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HomeMy WebLinkAboutMiscellaneous - 445 BOSTON STREET 4/30/2018 (2) 445 BOSTON STREET 210/107.0-0108-0000.0 r �r Y 1 . 1 l , Lot & Street �� :5 `�/ Map/Parcel- /0 CONSTRUCTION APPROVAL Has plan review fee been paid:C=� NO Permit# Plan Approval: Date: Z Approved by: � 4� D � Designer: O�fI�L Plan Date: � � Conditions: ��P 'eS �'IGT�c7Y` Water Supply: Town Well Well Permit: Driller: Well Tests: Chemical Date Approved Bacteria I Date Approved Bacteria If Date Approved Plumbing Sign-Off: Wiring Sign-off: 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 Certification? YES NO Other? YES NO Any Variance Needed? YES NO FINAL BOARD OF HEALTH APPROVAL: DATE: APPROVED BY: 41 Al �> Did • �� VIA) - 13 5� LO C' � .* 1 SEPTIC SYSTEM INSTALLATION CONDITIONS: S Is the installer licensed? CYES NO Type of Construction: NEW 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: YES NO DWC Permit Paid? YES NO DWC Permit# Installer: GG 41 -�S z1111 VA Begin Inspection: YES NO Excavation Inspection: Needed: Passed: By: ; Construction Inspection: Needed: s 'It Plan Satisfactory: YES: Approval of Backfill: Date: By: Final Grading Approval: Date: By: Final Construction Approval: Date: By: Certificate of Compliance: Approval: Date: � E 44 Commercial Street FtVC+E,jV 02767am, MA \w Tel: (508)880-0233 NppVER � HOp�pPRjMENT Fax: (508)880-7232 p March 15, 2017 North Andover Board of Health 1600 Osgood Street North Andover, MA 01845 Attention: Health Agent Reference: FAST® Wastewater Treatment System - Serial Number: 21762 Attached please find the Field Inspection& Service Report with field test results for services performed on 3/2/17 at the property of Anand Kulkarni located at 445 Boston Street,North Andover, MA. Please call if you have any questions or require additional information. Sincerely, Wastewater Treatment Services, Inc. Service Department Enclosures Copy to: Anand Kulkarni Massachusetts DEP . 1 I N C U g P U q R 1 E a 8450 Cole Parkway, Shawnee, KS 66227, Phone 913-422-0707, Fax 913-422-0808 e-mail:onsite biomicrobics.com,www.biomicrobics.com, 800-753-FAST(3278) MASSACHUSETTS FIELD INSPECTION & SERVICE REPORT For Bio-Microbics FAST°Systems 28121 INSTALLATION AUTHORIZED SERVICE PROVIDER Installation Address: 445 Boston Street Name: Wastewater Treatment Services,Inc. North Andover,MA 01845 Owner Name: Anand Kulkami Mail Address: 445 Boston Street Mail Address: 44 Commercial Street North Andover,MA 01845 Raynham,MA 02767 Phone: Fax: e-mail: Phone: (508)880-0233 Fax: (508)880-7232 e-mail: INSTALLATION INFORMATION Model No. Serial No. Startup Date Date of last pump out MicroFAST.5 21762 1/6/2003 826/14 App oval Type O General O Provisional O Piloting (x)Remedial O General Denite Seasonal Residence ()Yes (x) No EQUIPMENT YES NO MAINTENANCE PERFORMED AND COMMENTS Electrical Panel(s) Visual Alarm Operating x Audio Alarm Operating x (if present) Blower(s) Air Inlet Filter Clean x Blower Hood Vents Clear x Excessive Noise x Excessive Vibration x Treatment unit(s) Unusual Odor x Settleable Solids Test Performed Pump out Required x Primary Settling Zone Sludge Depth 14" Aerobic Treatment Zone Sludge Depth 18" Thickness of Scum Layer 011" Sludge Level Distance to Outlet I � P v r Depth of Ponding Within SAS Visual Observation Comments: Measurement Comments: EFFLUENT LIMIT RESULT Estimated Daily Flow 440 gpd pH(Standard Units) 6 to 9 7 Turbidity <40 NTU 7.88 Dissolved Oxygen >2 Mg/L 4.65 Color Clear Clear Temperature Odor Not Septic Earthy Effluent Solids (x)None 0 Some Effluent Samples Taken: Influent: ()pH ()BOD ()CBOD ()TSS ()TKN ()Nitrate ()Nitrite ()Total Nitrogen()Phosphorus()Spec.Cond. ()Ammonia ()Alkalinity ()Oil/Grease ()VOC ()Fecal Coliform Effluent: ()pH ()BOD ()CBOD ()TSS. ()TKN ()Nitrate ()Nitrite ()Total Nitrogen()Phosphorus()Spec.Cond. ()Ammonia ()Alkalinity ()Oil/Grease ()VOC ()Fecal Coliform Description of any maintenance performed since previous inspection&during this inspection: Cleaned Filter,Checked Splash Recycle,Pump(s) Inspected,Float(s)Inspected Notes and Comments: Pumps and floats have been inspected and are operational. CERTIFIED OPERATOR NAME CERTIFICATION NUMBER SERVICE DATE John Medeiros 17549 3/2/17 OPERATOR SIGNATURE 6j / y , Commonwealth of Massachusetts W Title 5 OfficialInspection rc�®`��® Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �N 445 Boston Road R X11 � Property Address .��UT- �.� Arnand Kulkarni Owner Owner's Name information is required for every North Andover Ma 01845 5/4/17 page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. - - - Important:When A filling out forms . General Information on the computer, use only the tab r 1. Inspector: key to move your cursor-do not Kevin Usilton use the return Name of Inspector key. Wastewater Treatment Services Q Company Name 44 Commercial Street Company Address Raynham Ma 02767 Cit /To wn State Zip Code 508-880-0233 S113528 Telephone Number License Number B. Certification 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: ® Passes rEl Conditionally Passes E] Fails ❑ Needs Further Evalu on by the Local Approving Authority .,,�. 5/4/17 Inspectg's SignatGre' Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system 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. ****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. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 445 Boston Road Property Address Arnand Kulkarni Owner Owner's Name information is required for every North Andover Ma 01845 5/4/17 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will 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. ❑ Y ❑ N ❑ ND,(Explain below): t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts F Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 445 Boston Road Property Address Arnand Kulkarni Owner Owner's Name information is required for every North Andover Ma 01845 5/4/17 page. CityrTown State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. , 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 445 Boston Road Property Address Arnand Kulkarni Owner Owner's Name information is required for every North Andover Ma 01845 5/4/17 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than Y day flow t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 G�/.aa.�.raa�/i diaea,�»r,P•rrf c7.P/r,�,,zeea, ��u. 44 Commercial Street FtECf j'4 02767am,MA 2pil vER Tel: (508)880-0233 SOH������T Fax: (508)880-7232 March 15,2017 North Andover Board of Health 1600 Osgood Street North Andover,MA 01845 Attention: Health Agent Reference: FAST Wastewater Treatment System-Serial Number: 21762 Attached please find the Field Inspection&Service Report with field test results for services performed on 3/2/17 at the property of Anand Kulkarni located at 445 Boston Street,North Andover,MA. Please call if you have any questions or require additional information. Sincerely, �uruufe�2fe> ��iu.�..f�.sa�e�o Wastewater Treatment Services,Inc. Service Department Enclosures Copy to: Anand Kulkarni Massachusetts DEP ,. �, ;, .i, Q���aa �� :.:� . 8450 Cole Parkway,Shawnee,KS 66227,Phone 913-422-0707,Fax 913-422-0808 e-mail:onsitena biomicrobics.com,www biomicrobics.corn.800-753-FAST(3278) MASSACHUSETTS FIELD INSPECTION&SERVICE REPORT For Bio-Microbics FAST®Systems 28121 INSTALLATION AUTHORIZED SERVICE PROVIDER Installation Address: 445Boston Street Nome:wastewater Treatment Services,Inc. Nonh Andova,MA 01845 Owner Name:Anand Kulkami Mail Address:445 Boston Street Mail Address:44 Commercial Street North Andover,MA 01845 Raynhwn,MA 02767 Phone: Fax: e-mail: Phone:(508)880-0233 Fax:(508)880-,7.232 e-mail: INSTALLATION INFORMATION Model No, Serial No. Stanuo Dnte Rpra of last wrmn out MicroFAST.5 21762 1/62003 826/14 Qporoval lyz O General O Provisional O Piloting (x)Remedial O General Dcnite Seasonal Residcncc O Yes(x)No EQUIPMENT YES NO MAINTENANCE PERFORMED AND COMMENTS Electrical Panels) Visual Alarm Operating x Audio Alarm Operating x (if present) Rlmver(s) Air inlet Filter Clean x Blower Hood Vents Clem x Excessive Noise x Excessive Vibration x Treatment unit(s) Unusual Odor x Settleable Solids Test Performed Pump out Required x Primary Settling 7-onc Sludge Deph 14" Aerobic Treatmrnt Zone Sludge Depth 18" Thickness ofScum Layer 0-" Sludge Levcl Distance to Outlet t Depth of Ponding Within SAS Visual Observation Comments: Mcasurcment Comments: EFFLUENT LIMIT RESULT Estimated Daily Fla. 440 gpd pH(Standard Units) 6 to 9 7 Turbidity 540NTU 7.88 Dissolved Oxygen >2 Mg/L 4.65 Color Clear Clcar Temperature Odor Not Septic Earthy EDlucat Solids (x)None QSome Effluent Snmpies Taken: Influent:()pH()BOD()CBOD()TSS OTKN()Nitrate()Nitrite O Total Nitrogen()Phosphorus()Spec.Cond.