner, occupant, and Board of Health . ✓ -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. V? As built plans. have been obtained and examined. Note if they are not available with N/A. ! The facility or dwelling was inspected for signs of sewage back-up. The site was inspected for signs of breakout . } .✓" All system components , excluding the SAS , have been located on the 4 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 . 4-1 7 FLOW CONDITIONS If residential number of bedrooms Z number of current residents _j garbage grinder, yes or no laundry connected to system, yes or no ?v seasonal use, yes or no If nonresidential , calculated flow: Water meter readings , if available: Last date of occupancy GENERAL INFORMATION Pumping records and source of information: A I inspection, yes or no System pumped as part of if yes, volume pumped Reason for pumping: K A.17efZ I U Type .of system Septic tank/distribution box/soil absorption system Single cesspool Overflow cesspool Privy inspection Shared system (yes or no) (if yes, attach previous records , if any) Other (explain) components. Date installed, if known. Source of Approximate age of all information: Sewage odors detected when arriving at the site, ye.s or no SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B SYSTEM INFORMATION continued SEPTIC TANK:— ( locate on site plan) depth below grade : -> material of construction: ---,-concrete metal FRP other(explain) dimensions : t :33 sludge depth 2 ', distance from top of sludge to bottom of outlet tee or baffle scum thickness distance from top of scum to top of outlet tee or baffle Z" 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. ) i.."I� �✓.J �^ti 7F ;+v P i i"/C`.�./ 5 T/t ut Tl. E rfir"`SES ilati'/ r9fi N DISTRIBUTION BOX: (locate on site plan) ifo z1 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. ) 1N,9Yc S/ �'.� Gr lJJ2Y Uv �i2 v 'Z X0 A PUMP CHAMBER: (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: Type leaching pits and number leaching chambers and number leaching galleries and number leaching trenches , number, length _L �ii=� � r"'i?�3n'r3� r �r�`� -16" P7 leaching fields , number, dimensions cverflow cesspool , number. i Comments : (note condition of soil , signs of hydraulic failure, level of ponding, condition of vegetation, recommendations for maintenance or repairs, etc. ) Lill ffr 2 'L.G�+.� ��.�_1"/��t_� .r`hi 2e CESSPOOLS (locate on site plan) : i 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. ) i 11 rPe SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B SYSTEM INFORMATION continued SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100 ' O< T 1z 19 r4 ti E 0 cur L•. t ? 1=1F_ LX> 1 r `\ LI, DEPTH TO GROUNDWATER r depth to groundwater method of determination or approximation: 8y TEST 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) `_ Backup of sewage into facility? A Discharge or ponding of effluent to the surface of the ground or surface waters? TL Static liquid level in the distribution box above outlet invert? A Liquid depth in cesspool <6'" below invert or avail_ar' Q volume< 1/2. day flow? Required pumping 4 times or more in the last year? number of times pumped 0 �Vp Septic tank is metal? cracked? structurally unsound? substantial infiltration? substantial exfiltration? tank failure imminent? Is any portion of the SAS , cesspool or privy: Y below the high groundwater elevation? .�_ within 50 feet of a surface water? ZL�^ within . 100 feet of a surface water supply or tributary to a surface water supply'.75 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) ? within 50 feet of a private water supply well? 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 analysis for coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. 13 ap, SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART D CERTIFICATION Name of Inspector Company Name Company Address k, 3 3 vV Yq k K t(Z i'Z 0 1,) qA,1,()U 1W,� Certification Statement I certify that I have personally inspected the sewage disposal system at this address and that theinformation reported is true, accurate and complete as of the time of inspection. The inspection was performed and anv 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 . Check one : 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 areas stated in the FAILURE CRITERIA section of this form. V 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. inspector ' s Signature Date Original to systen owner Copies to: Buyer ( if applicable) Approving authority Y DEP FILE #242 - Therefore, the North Andover Conservation Commission(hereafter the"NACC") hereby finds that the following conditions are necessary, in accordance with the Performance Standards set forth in the State Regulations, the local ByLaw and Regulations, to protect those interests noted above. The NACC orders that all work shall be performed in accordance with said conditions and with the Notice of Intent referenced above. To the extent that the following conditions modify or differ from the plans, specifications or other proposals submitted with the Notice of Intent, the conditions shall control. GENERAL CONDITIONS 1. Failure to comply with all conditions stated herein, and with all related statutes and other regulatory measures, shall be deemed cause to revoke or modify this Order. 2. This Order does not grant any property rights or any exclusive privileges; it does not authorize any injury to private property or invasion of property rights. 3. This Order does not relieve the permittee or any other person of the necessity of complying with all other applicable federal, state or local statutes, ordinances, by-laws or regulations. 4. The work authorized hereunder shall be completed within three years from the date of this order. 5. This Order may be extended by the issuing authority for one or more periods of up to one year each upon application to the issuing authority at least 30 days prior to the expiration date of the Order. 