()Ammonia()Alkalinity O Oil/Grease OVOC()Fecal Coliform Effluent:()pH()BOD()CBOD()TSS OTKN()Nitrate()Nitrite O Total Nitrogen OPhosphomsOSpec.Cond.OAmmonio OAlknlinity ()ViVGmwe OVOC()Fecal Coliform Description of any maintenance performed since previous Inspection A during(his insptction:Cleaned Filter,Checked Splash Recycle,Pump(s) Inspected,Float(s)Inspected Notes and Comments: Pumps and floats have been inspected and arc operational. CERTIFIED OPERATOR NAME CERTIFICATION NUMBER SERVICE:DATE John Mcdciros 17549 31VI7 OPERATOR SIGNATURE N. - Commonwealth of Massachusetts � o a Title 5 Official Inspection Form .ect%11E0 Subsurface Sewage Disposal System Form-Not for Voluntary Assessments SUS,01 jol 445 Boston Road ,OO'Xiitl 06 Property Address Amand Kulkami Owner Owners Name information is required for every North Andover Ma 01845 5/4/17 page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form.Inspection forms may not be altered in any way.Please see completeness checklist at the end of the form. Immo out forms A. General Information filling out forms on the computer, use only the tab 1. Inspector: key to move your cursor-do not KeyinUsilton use the return Name of Inspector key. Wastewater Treatment Services � Company Name 44 Commercial Street Company Address " Raynham Me 02767 City/Town Stale Zip Code 508-880-0233 S113528 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems.I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs F rth r valu Ion by the Local Approving Authority 5/4/17 Inspectp s Signat r Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection.If the system 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. —*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. ISnf•117 TQM 5 Ora I,spotlian Farm.Subu Sa Ge Disposal SO!-•Pepe 1 d 17 1 Commonwealth of Massachusetts ugTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 445 Boston Road Property Address Arnand Kulkarni Owner Owner's Name information is required for every North Andover Ma 01845 5/4/17 page. Cityrrown State Zip Code Date of Inspection B.Certification (cont.) Inspection Summary.Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired.The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Check the box for"yes","no"or"not determined"(Y,N,ND)for the following statements.If"not determined,"please explain. The septic tank is metal and over 20 years old'or the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exfillration 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. ❑ Y ❑ N ❑ ND.(Explain below): 6-•3/13 T,fre 5016oa'Imp—Fa S_bW.Ke Seweea D—.System•Pope 2 a 17 Commonwealth of Massachusetts UTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 445 Boston Road Property Address Arnand Kulkarni Owner Owners Name information is equired for every North Andover Ma 01845 5/4/17 r page. city/Town State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational.System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes(cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box.System will pass inspection if(with approval of Board of Health). ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment. 1. System will pass unless Board of Health determines In accordance with 310 CMR 15.303(1)(b)that the system is not functioning In a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 15 ns•N13 Tib 5 OY.oN Irq%—Farm S—Iamo D Sawep -s-poael Syslom•vape 3,f 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 445 Boston Road Property Address Arnand Kulkarni Owner Owner's Name information is required for every North Andover Ma 01845 5/4/17 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health(and Public Water Supplier,if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: This system passes if the well water analysis,performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must Indicate"Yes"or"No"to each of the following for all Inspections: Yes No EJ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool El ® Liquid depth in cesspool is less than 6"below invert or available volume is less than%day flow isin•yra TWO 5 or�o-swao,rn,.s"c::.ex so..a;e D. sroW snrom•v.qe 4 017 Commonwealth of Massachusetts lug; Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 445 Boston Road Property Address Arnand Kulkarni Owner Owner's Name information is required for every North Andover Ma 01845 5/4/17 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped: ❑ ® Any portion of the SAS,cesspool or privy is below high ground water elevation. El ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis.[This system passes if the well water analysis,performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails.I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems,you must indicate either"yes"or"no"to each of the following,in addition to the questions in Section D. Yes No ❑ ® the system is within 400 feet of a surface drinking water supply ❑ ® the system is within 200 feet of a tributary to a surface drinking water supply ❑ ® the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone 11 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. 15:13.3113 Tile 5Offdol LISP-Far-.S�ts,+ace Serape 0i3Pose1 Solem•Pne 5 of 17 'Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 445 Boston Road _ Property Address Arnand Kulkarni Owner Owner's Name information is required for every North Andover Ma 01845 5/4/17 page. Cityrrown State Zip Code Date of Inspection C.Checklist Check if the following have been done.You must indicate'yes"or"no"as to each of the following: Yes No ® ❑ Pumping information was provided by the owner,occupant,or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? 1:1 ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® El available as built plans of the system obtained and examined?(If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components,excluding the SAS,located on site? ® ❑ 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? ® 11 information the facility owner(and occupants if different from owner)provided with 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 ® ❑ Existing information.For example,a plan at the Board of Health. ® ❑ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms(design): 4 Number of bedrooms(actual): 4 DESIGN Flow based on 310 CMR 15.203(for example:110 gpd x#of bedrooms): 440gpd 6-3n3 Tile 5 MR i YISrPWM Fw SuSsvwreca S—iW D sP W System•Paas 6 cf 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 445 Boston Road _ Property Address Amnd Kulkarni Owner Owner's Name information is required for every North Andover Ma 01845 5/4/17 page. Cdyrrown State Zip Code Date of Inspection D.System Information Description: The system is designed for 440gpd. The system includes a 1500 gallon 2 compartment septic tank with a I/A technology(FAST)system in the 2n°compartment for treatment. The treated effluent flows by gravity to a pump chamber that inlcudes a pump and 3 floats with a alarm panel located in the basement. Number of current residents: 1+ Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system?(Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ® Yes ❑ No Seasonaluse? ❑ Yes ® No Water meter readings,if available last 2 ears usage est.50gpd 9 ( Y 9 (gPd)) Detail: system is under the design flow of 440gpd Sump pump? ❑ Yes ® No Last date of occupancy: current Date Commerciallindustrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft.,etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings,if available: 15116.3113 TNo 5 OMOW I 1�­Form.S.Owlece S—go o n;.oeoSyalo n•Pago 7 cf 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 445 Boston Road Property Address Amand Kulkarni Owner Owners Name informrequired a North Andover Ma 01845 5/4/17 page.etl for every page. City/Town State Zip Code Date of Inspection D.System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ® No If yes,volume pumped. gallons How was quantity pumped determined? Reason for pumping' Type of System: ❑ Septic tank,distribution box,soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system(yes or no)(if yes,attach previous inspection records,if any) ® Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): t5--&13 Tib 5 OAaq rnspacUpn Farm SWs law Sewage Dispa S"t—•Page 8d 17 Commonwealth of Massachusetts { Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 445 Boston Road _ Property Address Arnand Kulkarni Owner Owner's Name informarequired is North Andover Ma 01845 5/4/17 rage. for every - page. City/Town State Zip Code Date of inspection D. System Information (cont.) Approximate age of all components,date installed(if known)and source of information: 15years Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): 3+, Depth below grade: feet Material of construction: ❑cast iron ®40 PVC ❑other(explain): Distance from private water supply well or suction line: feet Comments(on condition ofjoints,venting,evidence of leakage,etc.): All piping looks good no signs of leakage and venting is good. Septic Tank(locate on site plan): Depth below grade: COT teat Material of construction: ®concrete ❑metal ❑fiberglass ❑polyethylene ❑other(explain) The septic tank has access covers to grade for inspection and pump out. If tank is metal,list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1500 gallon Sludge depth: 15 nn•3113 TEIe 5 O!d&I q ec:cr:F—Slow Se-ape D spoil System•Pepe 9 of 1 Q Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 445 Boston Road Property Address Arnand Kulkarni Owner Owner's Name information.s North Andover Ma 01845 5/4/17 required for every - page. Cityrrown state Zip Code Date of Inspection D. System Information(cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle Scum thickness 1 Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle — How were dimensions determined? sludge judge Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): No pumpout recommended,the structural integrity of the septic tank is good. No signs of leakage or inftration. The liquid level is at operating level throughout the system. The FAST unit is operating as designed. Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑concrete ❑metal ❑fiberglass ❑polyethylene ❑other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date is"•3113 Thio 5 ORmN Mpedw F—S,.bwiaca Se«apo Oiapose:Syrian•Pape 10 0 17 'Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 445 Boston Road Property Address Arnand Kulkarni Owner Owner's Name information is required for every North Andover __ Ma 01845 5/4/17 page. Ciryrrown State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): Tight or Holding Tank(tank must be pumped at time of inspection)(locate on site plan): Depth below grade: Material of construction: ❑concrete ❑metal ❑fiberglass ❑polyethylene ❑other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: — Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches,etc.): Attach copy of current pumping contract(required) Is copy attached? ❑ Yes ❑ No 15:m 117 T,.e 5 OFoM IrS,W—Fo'm'.SW[a'rr S—w 0: apoatl$Ya:em•Pepo 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 445 Boston Road Property Address Arnand Kulkarni Owner Owner's Name informrequired is North Andover Ma 01845 5/4/17 required for every page. Cityrrown State Zip Code Date of Inspection D.System Information(cont.) Distribution Box(if present must be opened)(locate on site plan): Depth of liquid level above outlet invert 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.)' Pump Chamber(locate on site plan): Pumps in working order. ® Yes ❑ No' Alarms in working order: ® Yes ❑ No' Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): The pump chamber is in good condition with no signs of leakage or infiltration. The pump,floats and alarm were all tested. If pumps or alarms are not in working order,system is a conditional pass. Soil Absorption System(SAS)(locate on site plan,excavation not required): If SAS not located,explain why: 15.-s•3113 T.-..5 Ofu F p—Gain.SW—d—S-9d D.IMIN S,—•Pepo 12 d 17 Commonwealth of Massachusetts ugTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 445 Boston Road Property Address Arnand Kulkarni Owner Owner's Name information is North Andover Ma 01845 5/4/17 required for every — page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number,length: ® leaching fields number,dimensions: 1-34'x40' ❑ 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 signs of breakout of hydraulic failure. The vegatation looks normal. Cesspools(cesspool must be pumped as part of inspection)(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 ❑ Yes ❑ No 151M•313 Tnb 5 Ctrs iNfpedk.!F—$,.bwr—sewne DifpMal SW—•Pea0130117 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 445 Boston Road _ Property Address Arnand Kulkarni Owner Owner's Name information is required for every North Andover Ma 01845 5/4/17 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation, etc.): 15ns•3113 rVW 5 0 rQW lmn Fprm'.Subsule Se.W,0s ,W Sysie,•Pepe 14 It 17 Commonwealth of Massachusetts Title 5 Official Inspection Form lug Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 445 Boston Road Property Address Arnand Kulkarni Owner Owner's Name informequine for is North Andover Ma 01845 5/4/17 required for every ---._ page. City/Town State Zip Code Date of Inspection D. System Information(cont.) Sketch Of Sewage Disposal System:Provide a view of the sewage disposal system,including ties to at least two permanent reference landmarks or benchmarks.Locate all wells within 100 feet.Locate where public water supply enters the building.Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately 1 a / �y�.. ak D * Q1a s a` a O fel .Clf^.FirY^L.. r P I 3y 1&i •113 To%5 Off—I h,pe 5—Sw^svf Sewepe DI,N,W System•Pope 15 d 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 445 Boston Road Property Address Arnand Kulkarni _ Owner Owner's Name tiis reequirequired ffor every North Andover Ma 01845 5/4/17 o page. City/Town State Zip Code Date of Inspection D.System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: 4+1 feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked,date of design plan reviewed: 2002 Date ❑ 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: Established ground water from the design plan on record with the Board of Health. Before filing this Inspection Report,please see Report Completeness Checklist on next page. i5no•L1J Trio 5 OTam Irepeaw Fpr.S_bue—So-o PoDiepeel5Y •P190 t6 c't] Commonwealth of Massachusetts lug` Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 445 Boston Road Property Address Arnand Kulkarni Owner Owner's Name Information is required for every North Andover Ma 01845 5/4/17 page. CRYrrown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary:A,B,C,D,or E checked ® Inspection Summary D(System Failure Criteria Applicable to All Systems)completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file 151.-W3 T,11050.OW Inspp[w Form;SuSs,08M Sawepn D-lipase.Sy-•Plp 0117 �,aa,�.ru.2�eii �izeafree�rf c�,e�uteeo, �z�. 44 Commercial Street Raynham,MA 02767 Tel: (508)8800233 Fax: (508)880-7232 March 15,2017 North Andover Board of Health 1600 Osgood Street North Andover,MA 01845 Attention: Health Agent Reference: FAsr Wastewater Treatment System-Serial Number: 21762 Attached please find the Field Inspection&Service Report with field test results for services performed on 3/2/17 at the property of Anand Kulkarni located at 445 Boston Street,North Andover,MA. Please call if you have any questions or require additional information. Sincerely, �ir¢tu�c� �.turZizurfs.