6. Where the Department of Environmental Protection is requested to make a determination and to issue a Superseding Order, the Conservation Commission shall be a party to all agency proceedings and hearings before the Department. 7. The proposed work includes: replacement of a subsurface disposal system and relocation of an existing driveway. 8. The work shall conform to the following (except as noted in the remainder of this document where revisions may be required): Notice of Intent filed by : Paul and Roberta Davis 443 Boston Street N.Andover,MA 01845 DATED: 7/14/95 Plan prepared by: New England Engineering Services,Inc. entitled"Subsurface Disposal System" DATED: July 25,1995 C:\Winword\00C\242- .doc 1 NACC 7/31/95 ° DEP FILE# 242 - 9. The following wetland resource area is affected by the proposed work: Bordering Vegetated Wetland (BVW). The Buffer Zone of this resource area is protected under the Local ByLaw. This resource area is significant to the interests of the Act and Town ByLaw as noted above. This resource area is also significant to the recreational and wildlife.interests of the ByLaw. The applicant has not attempted to overcome the presumption of significance of this resource area to the identified interests. 10. The NACC agrees with the applicant's delineation of the wetland resource areas on the site as shown on the plans dated 7/25/95 entitled"Subsurface Disposal System". Prior to the issuance of a Certificate of Compliance, the applicant will submit a plan showing the site's wetland delineation at a scale identical to the Town's wetland map for this location. 11. Issuance of these Conditions does not in any way imply or certify that the site or downstream areas will not be subject to flooding or storm damage. 12. The conditions of this decision shall apply to, and be binding upon, the applicant, owner, its employees and all successors and assigns in interest or control. 13. The NACC finds that the intensive use of the upland areas and buffer zone proposed on this site to construct a replacement subsurface disposal system and relocation of an existing driveway will cause further alteration of the wetland resource areas. In order to prevent any alteration of wetland resource areas beyond those proposed in the Notice of Intent and approved herein, a twenty five foot (25') no-disturbance zone and a fifty foot (50') no-construction zone shall be established from the edge of adjacent wetlands except at those locations as shown on the approved approved plans referenced herein (leach field 19' from BVW/limit of work approx. 5'). No disturbance of existing grade, soils or vegetation is permitted in the no-disturbance zone. (See Appendix 5 of the local Regulations). PRIOR TO CONSTRUCTION 14. No work shall be undertaken until all administrative appeal periods from this Order have elapsed or, if such an appeal has been filed, until all proceedings before the Department or Court have been completed. 15. This Order shall be recorded by the applicant at the Registry of Deeds immediately after the expiration of all appeal periods. No work shall be undertaken until the Final Order has been recorded in the Registry of Deeds or the Land Court for the district in which the land is located, within the chain of title of the affected property. In the case of recorded land, the Final Order shall also be noted in the Registry's Grantor Index under the name of the owner of the land upon which the proposed work is to be done. In the case of registered land, the Final Order shall also be noted on the Land Court CAWinword\00C\242- .doc 2 NACC 7/31/95 DEP FILE # 242 - Certificate of Title of the owner of the land upon which the proposed work is to be done. The recording information shall be submitted to the North Andover Conservation Commission on the form at the end of this Order prior to commencement of the work 16. A sign shall be displayed at the site not less than two square feet or more than three square feet in size bearing the words "Massachusetts Department of Environmental Protection, File Number 242- ". 17. Any changes in the submitted plans caused by the applicant, another Board's decision or resulting from this Order of Conditions must be submitted to the NACC for approval prior to implementation. If the NACC finds said changes to be significant, the NACC will call for another public hearing (at the expense of the applicant). Within 21 days of the close of said public hearing the NACC will issue an amended or new Order of Conditions. Any errors found in the plans or information submitted by the applicant shall be considered as changes. The proposed project may be still under review by other local or state boards or agencies. This may result in changes to the project plans or wetland impacts. If any such changes occur a revised plan and an explanation of the revisions shall be submitted to the NACC for review and approval prior to the start of construction. No work shall begin on a project until written approval has been granted by the NACC. 18. The applicant shall contact the Conservation Office prior to site preparation or construction and shall arrange an on-site conference with an NACC representative, the contractor and the applicant to ensure that all of the Conditions of this Order are understood. This Order also shall be made a part of the contractor's written contract. The applicant or contractor shall notify the NACC in writing of the identity of the on-site construction supervisor hired to coordinate construction and to ensure compliance with this Order. 19. The applicant shall submit a construction schedule/sequence to the NACC detailing the proposed sequence of work on site to complete this project. 20. Wetland flagging shall be checked prior to start of construction and shall bere re- established where missing so that erosion control measures can be properly placed and wetland impacts can be monitored. 