�t�.t�e Wastewater Treatment Services,Inc. Service Department Enclosures Copy to: Anand Kulkami Massachusetts DEP r ;T. 8450 Cale Parkway,Shawnee,KS 66227,Phone 913-422-0707,Fax 913-422-0808 e-mail:onsite biomicrobics.cgM,www.biomicrobics.com,800-753-FAST(3278) MASSACHUSETTS FIELD INSPECTION&SERVICE REPORT For Bio-Microbics FAST°Systems 28121 INSTALLATION AUTHORIZED SERVICE PROVIDER Installation Address: 445 Boston Street Name:Wastewater Treatment Services,Inc. North Andover,MA 01845 Owner Name.Anand Kulkami Mail Address:445 Boston Street Mail Address:44 Commercial Street North Andover,MA 01845 Raynham,MA 02767 Phone: Fax: a-mml: Phone:(508)880-0233 Fax (508)88017232 a-mail: INSTALLATION INFORMATION Mn elrSe ial No. Stanun Date Datc of last oumo out MicroFAST.5 762 1/62003 21 8)26/14 Anoroval lVoe O General O Provisional O Piloting (x)Remedial O General Denite $casanal Residence O Yes(x)No EQUIPMENT YES NO MAINTENANCE PEPFOR,VIED AND COMMENTS Electrical Panels) Visual Alarm Operating z Audio Alarm Operating x (i f present) Blowtr(s) - AlrinletFilterClean x Blower Hood Vents Clear I x Excessive Noisc I x Excessive Vibration x Treatment unit(s) Unusual Odor x Settleable Solid.,Test Performed Pump out Required x i Primary Settling Zone Sludge Deph 14" 1 Aerobic Treatment Zone Sludge Depth 18" 'I hickness of Scum Layer 011' Sludge Level Distance to Outlet Depth of Ponding Within SAS Visual Observation J Comments Measurement Comments: EFFLUENT LLMIT RESULT Estimated Daily Flow 440 gpd pH(Standard Units) 6 to 9 7 Turbidity 5 40 NTU 7.88 Dissolved Oxygen >2 Mg/L 4.65 Color Clear Clear Temperature Odor .Not Septic Earthy Effluent Solids (X)None OSome Effluent Samples Taken: Influent:()pH()BOD OCBOD()TSS OFKN()Nitrate ONitrite OTotal Nitrogen OPhosphorusOSpec.Cond.()Ammonia()Alkalinity O Oil/Grease OVOC()Fecal Coliform Effluent:()pH()BOD()CBOD()TSS OTKN()Nitrate()Nitrite O Total Nitrogen OPhosphoms()Spec.Cond.()Ammonia()Alkalinity ()O31/Grease OVOC()Fecal Coliform Description of any maintenance performed since previous inspection&during this inspection:Cleaned Filter,Checked Splash Recycle,Pump(s) Inspected,Float(s)Inspected Notes and Comments: Pumps and floats have been inspected and arc operational. CERTIFIED OPERATOR NAME I CERTIFICATION NUMBER SERVICE DATE John Mcdciros 17549 3217 OPERATOR SIGNATURE �ii.s�'eurcater Ci'eatnze�b cferv�.�, �ir� 44 Commercial Street Raynham,MA 02767 Tel:(508)880-0233 Fax:(508)880.7232 INSPECTION AND TESTING AGREEMENT Agreement entered into by and between Wastewater Treatment Services,Inc.(herein called WTS)and the FAST'System OWNER(herein called OWNER)for the inspection by WTS of certain equipment of OWNER which is described below. Upon acceptance of this agreement at WTS's office,WTS will render the following services only: Equipment will be inspected at least 2 times per year that this Agreement remains in effect,with the first inspections beginning . These inspections will include: 1) Testing of the sludge depth in the septic tank. 2) Inspection,power testing and clean/replacc intake filter of the air blower. 3) Inspection of the alarm system. 4) Inspect overall condition ofFAST*System. 5) Notify OWNER of any problems encountered. 6) Service other than routine maintenance will be billed at an hourly rate,plus travel and parts. WTS shall notify the local Board of Health and Department of Environmental Protection in writing within 24 hours of a system failure or alarm event including corrective measures that have been taken. OWNER will be billed standard WTS charges for any parts used in repairs or maintenance. Any additional labor time will be billed to the OWNER at current labor rates of$78.00 per hour. Emergency service between regular inspections will be provided at standard labor rates during normal business hours;at time and one-half after 5:00 PM and on Saturdays;and at double time on Sundays and holidays. Emergency service charges will include a minimum four(4)hours of labor, plus standard WTS charges for parts, plus mileage and travel charges. The annual rate includes routine maintenance,but does not include repairs required for damages caused by abuse,accident,theft,acts of third persons,forces of nature,or alterations made to the equipment. WTS shall not be responsible for failure to render the agreed services if caused by strikes,labor disputes,non-cooperation by OWNER,or other factors beyond the control of WTS. OWNER understands and agrees that WTS is not responsible for special,incidental or consequential damages, including but not limited to loss of time,injury to person or property,or equipment failure. OWNER agrees that WTS may enter OWNER's property and have acceptable access to all areas deemed by WTS to be necessary or appropriate for WTS to perform its duties hereunder. Current WTS practice is to send OWNER approximately 10 days before expiration of the term of the current contract an invoice for one year of service. It is OWNER's responsibility to timely return the payment. WTS must receive the payment before expiration of the current contract year to assure continuous contract coverage. MANUFACTURER MODEL NO. SERIAL NO. LOCATION ANNUAL RATE PERMIT Bio-Microbics MicroFAST 21762 North Andover,MA $370.00 Remedial Includes Field Testing EOUIPMENT OWNER Wastewater Treatment Services,Inc. *Signed by OWNER:' '.i" �C_ W Anand Kulkami .%� �_ Signed: *Address: 445 Boston Street 44 Commercial Street Raynham,MA 02767 Tele:(508)880-0233 *City: State:_Zip: Fax:(508)880-7232 North Andover MA 01845 ' Telephone �l Z - !,i"-3�'G± /".,, Effective Date of Agreement E-mail address: OWNER understands that(1)ANNUAL RATE payment is for one year only commencing on the effective date set forth above and is non-refundable;and(2)Current DEP Regulations require OWNER to maintain a service agreement for the life of the FAST'System. I HAVE READ AND UNDERSTAND THE FOREGOING. *Signed by OWNER:4,t--J '� Field Testine Onsite testing performed I time per year will be used to demonstrate that the systems are operating at a secondary treatment standard of 30 mg/L of BOD5 and TSS. The following will be performed: 1) Visual examination of the effluent for color,turbidity and effluent solids. 2) Settleable solids observation/measurement 3) Effluent pH to determine if the waste water is between 6 and 9 standard units. 4) Dissolved Oxygen,2mg/L or more,to ensure that the system is operating. 5) Turbidity,less than or equal to 40 NTU. If the effluent does not meet effluent quality standards,a grab sample will be collected for laboratory analysis. Results sent to state and local Agencies as well as the OWNER. OWNER is responsible for providing acceptable access to effluent for field testing and/or to enable a grab sample to be taken for laboratory testing performed. If such laboratory sample is required,OWNER will be responsible for charges incurred. IF REQUIRED,THE COST FOR THIS ADDITIONAL TESTING WH,L BE 3190.00MSIT. U *Approval for Additional Testing if Required t-d i Owner's Signature Operator assigned: Michael Moreau Telephone: (508)989-2744 •t y -r WASTEWATER TREATMENT SERVICES 11082 REFERENCE NO. DESCRIVf10N INVOICE DATE INVOICE AMOUNT DISCOUNT TAKEN AMOUNT PAID 445 Boston St Subirnittal Fee 445 Boston St 5/16/17 50.00 50.00 i i i i CHECK DATE CHECK NO. PAYEE DISCOUNTS TAKEN CHECK AMOUNT 5/16/17 11082 Town of North Andover 550.00 7891 Town of North Andover HEALTH DEPARTMENT CHECK#: &ORL DATE: LOCATION: o Ad H/ONAME: /yZZ52;/n I CONTRACTOR NAME: I h CJS, //O/1 i Type of Permit or License:(Check box) ❑ Animal $ ❑ Body Art Establishment $ ❑ Body Art Practitioner $ ❑ Dumpster $ ` ❑ Food Service-Type: 5 l ❑ Funeral Directors $ k.., 0_.Massage Establishment $ ❑_Massage Practice 8 ❑ Offal(Septic)Hauler' $ t ❑ Recreational Camp $ ❑ Sun tanning $ 'r ❑ Swimming Pool $ ❑ Tobacco $ ❑ Trash/Solid Waste Hauler $ ❑ Well Construction $ SEPTIC Systems: ❑ Septic-Soil Testing $ ❑ Septic-Design Approval $ ❑ Septic Disposal Works Construction(DWC) $ ❑ Septic Disposal Works Installers(DWI) $ ❑ Title 5Inspector C $ _ XTitle 5 Report D a5J $ 5P ❑ r.Othe (Indicate) r $ He 4h Agent Initials White-Applicant Yellow-Health Pink-Treasurer Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 445 Boston Street Property Address Thomas Connolly _ Owner Owners Name information is North Andover MA 01845 5/23/13 required for -. — every page. Cityrrovm State Zip Code Date of Inspection Inspection results must be submitted on this form.Inspection forts may not be altered In any way.Please see completeness checklist at the end of the form. 