21. A row of staked hay bales backed by trenched siltation fence shall be placed between all construction areas and wetlands. The erosion control barrier will be properly installed and placed as shown on the approved plans referenced herein and dated 7/25/95 and shall be inspected and approved by the NACC prior to the start of construction and shall remain intact until all disturbed areas have been permanently stabilized to prevent erosion. All erosion prevention and sedimentation protection measures found necessary during construction shall be implemented at the direction of the NACC. CAWinword\00C\242- .doc 3 NACC 7/31/95 DEP FILE#242 - 22. The applicant shall have on hand at the start of any soil disturbance, removal or stockpiling, a minimum of ten (10) hay bales and sufficient stakes for staking these bales (or an equivalent amount of silt fence). Said bales shall be used only for the control of emergency erosion problems, and shall not be used for the normal control of erosion. 23. A check payable to the Town of North Andover shall be provided in the amount of $ which shall be in all respects satisfactory to Town Counsel, Town Treasurer, and the NACC , and shall be posted with the North Andover Town Treasure before commencement of work. Said bond or deposit of money shall be conditioned on the completion of all conditions hereof, shall be signed by a party or parties satisfactory to the NACC, and Town Counsel, and shall be released after completion of the project, provided that provision, satisfactory to the NACC, has been made for performance of any conditions which are of continuing nature. The applicant may propose a bond release schedule keyed to completion of specific portions of the project for the NACC's review and approval. This condition is issued under the authority of the local ByLaw. DURING CONSTRUCTION 24. Any fill used in connection with this project shall be clean fill, containing no trash, refuse rubbish or debris, including but not limited to lumber, bricks, plaster, wire ,lath , paper, cardboard, pipe, tires, ashes, refrigerators, motor vehicles or parts on any of the foregoing. 25. No exposed area shall remain unfinished for more than thirty (30) days, unless approved by the NACC. 26. No regrading in the buffer zone shall have a slope steeper than 2:1 (horizontal: vertical). Slopes of steeper grade shall be rip-rapped to provide permanent stabilization. 27. There shall be no stockpiling of soil or other materials within twenty-five (25) feet of any resource area. 28. Washings from concrete trucks, or surplus concrete, shall not be directed to, any drainage system, or wetland resource area. 29. All waste generated by, or associated with, the construction activity shall be contained within the construction area, and away from any wetland resource area. There shall be no burying of spent construction materials or disposal of waste on the site by any other means. The applicant shall maintain dumpsters (or other suitable means) at the site for the storage and removal of such spent construction materials off-site. CAWinword\00C\242-_doc 4 NACC 7/31/95 J DEP FILE # 242 - 30. Accepted engineering and construction standards and procedures shall be followed In the completion of the project. 31. Members of the NACC or its agent shall have the right to enter upon and inspect the premises to evaluate and/or effect compliance with this Order of Conditions. The NACC reserves the right to require, following field inspection, additional information or resource protection measures. 32. During and after work on this project, there shall be no discharge or spillage of fuel, or other pollutants into any wetland resource area. If there is a spill or discharge of any pollutant during any phase of construction the NACC shall be notified by the applicant within one (1)business day. No construction vehicles are to be stored within 100 feet of wetland resource areas, and no vehicle refueling, equipment lubrication, or maintenance is to be done within 100 feet of a resource area. AFTER CONSTRUCTION 33. No underground storage of fuel oils shall be allowed on any lot within one-hundred (100) feet of any wetland resource area. This condition shall survive this Order of Conditions, and shall run with the title of the property. This condition is issued under the authority of the Town's Wetland protection ByLaw. 34. Fertilizers utilized for landscaping and lawn care shall be organic and low-nitrogen content, and shall be used in moderation. Pesticides and herbicides shall not be used within 100 feet of a wetland resource area. This condition is issued under the authority of the Town's Wetland Protection ByLaw. 35. Upon completion of construction and grading, all disturbed areas located outside resource areas shall be stabilized permanently against erosion. This shall be done either by loaming and seeding according to SCS standards. If the latter course is chosen, stabilization will be considered complete once vegetative cover has been achieved. 36. Upon completion of the project, the applicant shall submit a letter to the NACC from a Registered Professional Engineer certifying compliance with this Order of Conditions and the approved plans referenced herein (or approved revisions). A stamped"As-Built" topographic plan of all areas within the jurisdiction of the Wetlands Protection Act and ByLaw shall be submitted when a Certificate of Compliance is requested. This plan will include: A) "As-Built" elevations of all drainage structures constructed within 100 feet of any wetland resource area; C) Distances from structures to wetland resource areas; CAWinword\00C\242-_.doc 5 NACC 7/31/95 DEP FILE # 242 - D) A line showing the limit of work. "Work" includes any disturbance of soils or vegetation. 37. The following special conditions shall survive the issuance of a Certificate of Compliance for this project: 13. A 25' No-Disturbance Zone and a 50' No-Construction Zone shall be established from the edge of adjacent wetland resource areas except in those locations approved under this Order of Conditions. Future work within 100' of existing wetland resource areas will require a separate filing with the NACC (refer to Section XI (page 18) of the Regulations for performance standards within these zones); 32. Discharge of spillage of pollutants; 33. Prohibition of storage of fuels underground; 34. Limitations on the use of fertilizers, herbicides and pesticides. CAWinword\00C\242-_.doc 6 NACC 7/31/95 a . 310 G2M 10.4 9 DEP Fie•No. �.._.. L5 l�J 6 U U (ro be provides trf DU)3 � Gty�o� North Aiuiover - 1995 Apps al l and Roberti T)��ri c =,g�th NORTH ANDOVER D° efanae Of � of xna'a c b u s e t t s CONSERVATION COMMISSION Defend e va.iLed States notice of Intent of Aaeri= Ondor the Uzosachusettz Watlands Protection Act, G.L. c. 131, 540 and Application for a Dapart,..nent of the Ar--y ?*=it Part .1; Gaaeral Zcfor--ation street Add.-ess 443 Boston Road, North Andover, Ma NI;Z:e: C TypeResidential. Aescr'-r-etic. Replacement of subsurface disposal system :- Ce_ e ; ` Rec_s-.e_e,. _a^:d; 4 . Apw -=an Paul and Roberta Davis Te ; . Ad�'_ess 443 Boatoll St N. A11.8over. : . ?toyer Owner Same as aDplicant Te- Ac =es 6 . Re.=ese-_at_ a Te Tim} England Fn�,jn��ring �prtr;roc Tn� 686-1768 Ad^_eea l . 33 Walker Rd North Andover, Ma 01845 7 , the Ccnse^✓at_cn Cc--4ssicn and the Depart.-Aer.t' a Regional o:_` ce ea_�. a. Have bee. aer._ b;; certified =ail or hard deliver, 2 copies cf cc:.�-etec "�ct_ce c. Intent, vitt: supporting pians and dcc;; ntsl Yea {3 No b. Has the fee been su~"ittsd7 Yes No Q C . otai riling Fee sub" _tec T _ ^c gee 40.00 State Share of Fi..n- Fee 15.00 d. c_:f/^owr Share cf Fi:_ �- - f ^525. Yew. '� dE (�4 of .ee in excess o� e . .e a brief statemer.= at_ached _^c eating how the aF�__ca.^.` ca:.c'__ar-ed :::e fee? ( Yes ❑ Nc 3-1 t wT'�Gd' ,`l�k {',a, ni§."7F'Si' .,'s.9 K "1... n g , gave all obtainable p0=jt'. , vazianees and apprnvals required by locrl by-law been -,)jtained? Yes ❑ No obtained Applied tor: Not Applied For: Board of Health Senri� — 4 . X . any portion of t to c. 1he site subject to a Wetlands Restriet n order puraus:.` T 3t, S40x or G.L. c. 130, 81057 'is: L,JJ No G.... 10. List all plans and supporting documents sub-fitted with this Notice of Intent,. Identifying N *^ r;Lat ter Title, Date Subsurface disposal. system Davis, 443 Boston Street, N. Andover, Pia. 01845 __ . Check those :escu_ce areae within wt - work is p= . c5e- (a , Buffer zone C1 and: Lard Subject cBark C:' Bordering veaetnted wetland* [I Bordering ❑ Land Under water Body z water-aay* ❑ Isolated (c) coastal : Land Under the ocean* ❑ Designated Port Area* ❑ coastal Beac :* ❑ coastal Dune ❑ Barrier Beach* Q Coastal Bank Roeky +ntertidai Shore* ❑ salt Harsh* ❑ Land under Salt Pond* ❑ Land Container , shellfiah* ❑ Fish Run* *Likely tc inyc ve U.S . A--=y Corps of Engineers conc :rrent jur=9dic_io See General Instruct_cns for Completing Notice of Intent ��L 12. tri the proje_t 'All thin asLimatad. habitat whish is indicated on the most recent Estimated Habitat Hap of State-Listed Rare "lietlands wildlife (if any) published by' the Natural Seritage and Endangered Species Program! YES ( No ( X j Date printed on the Estimated Sabitat Map NO NAP AVAILABLE ( I (if any) 1995 If yes, have you sent a copy of the Notice of .ZAtent to the Natural Heritage and Endangered Species program via the U.S. Postal Service by certified or priority snail (or othervise sent .it in a manner tbat :quarantees deliver^f within two days) no later than the date of the filing of this Notice of Intent with the conservation comzaission and the DLP regional office?. YES ( j NO I l If yes please attach evidence of timely =ailing or other delivery to the i Natural Heritage and Endangered species Program. part II: Sit® Description indicate which of the following information has been provided (on a plan, in narrative description. or„calculations) to clearly, completely and acc--rateiy describe existing site condit;ons . Identifying Number/Letter (of pian., narrative or calculations) ha*ural Features So, s Vegetation �� — Tcrogrnr�:y open water bodies(includin.g ponds and la}:es ) -- Flowing water bodies(inclu.ding streams and rivers) { Publ c and private surface water and ground water su-,;:ies on or within 109 feet of site 1 flax:- annual ground water elevations wit' dates anz location of test I Boundaries of resource areas checked under Par= 1, item 1: above Other Man-made Features : 1 Structures (such as buildings, piers, towers anal headwalls) Drainage and flood control facilities at the site and immediately off the site, including culverts and. open channels (with inverts) , dams and dikes I Subsurface sewage disposal systems Underground utilities 3_3 ( Roadways and parking areae ianLo and -' Other Part liar Work Description indicate which of the following inforr:ation has .been prcvided (on a plan, in narrative description or calculations) to cl©arly, coapiateiy and acc-rataly dascr'bs vork propos®d within each of the resource areas checked in Part i, item 11 . absv®. Identifying Nu=r er/Lattor (of plan, narrative or calculations) Elan 42 and Cross soctiOn o' ; f stuctures (such as buildings, piers , toners and headwalls) r Drainage and flood control_ fac_lit; es , ir.c_ :ci^c - _versa and open channels(with inverts ) , dasr.s and dikes ( subsurface sewage disposal eyste.ms t uncer= .. .. ..._-"- ties -- F' l_t:g, dredging and excava`_. . , ... -_ vc- -ne an-4 ccm.pnsition of material Compensator— storace areas , where required in acccr::ance with Part i':, Secticr. 