'm'°"a"` When filling out A.General Information forms on the computer,use 1. Inspector: �„"� only the tab key RECEIVED to move your Ben aurin C.Osgood,Jr. cursor-do not � use the return Name of Inspector key. none _ 11 IN 0 3 2013 Company Name _ 24 Julie Ave TOWN OF NORTH ANDOVER Company Address MAIL I K u1cPAkTIV0K-N­T�- Salem NH 03079 Cityrrovm State Zip Code 508-328-4633 870 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems.I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 5/23/13_ Inspector' ignature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection.If the system 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. "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. ;�; `'i �.� , . , l5 ��1�..� ;'` Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 445 Boston Street Property Atldress Thomas Connolly Owner Owner's Name information is required for North -.- h Andover MA 01845 5/23/13 e0 every page. CitYRown State Zip Code Date of Inspection B. Certification(cont.) Inspection Summary:Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired.The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Check the box for"yes","no"or"not determined"(Y,N,ND)for the following statements.If"not determined,"please explain. The septic tank is metal and over 20 years old'or the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent.System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. A metal septic tank will 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. ❑ Y ❑ N ❑ ND(Explain below): �' �O.'. .�.Gl' q':_ �t'..:' ):� i fSGfSR;.,tf�t . ._i.. . . _ _,_ .. :� .. ' .� '.15:-�: �� - ,,y vJ Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 445 Boston Street Property Address Thomas Connolly Owner Owner's Name requir ation is North Andover MA 01845 5/23/13 required for -- every page. City/rovm StateZip Code Data of Inspection B.Certification (cont.) B) System Conditionally Passes(cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box.System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ NO(Explain below) ❑ obstruction is removed ❑ Y ❑ N ❑ NO(Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ NO(Explain below). ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below). ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below) C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh .. - - t�e; ' .a!i � . �� {lU1�ii:.�tV ., � ^4 i ,�T .�... Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 445 Boston Street _ Property Address Thomas Connolly _ Owner Owner's Name information is North Andover MA 01845 5/23/13 required for - every page. Cily/To�vn State Zip Code Date of Inspection B. Certification(cont.) 2. System will fail unless the Board of Health(and Public Water Supplier,if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this forth. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool El ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool El ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6"below invert or available volume is less than%day flow .. .� n✓� Commonwealth of Massachusetts -- Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 445 Boston Street _ Property Address Thomas Connolly Owner Owner's Name information isrequNorth Andover MA 01845 5/23/13 everyfor _ every page. City/Town State Tip Code Date of Inspection B. Certification(cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped: ❑ ® Any portion of the SAS,cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis.[This system passes if the well water analysis,performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails.I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems,you must indicate either"yes"or"no"to each of the following,in addition to the questions in Section D. Yes No ❑ ® the system is within 400 feet of a surface drinking water supply ❑ ® the system is within 200 feet of a tributary to a surface drinking water supply ❑ ® the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered"yes"in Section D above the large system has failed.The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304.The system owner should contact the appropriate regional office of the Department. .. .. .. } - .. ;i. ,.I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Forth-Not for Voluntary Assessments 445 Boston Street _ Property Address Thomas Connolly Owner Owner's Name Information isrequNorth Andover MA 01845 5/23/13 everyfor every page. CityRavm State Zip Code Date of Inspection C.Checklist Check if the following have been done.You must indicate"yes"or"no"as to each of the following: Yes No ® ❑ Pumping information was provided by the owner,occupant,or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? El ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® E3 available as built plans of the system obtained and examined?(If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components,excluding the SAS,located on site? ® ❑ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the baffles or tees,material of construction, dimensions,depth of liquid,depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: ® ❑ Existing information.For example,a plan at the Board of Health. El ® Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(5)) D. System Information Residential Flow Conditions: Number of bedrooms(design): 4 Number of bedrooms(actual): 4 DESIGN flow based on 310 CMR 15.203(for example:110 gpd x#of bedrooms) 440 t'.; - � ,. .,L. ..i�r I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 445 Boston Street Properly Address —— — Thomas Connolly _ Owfer Owner's Name information a North Andover MA 01845 5/23/13 required for _— every page. City/rows State Zip Code Date of Inspection D. System Information Description: Number of current residents: 3 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system?(if yes separate inspection required) ❑ Yes ® No Laundry system inspected? ❑ Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings,if available(last 2 years usage(gpd)): Detail: Sump pump? ® Yes ❑ No Last date of occupancy: Current Date Commercial/industrial Flow Conditions: Type of Establishment: — Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft.,etc.): — Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings,if available: .. it r _ � J .�ft� .• r�lt: Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 445 Boston Street Property Address Thomas Connote Owner Owners Name information a required for North Andover MA_ 01845 5/23/13 every page. CdYR'�' on Stale Zip Code Date of Inspection D. System Information(cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Pumped 4-18-13 Per owner Was system pumped as part of the inspection? ❑ Yes ® No If yes,volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank,distribution box,soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system(yes or no)(if yes,attach previous inspection records,if any) ® InnovativelAltemative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): ,,. , c ,�< ,. ,. .i . Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 445 Boston Street Property Address —— Thomas Connolly Owner Owner's Name information a required for North Andover MA 01845 5/23/13 every page. City?own Stata Zry Code Date of Inspection D. System Information(cont.) Approximate age of all components,date installed(if known)and source of information: System installed in 1984 per as built on file at BOH Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: fleet Material of construction: ❑cast iron ®40 PVC ❑other(explain): Distance from private water supply well or suction line: N/A feet Comments(on condition of joints,venting,evidence of leakage,etc.): Pipe looks good in basement Septic Tank(locate on site plan): Depth below grade: 1.0 feet Material of construction: ®concrete ❑metal ❑fiberglass ❑polyethylene ❑other(explain) If tank is metal,list age. — years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1500 gallons Sludge depth: 0" --- Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Forth-Not for Voluntary Assessments 445 Boston Street Property Address Thomas Conn Owner Owner's Name info oration is required for North Andover MA_ 01845 5/23/13 _.