10 _57 (4 ) of t: rec_-at__ns . hat--tan Other pcjZ,t sc r:!e Discharce "-' Description of, character_st-' =3 of discaarge `r_:n int source (bot: closed and open c ar.nel) , when pc ^f disc-arae falls within resource area c::eckea un-er Par. I , iters 11 atove, as eupperted by standard enc-neer-ng calculations , data anal plans , the fcllowing: 1. Deiineation of the drairage area contributing to the point of ciscnarge; z. Pre aro post otveloornent peak cut-off from the drainage area, at the point of discnarge, for at teest the 10•yrar aro iop•year frewem y storm; i Pre- enc post daveitxs ttt rate of infittration contributing to the resource area eflecrec voer Part 1, iter- 11 aboye; Estivated eater quatity cfteracteriatics of pre- &rid post•oeyetocrryrnt run"'" at the poi^.t of disc^erGe. 3-4 {M1�k. Part IY: Mitigating !. Clea ,vj tte!y rrd arcvra'ely desir"ae, with reference to supporting pima and calculations where nt~crsgsry. (a) All wmasurea and dvsigm gropPoamd to amot the petrforowencr standards set forth under each resource area specified in Part i1 or Part 111 of the rogulatiom: or (b) 61hy the presuaatic- get forth a-6er eeich resource area spaeified in Part 11 or Part 111 of the rew l a t i ores do rot apply. F:� coastal Resource Area Type: identifying num.:er or Zr.lanc letter of aup.per_ documents Ccasta Rego . Area Type :• Idert:fy. ng nu.; er or J rasta letter of suY;cr- documents i I l I 1Pnt: f1 irk nu �er or coastal Resourcr- Area Type: letter of Bup.'.rt CJ Inland documents Z, Cleary, CCMetely aro accuratety describe, rite refere+rce !e supporting piers and calc:!atIcm wAere roaceseary: (a) all treasures anC Oesigns to regulate wort within the Buffer Zone so as to ensure !`et said wort dors riot alter an area specified in Part !, Sectors 10.02(1,,(0) 01 these e9u;8tix s; or, (b) {fwork in the Buffer Zone will alter such an area, all measures anq designs protx sec to meet • ;,er�orvarce staroares ZSrI,lisneo f:r t ao;,�e reSC-lr-e area, sperifieJ Fart ;1 a- D of hose regillati.—. ,2Q Coastal Resource Area '.ype Bordered Identifying nurber or Iant By 100-Feet ojBcretionary Zone . letter of su7= _ _ do_.i,eats Installation. of a new subsu.f:ace disposal system l,,'ork to take place within 5 feet of a B.V.W. iti'et.land will be protected during construction wi.tb a row of silt fence. Wetland will be protected from effluent by watterproofed concrete walls. I ?-a Part vs Additional information for a Department of the Army Permit 1. coE Application No. (to be provided by COE) 2 . (Name of waterway) 3 . Names and add-reaves of property owners adjoining your property: d . Docz:,ent other project alternatives (i.e. , other locations and/or construction methods, particularlythose that mould eliminate the discharge of dredged or fill material into waters or wetlands ) . K . 8h" x 11" drawings in planview and cross-section, showing the resc::ce area and the proposed 'activity within the resource area. Drawings must be to scale and should be clear enough for photocopying. Cart,ificatic- is required from, the Division of water Pollution Control before the Federal perr:it can be issued. certification may be obtained by ccr.tact_na the Division of Nater Pollution control, 1 winter Street, Boston, Massachusetts 02108 . where the activity will take place within the area under the Hassac'huaetts approved Coastal Zone Hanagerent Program, the applicant cer' .fiss :hat his proposed activity complies with and will be conducted in a manner that is _on5istent witn the approved proq._- r. ;.r.fcr—_aticn provided will be used in evaluating the application for a per-�t and is made a matter of public record through issuance of a public notice . Disclosure of this infor-nation is voluntary; however, if necessary in!c^ation is not provided, the ap lication cannot be processed nor can a permit be issuec. i hereby certify under the pains and penalties of perjury that the fcrecc_—nc Notice of intent and acct-,canying plana, documents and suppert:n; data are true and co=Ylete, to the best of my knowledge. Si gnat:.re of applicant Date 1� C. -zLl Sig—at.—.4e o: applicant' presentative�04Date FORM *Exception to EMG Form 4345 approved by NOUSACE, 6 May 1482" MED IDO (TEST) 1 MAY d2 •This docunent contains a joint oet>arTment of the Army and State c'. Massacn;,setts apptication for a permit to obtain permission to perfcrr,. activities in United States waters. The Office of Manage-e-' aro B uciget(oM8) has epproved those questions recW red by the us Army Cores of Engineers. 0148 Murrber 0702.0036 oral expiration Cate of 30 sevterrner 1983 appties". This statetrxnt will be set in 6 point type. 3-7 I FII,.ING FEE CALCULATION WORKSHEET plants, roadways/driveways NOT subject to 310 CMR 10.53(3e) SHALL NOT BE SUBJECT TO ADDITIONAL FEES CAIEGGRY 1 $55 PER ACTIVITY $ No. it said activities are reviewed under a SINGLE NOT L'. Cenfstrnction or EACH 'ROAD'WAY/DRIVEWAY within the A. Existing House!rasidentlsl lot (addition, deck, ,^ Buffer sun[; or Coastal Fluodzone NOT reviewnhle gerage,poal, shed,or DRIVEWAY) under 510 CHR 10.53 ('3e) and NOT associnted with a Sni B, Site Preparntion (remuvnl or v,rgototion, exca- vation �)rn�li(,0 „I,,.r;, 1),)m! t:vn:,Lrt)ction isn't category 4) proposed under this NUl) L'. Contcol ar nuisance vegetation Uy ;emovai, hTOTAL CATEGORY 3 ACTIVITIESerb• icides, etc. wiLhin n Rcc;uurce ',rc:, PER 1.0T pursuant to 31G .:'"•R :0.53(x) CA1CiT)f? .r 75 'f:R :�C1(tiTY D. Resource -Iren CIM 10.53 (p1 .:,il,[;r '•,n. .: u _ -__.__ A. ( i! >tiT T:.wr;O ( i.L l"�T;,'CRi) S ^+, ,. •., 1 ,Er,r �._� ._.. „i11VC-0,y under 310 C!i') .10.53 , 3e) u r;ati j tt frf!!I[,fF( +1 (),Icri[.lA1_ 1NST1Tli- `Lul `„ jY :r j ,I• n a:,••, !)n rr�:Ci, 11 ;1 ;I'rl' ( 1' rep(i1CC m'.t r?!, '1 (.•. �; i..)'.. - I r;E "atrCl r` ?n Mo1)itorif',y (OPAL CAIECORY 1 ,C7IVITIf.:S " :ot, .' i —._.-... C , a(. C 0 R1' ' e s ; t n Ti' )a r:3t ,' ! ,.: lc'l t':,. ,'1 Oa5lt'3, i., •--.-.___. . ':;e) - P.qr k t n, ,ercr PaW.)On, C. 9eech `�aur,sl?mt' mil '1 I11)' ..... AsJ*) --IATCD wit`, n .;FH lot i D. Coastal Activitiee `;t1'R 10.211 (le-c) inclur,inq 7a-Electric eneca iun Facilities, I . ALlr'j`.A1 !(%'f Of �C501MCE ;REd d oiversion or .,atter 7b-Public Jtilittes, c asta ., rued Projects „ r, —— - includinq PE.�v,^/r!A1 fil C� .t Tl^:G piers, a-111f J f "i„ ',RC''. IUS „,Sic CL. SUP non- bul Idinya :•;1.rfrCs, m: 1 t , n1 r. 1 1^JEcts, r r[ r UT'IE i' ?f'nrf r II.' ... I`, f.. LimII ;D 1"'0_ RC1 I' :! ;•')r_.,ur:f. to iii) C11R 10.53 (a-u; .. ~Ii! :It [ .51 ner `notl:rint '— -- J. r�11r( 1 ! I�_ �'�. '+r: �'. .',! C'' 1[�= •'U.. _, ?tits. ]t rt,p: ;.)",d (n NEW-at)rict.11t.�.,ral �aoiiii r, t,)ral r'.' acts ipia(. C.1 TE(:C(tY a •1i.11V(T[ES G. E A C I 1 '4 E.T!.AND n{:11Ir AY iii.)`.',i':u +:)it.%':`aLed with a SF pucyuent to 3l0 'i1'. 10.5311rr:' CgTi:';UI?t 5 12 ;;ET> (.l; r_aR F00T ; 10[al. 1"r;ET N01 10 BE f, ANY point so'.rt:e :fisc +r:;h MANS ,il ,'1R ii!iF.E 1H1!q b1000 .�.. T A, Cnl`sf On recon9t- rr. (�i"P.� 2 t 1TfC; a. h e • • _-. . _.,actio I or rep.oce- 1. ANY O �.1 :;rt Tr r,'7C .^t „ [' n ,r 1+ , at.. oriel :,; ;> a u , ,c ti m„ i u 5 IC�:S, L.F. . '� ,, i)I ES, or et ,Wr 1 . !r3' ,>n9 in,.,erin atc�.rCkare on CT?.3;T.At or l.'. 4N Rr�, l R s L D _�J qr 4 CL TOTAL CALCGOiTY Z tCTI' I".E ;r A •' i", Jiac_ enL of 1?IP-RA' ar :thcr C i.):J the �m t --- - — material nn c o a 3 t a I or inland resource arr!13y TOTAL. CAIECCRY 5 ',CT11IIIC5 51 1[ PPEPM ,ll')' for a"+Y deveiopmr>,. other then _ 101 A.. t,IL,PI C "CE C:1-C ;'.r.1E0 ror a SF I")CLJUP? ', re—)vii1 or vrrn ration ex,[ev9t Jn graoinq wr•Cn actual- ccistruction 3 iPERSON Sn11:Cp1!t..f P^ t ';nmol NOT proposeri under this N01, i' Vr3 ,�` ' , 14�L. 4'�„nso 8, CONS iPUC TIO`: 0,r E•1(.H n L•t1 ll.(N: wi,hln commercialADORES5, •_T — - industriat in3ti�uIi,inat, o non rtmtant/condo/ townhuaa; r:e of .�ev,l,rment, a);� r'r.RT ar tiht h TELEPItO'tF .IJ'tUEP is in a GUf-f CR ZONE or R(-SCURCE AREA. Associatea V '� activities; cite prepriration retentionidetention S(C';•til!tF __ _ DATE 1� basin conat, .:ctiun,oeptic syetems, parking lot;), utiliIie,I ;ioIk �)0r)rce,,:Ji2Ch0r !=.9, sewerage t.reatmer,L �I:1C'C \'IJ�.Sicticr tKTI CE OF I24TD lI' FEE IRAN IITrA7, FORM DEPARTMENT OF ENVIRCMUTM P%yI'Fr CN DIVISION OF WETLANDS AND FSS RMUTATIC t4 14,=CE E OF 12T=1 ��(NOI) APPLI CAKT: F' °Y n ?ti8I1e {t_u �L^�a lai — Name Street City/TCxTnJ;�cvL2 _ City/T wn "tate Zip Cade Ut f� `I.S� State Zip Code i C TT /ILkr FZrfi rcE PrTr :" I S PFmS DEP F=7 Nt.PB'E-R (if available) 1I may:, F"EE DISPC FEE al 1431 Filix)g Fee: $_. ;fir`' ' p U � Total Fee:tarmined in Natio of State : -zxe of Filing Fee: $ ISIC)o Insufficient Fee letter fresn (1/2 of fee in excess of $25.00) servation omission) Stare of State Share of Fee: $ 1 irnq Fee: -c Lj C'.) • U C� (1/2 of to*'al disputed fee) S:Ia-F- cf Fee: $_. (11/2 of '4oU�i di PI fr � _ 117_moi Z1_)CI'ICX 7S 1, Se.—'' this Fee Transrratta l form with a cha& Cr money order, pale to the cf Ms.;aciiusatts, to tl�e DE' Loc:-, BC.: Pt: Departrent ent o f Ermrirorrmntal Protection Box 4062 Das`on, MA 02211 2. At to oh a cam.' of this for. to the t7ot ce of Intent su .it+ i to tt e loci _ Gonse.. 3. Atte. a cons, of this form arra a �T of the DEP die. - to each of the Notice of Intent fore sutritted to the DEP regional office. 09 0o/E9 APPENDIX 2 North Andover Conservation Commission WAIVER REQUEST All projects submitted for review to the Conservation Commission should comply with the North Andover Wetlands Regulations as well as the State Regulations (310 MR) . If you cannot comply with any portion of the North Andover Wetlands Regulations you should file this waiver request identifying any areas where your proposed project is not in full compliance. Proj ect 2 y3 Ir Applicant: Va..I O�..Ls Applicant ' s i Address2 3 7-C S7 W 41170-171 �2� 1 Phone l I hereby request a waiver from Section(s) X I To ,9i/�•-� 1 C c,n s;�✓ 47-. S c cc ,S of the North Andover Wetlands Regulations. The reason (s) for this waiver request are described below. /1 7�z e xis. in�7 Sy /mac.Q Sigrt9ture of Ap cants Date 53-7119/2113 425 NEW ENGLAND ENGINEERING SERVICES INC. saoozosss 33 WALKER RD., STE. 22 NORTH ANDOVER, MA 01845 v 19 cj PAY TO THE �// ORDEROF /c.:C,' ^ 1�'c'/i;n �S(uvd2 �C.•. C` �. DOLLARS i 7 n FLRST ESSEX BANK- 1 Lawrence.Massachusetts 01842 MEMO ' n 1: 21137LL90: 58-0020 C3 C3 9 16L, 25 mm-- 53-7119/2113 426 NEW ENGLAND ENGINEERING SERVICES INC. 580020669 33 WALKER RD., STE. 22 ` NORTH ANDOVER, MA 01845 1 19 t etl o PAY TO THE �- _.11� �•�ass I Q i _.k ORDER OF�C .y1 Yh C.^ DOLLARS j FLRST ESSEX BANK- 1 # Lawrence,Massachusetts O1S42 � ib n � r MEM O 1: 2 L L37 L L9 11: S8-002066-911' ZC3 LIST OF PARTIES OF INTEREST PAGE I OF SUBJECT PROPERTY IMAP 'IPARCEL !NAME 'ADDRESS P,.4 I Ic, ABUTTERS MAP —!PARCEL 'NAME ADDRESS Rc; !SAM P jc7 oj )o m 4 15 iC7 L_A). n/- 19 A ' JC7 j,) T- 0 ;C7 Qz r I-o,r) f,+ CG.i-1. li MC: z F_ L/V Itc -7 E7 p H Z R Elk; I-D E N 3 Ln-s T-C c, to T H VAA 15; 5 7L2A; 57, A/"D rt P-C c c q j3 s L 5;T_. A F32 A)ETH 2YI G T "CL ,tit c ur t --,?t-.2 R E,q aI.v 6- 61/p Fr,pvue)5; L ij 3 f4 !Z q ,J.Ai Lj:Z !V..C— .A., L L IPL-A,,-j -fPTHY R E E',A,' L L 0 (2 A -7 , TIS 2S7 L)L 14 71, \,i�LA�,, C-r9 L 8. 3 3 L4 IA_; I L L 0 0., i< t7 6- _IA;o 7- W: L 0 V-! & J2 L ------------------- 53-7119/2113 438 NEW ENGLAND ENGINEERING SERVICES INC. 580020669 33 WALKER RD., STE. 22 NORTH ANDOVER, MA 01845 ✓ 19_ PAY TO THE•— F ORDER OF 7�,,ez a DOLLARS FIRST ESSEX BANKm 1 MEMO Lawrence,Massachusetts 01842 '�� is 2 L L 3 7 L 9 is 5811100 20661119ii' 0, 38 --� S roc/ -rJ N/1 S/X I No OF MgSp .t o=� JOSEPH Gds 1. a UBARBAGAIIO Nn. 464 2 - IC -` �%/ A Q�✓ OFF /sTs SSio ry At sa _�,��.�.6...e_,rm,. �P✓,._.;�-��.--3 A sl TO: NORTH ANDOVER, MASS a 19 77 BOARD OF HEALTH • FROM: DESIGN ENGINEER Re: Soil Absorption Sewage System Inspection This is to certify that I have inspected the construction of the said disposal system at �® 7 dSc-,-7—a'/V 77`1 North Andover, Mass. SITE LOCATION The grades and construction are as specified in my plans and specifications dated 19 \ads IVNO/ .ay ��lsi� yo b9b ' N a P o In o/ eg. nitarian Hd3S y�e sseiv j o til --- --- -- -- - - - ,..,:.. - '-�,•��Oft ti • Z��i" - - , . _ .