— every page. Cay/TownState Zip Code Date of Inspection D. System Information(cont.) Septic Tank(cant.) Distance from top of sludge to bottom of outlet tee or baffle N/A Fast System Scum thickness �1 Distance from top of scum to top of outlet tee or baffle N/A _ Distance from bottom of scum to bottom of outlet tee or baffle N/A How were dimensions determined? measure tape Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): Tank in good condition.Fast tank appears to be operating properly. Grease Trap(locate on site plan)' Depth below grade: feet Material of construction: ❑concrete ❑metal ❑fiberglass ❑polyethylene ❑other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date •••1 • Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 445 Boston Street _ Property Address Thomas Connolly Owner Owner's Name information is required for North Andover MA 01845 5/23/13 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): Tight or Holding Tank(tank must be pumped at time of inspection)(locate on site plan): Depth below grade: --- Material of construction: ❑concrete ❑metal ❑fiberglass ❑polyethylene ❑other(explain): Dimensions: -- Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alar and float switches,etc.): Attach copy of current pumping contract(required).Is copy attached? ❑ Yes ❑ No Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 445 Boston Street PropertyAddress Thomas Connolly Owner Owner's Name info oration is required for North Andover MA 01845 5/23/13 .- every page. cityrrown State Zip Code Date of Inspection D. System Information(cont.) Distribution Box(if present must be opened)(locate on site plan): Depth of liquid level above outlet invert 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.): Pump Chamber(locate on site plan): Pumps in working order: ® Yes ❑ No Alarms in working order: ® Yes ❑ No Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): Pump chamber clean and in good operating condition Soil Absorption System(SAS)(locate on site plan,excavation not required): If SAS not located,explain why: l .. �: Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 445 Boston Street Property Address Thomas Connolly Owner Owner's Name information is North Andover MA 01845 5/23113 everyfor every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: — ❑ leaching galleries number: ❑ leaching trenches number,length: ® leaching fields number,dimensions: 1 Field 34'x40' ❑ overflow cesspool number: ® innovativelaltemative system Type/name of technology: FAST Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,etc.): Area of system looks normal.No ponding,damp soil,or unusual vegetation.No observation port present in pressure dosed system so probed into field to inspect stone.Stone appeared clean and dry indicating normal operation. Cesspools(cesspool must be pumped as part of inspection)(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 ❑ Yes ❑ No Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Forth-Not for Voluntary Assessments 445 Boston Street Property Address Thomas Connolly — Owner Owners Name information is required for North Andover MA 01845 _ 5/23/13 every page. CdyRown State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: — Dimensions — Depth of solids Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation, etc.): Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Forth-Not for Voluntary Assessments 445 Boston Street Property Address— --- ----------------------------------- Thomas Connolly__ Owner Owners Name information Is —required for for North Andover MA___ 01845__ 5!23113 every page. City/Town - ---- State Zip Code Date of Inspection D. System Information (cont.) — Sketch Of Sewage Disposal System:Provide a view of the sewage disposal system,including ties to at least two permanent reference landmarks or benchmarks.Locate all wells within 100 feet.Locate where public water supply enters the building.Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately �t srrtN cEs A-7gNK 3L,yr '{ 82 8-TA�1K rr,3r I-lo,�si: rsv� Ggt.r.,N h?sT 77,44, te.a• (ygtton� Pu.K P !r -7 L1NfrJ ' I M*VtfD,o f Syr Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Forth-Not for Voluntary Assessments 445 Boston Street Property Address Thomas Connolly Owner Owner's Name information s North Andover MA_ 01845 5/23/13 required for every page. CitYRown State Zip Cade Date of Inspection D.System Information(cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: 2 feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked,date of design plan reviewed: 4/12/2002 Rev to 9/30/02 Date ❑ 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: System designed 2 feet above ESHGW as determined by soil evaluator Micheal O'Neill on 9/25/2001. Before filing this Inspection Report,please see Report Completeness Checklist on next page. ;r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 445 Boston Street Property Address -- Thomas Connolly Owner Owner's Name require fo is North Andover MA 01845 5/23/13 required for — — every page. Cflyrrown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary:A,B.C,D,or E checked ® Inspection Summary D(System Failure Criteria Applicable to All Systems)completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file Town of North Andover 04,M�R�:gy Office of the Health Departmento 3"- - P Community Development and Services Division 27 Charles Street ;••.,,,,, 4,� North Andover,Massachusetts 01845 �''"C_ Sandra Starr Telephone(978)688-9540 Health Director Fax(978)688-9542 TOWN OF NORTH ANDOVER BOARD OF HEALTH CERTIFICATE OF COMPLIANCE DATE OF COMPLIANCE 10/25/2002 This is to certify that the individual components Q, entire(X)subsurface disposal system constructed (),repaired (X),or upgraded() by Jack Sullivan at 445 Boston Street has been installed in accordance with the provisions of 310 CMR 15.00(Title 5),North Andover Board of Health septic system regulations,and the design plan approval#1188 dated October 11,2002. The Issuance of this certificate shall not be construed as a guarantee that the system will function satisfactorily. Post-it*Fax Note 7671 Dale/ To �J D/yE' From �/Zy� Co.Dept. co �Qy�Yf, Board of Health Inspector Phon X Phone Fax Fax L I BOARD OF APPEALS 688-9541 BUILDING 689-9545 CONSERVATION 698-9530 NIJRSE 688-9543 PLANNING 689-9535 Acknowledgement RE:FAST System Property Address: 445 Boston Street,North Andover,Massachusetts I,Anand A.Kulkarni,the Buyer of the above-referenced property,have been informed by the Sellers, Thomas P.Connolly and Maureen Foley Connolly,that there is an alternative sewage disposal system on the property-the FAST system-and that as the owner of the property I must maintain an operation and maintenance contract with a Massachusetts certified operator. I acknowledge receipt of the following items from the Sellers: A copy of"Standard Conditions for Secondary Treatment Units Approved for Remedial Use" A copy of"Revision of Approval for Remedial Use" Title V report The current operation and maintenance contract with Wastewater Treatments Services,Inc. A copy of the latest inspection by Wasterwater Treatment Services,Inc. FAST system Owner's Manual FAST system Service Manual FAST system Installation Manual A copy of the Notice of Alternative Sewage Disposal System recorded with the Essex North Registry of Deeds("the Registry")at Book 13943 page 340. A copy of Variance/Deed restriction recorded with the Registry at Book 7184 Page 125. A copy of the Department of Environmental Protection approval letter recorded with the Registry at Book 7425 Page 192. 