�r ;��_ � ,,ms;µ� /J 4/V/'�,�p� •� 01 7Yn d dam, 1� X01- 1 , . �'n� loo L�7 t54 0 lot Q WA 1f got A'3 - . _ t,0µ fi"°V� • Hova ___— AA/?) P' ,-T � '?,F-,4 f A LLC ,F B �!rr^R.�t! g �ar: r, , ,N�. �l84 o4 .4 1 4 ! t ta'tn .fr E G•F%C Alm �'C1/N!�✓*/r. G,dr-"t A :1077o t/ A L to F1" K e -3 ~7 0�4 HIAI SAriVA M.AI. 1 40 ll rr� MIAI MIAI• M/UIIAI �\ � � ,� � �'*` .. � � -fix-r•j' r��-� ` ( t' .. t r r L ,fir" ,; ` � � 1) ' •.� `_,. �, li SII � 1'' s�"FL. T,Z'�1��5 • AtX) J ^<. _•'►_ ti ,. �.an..:.sc*7. ;,'y.^�a.ar'{"h.t9 w/',-r-:.'t • =..R. c" r-'r-J ._. .t� • Pt1 , .. 1c?r x,11 i D D 100 r& -;Dee tS A% C Cd� 7-1119r -724)AIP5 94 CJ 5 Y5re/q //15PGc-T&1' /97- LL1957- a��cc Eve Y S A40A-17 HS �/oG�T 51,161141,7-e-U 7Z Town of North Andover, Massachusetts Form No,a MORrh BOARD OF HEALTH C 19 11 (� Catt�ao ,a 1q.0 31 F e P DESIGN APPROVAL FOR ,SSACHUSft'A SOIL ABSORPTION SEWAGE DISPOSAL SYSTEM Applicant 801A L `' — JeO ba-t� 'bQ°u � Test No. Site Location "l 5 � Yl Reference Plans and Specs. ENGINEER DESIGN DATE Permission is granted for an individual soil absorption sewage disposal system to be installed in accordance with regulations of Board of Health. CHAIRMAN,BOARD OF HEALTH Fee Site System Permit No.�3 Town of North AndoverNORTM OFFICE OF 3?Og tao ,a�Q�OL COMMUNITY DEVELOPMENT AND SERVICES p 146 Main Street KENNETH R.MAHONY North Andover, Massachusetts 01845 9SSACHUS�t Director (508) 688-9533 M E M O R A N D U M TO: Conservation Commission FROM: Sandra Starr, Health Ad t ato ` RE: 443 Boston Street - Septic System Location DATE: August 2 , 1995 I have reviewed the proposed septic design plans for the repair of the failed system at 443 Boston Street. Because of the high water table, the location of the house and the general topography of the lot, the site of the proposed septic system as shown on plan #030 by New England Engineering dated July 25, 1995 is the best, if not only, location available. The distance to wetlands has been maximized as much as possible but approval of the plans depends upon variances which must be granted by the Board of Health. SS/cjp BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 Julie Parrino D.Robert Nicetta Michael Howard Sandra Starr Kathleen Bradley Colwell Town of North AndoverNORTH r , OFFICE OF 3?°<<` ° ��L COMMUNITY DEVELOPMENT AND SERVICES ° : p 146 Main Street KENNETH R.MAHONY North Andover,Massachusetts 01845 9SSgcN�SEt Director (508) 688-9533 M E M O R A N D U M TO: conservation commission FROM: Sandra Starr, Health Ad t ato RE: 443 Boston Street - Septic System Location DATE: August 2, 1995 I have reviewed the proposed septic design plans for the repair of the failed system at 443 Boston Street. Because of the high water table, the location of the house and the general topography of the lot, the site of the proposed septic system as shown on plan #030 by New England Engineering dated July 25, 1995 is the best, if not only, location available. The distance to wetlands has been maximized as much as possible but approval of the plans depends upon variances which must be granted by the Board of Health. SS/cjp BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 Julie Partin D.Robert Nicetta Michael Howard Sandra Starr Kathleen Bradley Colwell Town of North Andover Q NORTH , OFFICE OF COMMUNITY DEVELOPMENT AND SERVICES ° A 146 Main Street KENNETH R.MAHONY North Andover, Massachusetts 01845 9SSACNUS�� Director (508) 688-9533 FAX TRANSMITTAL DATE: Deliver to 19771 69I eY From 6�qyb Company A FAX Number �,¢, ©�7� FAX Number: 508-688-9542 Total Number of Pages Including Transmittal Form 1:2— ii- I�P-y)' BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 Julie Parrino D.Robert Nicetta Michael Howard Sandra Slam Kathleen Bradley Colwell P� 1 �l PLAN REVIEW CHECKLIST ADDRESS /` TO/�J ENGINEER ��6X) CEJ GENERAL 3 COPIES STAMP LOCUS NORTH ARROW (/ SCALE !s-� CONTOURS C/ PROFILE t� SECTION BENCHMARK L--' SOIL & PERCS /' ELEVATIONS WETS. DISCLAIMER WE LS & WETS b WATERSHED?� DRIVEWAY (Eley) WATER LIE' FDN DRAIN SCH40 L/�TESTS CURRENT? SOIL EVAL SEPTIC TANK MIN 1500G-9---- . 17 INVERT DROP GARB. GRINDER(+200% EDF) 25 ' TO CELLAR MANHOLE ELEV GW # COMPS. D-BOX SIZE # LINES FIRST 2 ' LEVEL STATEMENT INLET /U .g3 - OUTLET. _ / (2" OR . 17 FT) TEE REQD?)S: LEACHING MIN 660 GPD? RESERVE AREAb(I 4 ' FROM PRIMARY? — 2% SLOPE 100 ' TO WETLANDS 100 ' TO WELLS (/ 4 ' TO S .H.GW L,---(5 ' >2M/IN) 35 ' TO FND & INTRCPTR DRAINS 325 ' TO SURFACE H2O SUPP ?----- 4 ' PERM. SOIL BELOW FACILITY f MIN 12" COVER FILL? (----r25 ' if above natural elev; 101if below) BREAKOUT MET. TRENCHES MIN 660 gpd SLOPE (min . 005 or 611/1001 ) SIDEWALL DIST. 3X EFF. W OR D MIN 6 ' RESERVE BETWEEN TRENCHES? IN FILL? MUST BE 10 ' MIN. 4" PEA STONE? VENT? (>3 ' COVER; LINES >501 ) BOT + SIDE X LDNG = TOT (L x W x #) (DxLx2x#) (G/ft2) Copyright C 1995 by S.L.Starr PITS MIN 660 LEACHING MIN 1 (131x16 ' ) PIT MANHOLE/PIT GW MIN 4 ' BELOW BOTTOM EXC 2x EFF W OR D 12"-48" STONE BOT + SIDE x LOAD = TOTAL (L x W x #) (2x(L+W)xD x #) (G/ft2) CHAMBERS MIN 660 LEACHING GW MIN 4" BELOW COVER >3 FT - VENT MANHOLES 12"-48" STONE SPLASH PADS SLOPE . 005 BED/TRENCH (Bed max. 60 ' X 601 ) MIN 13 ' X 16 ' PIT BOT + SIDE X LOAD = TOTAL (L x W x #) (2 x (L+W) xD x #) (G/ft2) FIELDS MIN 660 GPD -x 900 ft2 BED ✓ GW MIN 4 ' BELOW BOTTOM OF FIELD PIPE ENDS JOINED? 4" PEA STONE? c-' DIST LINE SLOPE . 005? �--� >31COVER-VENT SCH 40 �— MIN 12" COVER �- RATE LDG X 660 = 9D0 X /41- = TOTAL 477 G/ft2 REQ'D (ft2) LXW DOSING TANKS AND PUMPS DIMENSIONS X X = PUMP CAPACITY gpm (2 7 Td� L W D Vol. DISCHARGE SIZE DISCHARGE RATE DISCHARGE TIME gpm MANHOLES. TO GRADE ALARM SEP. CIRC. Z � GW (Min. 1 ' below inlet) HWL LWL CHECK VALVE/ BLEEDER HOLE // MANUAL OP. SWITCH Copyright 0 1995 by S.L.Starr or M01-111A.) Town of North Form No.3 ..�Jv L.LJ BOARD OF HEALTH ei I 9 °c DISPOSAL WORKS CONSTRUCTION PERMIT ,SSACHUSES Applicant— T-t /1-1/1 � NAME ADDRESS TELEPHONE Site Location Permission is hereby granted to Construct ( ) or Repair ( an Individual Soil Absorption Sewage Disposal System as shown on the Design Approval S.S. No. 