1 ,, I n / l 13k13943 P9340 417495 08-11-2014 & 03=295, i Notice of Alternative Sewage Disposal System M.G.L.c.21A,§l3 and 310 CMR 15.0287(10) [This Notice to be recorded and/or filed for regJstralton In the c1Wa of tlth,ofthe Propertyserved by an Alternative Sewage Disposal System("Alternative Sytttm"),I NAME(S)OF OWNER OF PROPERTY SERVED BY ALTERNATIVE SYSTEM: , ; '7110k'A P �N, di E.ie ADDRESS OF PROP r TY SERVED BY ALRNATIVE SYSTEM: goS�h �7fYd"t )V0 VIA a TITLE REFERENCE FOR PROPERTY SERVED BY ALTERNATIVE SYSTEM(check and complete eacp that appllesl: / . Deed recorded with the�cc'Y xegfaM of Deeds In Book� 6,Page—1— _Certificate orTitlo No. iscoed by the Died Registration Office of the lteglsny District _Soorco of title other than by deed III,Alternative System owner(s)Is other thea Property Owotifs),complete the followlag:l Altemative System Owner Name: Alternative Symm Owner Address: WHEREAS,Section 15.280 of Title 5 of the State Environmental Code("Approval of Alternative Systems"), provides for the Massachusetts Department of Environmental Protection(the"Department")to approve or certify,as appropriate,all proposals to construct,upgrade or replace on-site sewage disposal systems using alternative systems; WHEREAS,owners and/or operators of approved or certified alternative systems are subject to general conditions,as specified in Section 15187 of Title 5 of the State Environmental Code,310 CMR 15.287,and tray be subject to spcc:ial conditions,as specified in the Department's approvals or certifications;such general and special conditions potentially including,without limitation,requirements relating to the use of trained operators,periodic inspections,maintenance,sampling,reporting and/or recordkoeping; WHEREAS,Section 15.287(10)of Title 5 of the State Environmental Code,310 CMR 15.287(10), requires that"prior to obtaining a Certificate of Compliance for installation of a new or upgraded system,the system owner shall record in the chain of title for the property served by the alternative system in the Registry Page 1 of 3 f t .. r Of Deeds and/or land Registration Office,as applicable,a Notice disclosing both the existence of the alternative L on-site system and the Department's approval of the system The system owner shall also provide evidence of ` such recording to the local Approving Authority ff and WHEREAS,the Property is served by an alternative sewage disposal system. NOW,THEREFORE,Notice of an alternative sewage disposal system is hereby given for the above-referenced Property,as follows: 1.Existence.An alternative system has been installed as a new or upgraded alternative sewage disposal system,on or f adjacent to the Property,and serves the Property.The trade name and model numbers)of the alternative system are as follows: 'rade name of techaologv: - Manufacturer Nam flu Model number(s): -f 2��� 2. Aoorovat/Certification.On A'.1S/J-°i--Idahl,the Department,pursuant to its authority under the section of Tide 5 as specified below,appro or certified the technology used in the above-referenced altemativc system, under MassDEP Transmittal Number ITroasmiltal Number of approval or cerdikNionl. [ k one of the followlna,as applicable:] Approved for remedial use under 310 CMR 15.284 Approved for piloting under 310 CMR 15.2R5 _Provisionally approved under 310 CMR 15.286 _Certified for general use under 310 CMR 15.288 A copy of the Department's ApprovaL/Certification is available from the Department in person or online at the Department's websito:httn'I/www mass aov/dee. WITNESS the execution hereof under seal this . day of A- w T 20J made by the 1, above-named Altemative System Owner(s). � IAMeroative System Owners printName(s): THok.,A, P- (Ayvvf�., AvlLciv y E COMMONWEALTH OF MASSACHUSETTS ss On this a o 2dbefore me,the undersigned notary public,personally appeared —(hprU ipllpN�YJ) r1, l re of doenmen signer),proved to me through satisfactory evidence of identifi tion,which were to be the person whose name is signed on the preccding or attached document,amt acknowledged tome that(he)(she)signed it voluntarily for its stat purpose. (offici signature andsenl ry) �,' PATRICIAESIFFERIEM t norsRrruauw EkljMOF UAVA ISMS 1.4y Comm Elates Kim S.2017 Page 2 of 3 i 1Comptete the following Property Owner(s)Consent if Alternative System Owners)in other than the Property l><vaer(s):I CONSENTED TO: iroperty owners)l print Narne(s): Date: COMMONWEALTH OF MASSACHUSETTS .ss On this_day of 20_before me,the undersigned notary public,personally appeared (aamo of document signer),proved to me through satisfactory evidence of identification, which were to be the person whose name is signed on the preceding or attached dowment,and acknowledged to me that(he)(she)signed it voluntarily for its stated purpose. (official signature and seal of notary) Upon recording,return to: ndame and address of Property Owaer(a)) Page 3 of 3 Via— .._.___.- --'— ---' _- -.-- -- ------------- —-' - — WITNESS my hand and seal this 291"day of August,2014. Anand A.Kulkarni COMMONWEALTH OF MASSACHUSETTS AIL-� ss. On this 291"day of August,2014 before me,the undersigned Notary Public,personally appeared Anand A.Kulkarni and proved to me through satisfactory evidence of identification which was to be the person whose name is signed on the preceding or attached document,and acknowledged he signed it voluntarily for its stated purpose =VASILIOSOTSIRIS Notary Public b;,c ExptN05ETT6M Commission ex ires: E.P�res Y P 2016 : '' � `�l �' I. � , - , z�P;ar�,; z�o����ry t...R,,��.,.. ... `: e,-a:-�.�.,,-r.,;...1 Blackburn,Lisa From: Sawyer,Susan Sent: Tuesday,August 12,2014 8:58 AM To: Blackburn,Lisa Subject: FW:RE:RE:RE:FAST system Attachments: Recorded Notice of Alternative System.pdf PIs print out and just put in the health folder for this address. Not sure if it is still out.I have been working with this homeowner. You can put this email trail in as well.It kind of explains why she did this now. thx From:maureenfconnolly@verizon.net[mailto:maureenfconnolly@verizon.net] Sent:Monday,August 11,2014 5:03 PM To:Sawyer,Susan Subject:Re:RE:RE:RE:FAST system Susan, Attached is a copy of the recorded Notice for,for your records. Thanks again for all of your help. Maureen On 08/11/14,Sawyer,Susan<ssawyeKaptownofnorthandover.com>wrote: You did great.I am sure your buyer will appreciate your thoroughness. Susan From:maureenfconnollvCaverizon.net[mailto:maureenfconnollvCO)verizon.net] Sent:Monday,August 11,2014 11:58 AM To:Sawyer,Susan Subject:Re:RE:RE:FAST system Susan, According to Claire the DEP does not maintain a list of operators for the FAST system. The company who supplies the system maintains a list of approved operators. I have given the buyer's attorney the name of the company that we have used since our system was installed. I will record the Notice of Alternative Sewage Disposal System at the Registry of Deeds and forward a copy to you and the buyer's attorney At the closing I will give the buyer a copy of: -Standard Conditions for Secondary Treatment Units Approved for Remedial Use -Revision of Approval for Remedial Use 1 I. -Operations and Maintenance Agreement with Wastewater Treatment Services -the most recent inspection report by Wastewater Treatment Services Also.I will hand over all manuals we have on the FAST system. And I understand that we should have the buyer aknowledge receipt of all the items we hand over to him. If there is anything else that we need to do to comply with the regulations regarding the FAST system.please let me know. Thank you for your help. Maureen On 08/11/14,Sawyer,Susan<ssawver(cDtownofnorthandover.com>wrote: It is good that you spoke to Claire Golden and you can now pass that on if you are questioned.NA does not have an additional requirement;I was merely pointing out to you that this is the current rule and that the buyer's agent might be looking for something,but I did say that"the main key is for all the information to be given to the new owners,so they know all about it". I hope she was able to answer the question about"whom"can do the testing of the system.If so,I would appreciate knowing her response. I go to Claire about"everything septic"so you found the right person to ask. Susan From:maureenfconnolly(a)verizon.net fmailto:maureenfconnollvCayerizon net] Sent:Thursday,August 07,2014 1:29 PM To:Sawyer,Susan Subject:Re:RE:FAST system Thanks Susan. I could not find the deed template on the state website. So will this type of form you attached satisy North Andover requirements? 