'Vl CHAIRMAN,BOARD OF HEWrTH r Fee D.W.C. No. Town of North Andover f MORTH , OFFICE OF ?o•"• • , 0 COMMUNITY DEVELOPMENT AND SERVICES ° . A 146 Main Street s - KENNETH R.MAHONY North Andover, Massachusetts 01845 93SACHUst Director (508) 688-9533 TOWN OF NORTH ANDOVER BOARD OF HEALTH August 25, 19 95 CERTIFICATE OF COMPLIANCE This is to certify that the individual subsurface disposal system constructed ( ) or repaired (X ) by Tim Melvin installer at 443 Boston Street, North Andover. MA has been installed in accordance with the provisions of TITLE 5 of the State Sanitary Code and with Board of Health regulations as described in the Design Approval Permit #753 dated July 31 , 1995 . THE ISSUANCE OF THIS CERIFICATE SHALL NO BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORILY. c Board of Health Ins ector BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 Julie Partin D.Robert Nicetta Michael Howard Sandra Starr Kathleen Bradley Colwell FORM iJ - LOT RELEASE FORM INSTR ONS: This form is used to verify that all necessary approvals/permits frc Boards n epartments having jurisdiction have been obtained. This does not retie the ap and/or landowner from compliance with any applicable or requirements. *****************************APPLICANT FILLS OUT THIS SECTION******�*******��*��*y 02ev� fi APPLICAN �� d kN < l� �' PHONE� 794 7-562 LOCATION: Assessor's Map Number (Q 7 b PARCEL d SUBDIVISSIION LOT(S) TREET IS� bN S r ST.NUMBER 4 ********OFFICIAL USE ONLY******************** RECOMMENDATIONS OF TOWN AGENTS: CO re C o OR DATE APPROVED DATE REJECTED Cot TO DATE APPROVED DATE REJECTED COMMENTS FOOD INSPECTOR-HEALTH DATE APPROVED DATE REJECTED SEPTIC INSPECTOR-HEALTH DATE APPROVED. U-'> DATE REJECTED _QQMMENTS �P�-5�.� t—� ��C^" �d +-� ny- PUBLIC WORKS-SEWER/WATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR DATE Revised 9M Jim ,, .. 0 .. i Address l3 aSTc,,y_ S7— Title of File Page of Date File Open: Date file closed: Doc Document/Action Title Date of6Zefer to other Purpose of Document/Action and notes action Document/ document/ Num. Action De artment Board of Appeals - Board of Health - Planning Board - Conservation Commission - Building Department � d Commonwealth of Massachusetts City/Town of System Pumping Record Form 4 DEP has provided this form for use by local Boards of Health. Other forms may be used, but the information must be substantially the same as that provided here. Before using this form, check with your local Board of Health to determine the form they use. The System Pumping Record must be submitted to the local Board of Health or other approving authority. A. Facility Information Important: When filling out 1. System Location: C�"`�'� C� forms on the ��- computer,use only the tab key Address 4, f to move your cursor-do not City/Town State Zip Code use the return key. 2. System Owner: Name Address(if different from location) CitylrownStat --Zip Code -a56 a Telephone Number B. Pumping Record 1. Date of PumpingDateQuantity Pumped: Gallons 3. Type of system: ❑ Cesspool(s) eptic Tank ❑ Tight Tank ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes �lo If yes, was it cleaned? ❑ Yes ❑ No 5. ConditioSysteno m: 6. System P�tmped^� ( �ojj��`"'JJ��u & �' Name Vehicle License Number Company 7. Location w co tents were d' osed: Signature H er Date t5form4.doc•06/03 System Pumping Record•Page 1 of 1 i I Commonwealth of Massachusetts W City/Town of System Pumping Record RECEIVED w Form 4 G 2 4 2009 M AU DEP has provided this form for use by local Boards of Health. Other for y, ut the information must be substantially the same as that provided h Z. check with your local Board of Health to determine the form they use. The Sys Ing Record must be submitted to the local Board of Health or other approving authority. A. Facility Information 1. System Location: Left side of house, Right side of house, Left front of hou �ffight�front �house�, Left rear of house, Right rear—of ho se. C H H Q3 Address ,, �` j .. ��® y`Cil Cityrrown State Zip Code 2. System Owner: Name Address(if different from location) City/Town State Zip Code 71 Telephone Number r B. Pumping Record 1. Date of Pumping Dat t 3� 2. antity Pumped: — � — Gallons 3. Type of system: ❑ Cesspool(s) Septic Tank ❑ Tight Tank ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes YNo If yes, was it cleaned? ❑ Yes ❑ No 5. Condition of System: � f 6. System Pumped By: Neil Bateson Name Vehicle License Number F5821 Bateson Enterprises Inc Company 7. Location where contents were disposed: G.L. .D Lowell Waste Water Snfur476f Haul r d Date t5form4.doc•06/03 System Pumping Record•Page 1 of 1 Commonwealth of Massachusetts u City/Town of RECEIVED System Pumping Record Form 4 AUG 15 Z011 �M DEP has provided this form for use by local Boards of Health. Other form MR LVA AJ information must be substantially the same as that provided here. Before your local Board of Health to determine the form they use.The System Pumping Record must be submitted to the local Board of Health or other approving authority. A. Facility Information 1. System Location: Left front of hous �fro6tofleft side of house, right side of house, Left rear of house, right rear of house, left , ht rear of building, under deck. 44-3 A, Cityrrown State Zip Code 2. System Owner. Name Address(if different from location) City/Town State ,.li�de Telephone Number B. Pumping Record 1. Date of PumpingDate 2. Quantity Pumped: Gallons 3. Type of system: ❑ Cesspool(s) eptic Tank ❑ Tight Tank ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes No If yes, was it cleaned? ❑ Yes ❑ No 5. Condi ion of System- 6. System Pumped By: Neil J. Bateson F5821 Name Vehicle License Number _Bateson Enterprises Inc. Company 7. Loc where contents were disposed: Z16. S. Lo 11 Waste Waten Signatur of Kault Date t5form4.doc•06/03 System Pumping Record•Page 1 of 1