2 w � I spoke to ClaireGolden in the Wilmington DEP office.She told me that for state DEP requirements I do not need the deed disclosure since our system was installed before that requirement came into effect.But she told me local boards of health may have additional rules so I needed to talk to you and go through the steps needed for my sale to satisfy North Andover requirements. Please let me know if I need to come in and meet with you to go over the North Andover requirements for my sale or if your office has some sort of checklist I need to go through.The closing date is August 29th,so I want to be sure we take care of everything needed before then. Thank you for your help. Maureen On 08107/14.Sawyer,Susan<ssawyerantownofnorthandover.com>wrote: http://www.hingham-ma.pov/health/Docunients/Septic IA Deed%20Restriction.r)df something more like this.Your deed restriction is mostly about bedrooms and BOH approval. This form I found on Hingham's website is a state form and makes it clear;what the system is etc. I believe the main key is for all the information to be given to the new owners,so they know all about it; maintenance,testing,etc. 1 know you asked about who can do the testing,but I ended focusing on disclosure;1 believe that information can be found in the approval documents. From:Sawyer,Susan Sent:Tuesday,August 05,2014 4:33 PM To:'maureenfconnollv(o)verizon.net' Subject:FAST system Maureen, 1 do not see anything in the file in regards to you placing a notice of disclosure on the deed,though current rules require it.This could be an issue with the buyer.However,please see a couple of references below.It is clearly the owners responsibility to pass on the information.1 would expect that the new owners should be provided the information regarding responsibilities that they will need at minimum,as the Health Department will be looking 3 for the new contract.I would recommend speaking with the inspector:if he is terminated,he will notify this office. It is a violation of the DEP code for them not to continue...:(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: Certification of Operators of Wastewater Treatment Facilities,or otherwise with a person qualified to operate and maintain the system in accordance with the Department's written approval. FYI other references are the Standard Conditions for Secondary Treatment http://�N�Ar",.mass.pov/eea/doc s/den/water/wastewater/o-thru-v/standrem.pd f see first page and the first bullet 310 CMR 15.287(5) (5)Prior to the transfer of any ownership interest in an alternative system,or of any right or responsibility to operate an alternative system,the owner or operator shall provide written notice to the proposed 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.In addition,the owner shall include either a copy in full or a reference to the notice of the alternative system described in 310 CMR 15.287(l 0),and the recording information for that notice,in the instrument of transfer of any such ownership interest.In the event of the transfer of any such right or responsibility without a transfer of ownership interest,the owner or operator shall include a copy in full or a reference to the notice of the alternative system described in 310 CMR 15.287(l 0),and the recording information for that notice,in the agreement transferring such right or responsibility. There is a lot to read on this. Sorry if I confused you even more. Susan 4 Susan Sawyer Public Health Director 'i'o%%o of North Andover 1600 Osgood Street Suite 2035 North Andover,MA 01845 Phone 978.688.9540 I'ax 978.688.8476 Email muilimsawvcro townolnorthandover.com Web a�v%e.l'ownofNorthAndover.coan ❑x =x_ 5 1WO'Neill Associates Civil Engineers and Land Surveyors 234 Park Street North Reading.MA 01884 (978)664-8141 Fax(978)66"142 Email: oneillmftplink.net June 11,2002 TOVtn)OF NORTH ANDO'u ER/ BOARD OF HEALTH North Andover Board of Health EJUNI2002 27 Charles Street t North Andover,MA 01845 Attention: Sandra Starr,R.S.,C.H.O. RE: Subsurface Septic Disposal System Upgrade 445 Boston Street,North Andover Map 1070,Parcel 108 Dear Members: On behalf of the applicant,Thomas P.and Maureen Connolly,we are requesting placement on the Board's next meeting agenda to discuss several variances from 310 CMR 15.211(1)and 310 CMR 15.104 for the septic system upgrade referenced above. The requested variances are as follows: 1. Reduction of the required 50 foot setback from a disposal field to the bordering vegetated wetlands to 33'per 310 CMR 15.405(1)(f). 2. Reduction of the required 10 foot setback from a septic tank to a building foundation. The provided setback is 8 feet. 3. The last variance involves the use of a laboratory derived percolation rate for design of the disposal system rather than the field method de`ned in 310 CMR 15.104& 15.105. When the last deep observation hole(T-4)was completed (1/14/02),the groundwater was too high to perform a percolation test. In accordance with the 9/8/00 MA DEP Policy#BRP/DWM/PeP-P00-4(Title 5 Alternative to Percolation Testing Policy for System Upgrades),a soil sample was collected and sent to a testing laboratory for analysis. Based on this analysis and the procedures described in the DEP policy,an estimated percolation rate was established for design purposes. As part of this policy,the applicant is required to request the appropriate variance from both the local Board of Health and the DEP. r r EI North Andover Board of Health Attention:Sandra Starr Re:445 Boston Street,North Andover Page 2 Should you have any questions concerning this matter,please do not hesitate to contact us at(978)664-8141. Very truly yours, '1q O'Neill Associates Michael G.O'Neill,P.P.E. NO OTM TOWN OF NORTH ANDOVER HEALTH DEPARTMENT _ 27 CHARLES STREET NORTH ANDOVER,MASSACHUSETTS 01845 Sandra Starr Telephone(978)688-9540 Public Health Director FAX(978)688-9542 July 15,2002 Michael O'Neill O'Neill Associates 234 Park Street North Reading,MA 01864 Re: 445 Boston St. Dear Mr.O'Neill: This letter comes to confirm that at their regularly scheduled meeting on June 27,2002,the North Andover Board of Health granted the following variances for the repair of the septic system at 445 Boston Street, North Andover: • Variance to percolation test under the Alternative To Percolation Testing Policy—310 CMR 15.104 • Distance to wetlands from 50 feet down to 33 feet-310 CMR 15.405(1 xb) • Distance of septic tank to the foundation from 10'to 8'— • Although not exactly a variance,please add a note to the plan that the leach area is 2'to groundwater with a FAST system in place. These variances were approved on condition that a restriction be placed on the deed limiting the dwelling to the number of rooms currently existing,or until tie-in to municipal sewer. This statement should be placed on the plan before final approval.In addition,the existing well shall be appropriately abandoned by a licensed well driller. If the existing well is to be used,there shall be no connection at the house. All plumbing for the well must remain outside of the house to prevent cross connections and contamination. Should you have any questions,please call the Health Department at 978-688-9540,Monday through Friday between the hours of 8:30 and 4:30. Sincerely, Sandra Starr,R.S.,C.H.O. Health Director Ce: Conley File TOWN OF NORTH ANDOVER SEWAGE DISPOSAL SYSTEM INSTALLATION CERTIFICATION The undersigned hereby certify that the Sewage Disposal System 00 constructed: ( )repaired; by To 14r/ 11, f JLL'V f'j 7t -TIIS141LFI� located at_ yy� gO�TON IT,2Et1" was installed in conformance with the North Andover Board of Health approved plan, System Design Permit#117Y,plan dated 5 r2 02 ,with a design flow of VYO gallons per day. The materials use 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: O O C Engineer Representative Final inspection date: 10/15/02- C Engineer Representative Installer. Lic.#: 151-2 Date: Engineer: �•` Date: tt t3-oZ M*HAFl c�oa ��n O O'NEO'LL ;1u No.27918 CIVIL O ���\4SSi0gN E46� �rLi r-.VQ i� ..r 1J .� , �:,. O'Neill Associates Civil Engineers and Land Surveyors 234 Park Street July 26,2001 (978)6645341 North Fax(978)664-8142 Email: oneillrr@iiplink.net Ms.Sandra Starr,R.S.,C.H.O. Town of North Andover Board of Health Community Development and Services Division 27 Charles Street North Andover,MA 01845 RE: 445 Boston Street North Andover Septic System Replacement O'Neill Project#01-155 Dear vis.Starr, On behalf of the homeowners,Maureen and Tom Connolly,we are requesting an appointment be scheduled for soils testing at the above-referenced location. Enclosed herewith please find the following: 1. Completed application for soils test. 2. Proof of land ownership-2001 Real Estate tax bill. 3. Check#527 in the amount of$200 for upgrade. 4. Plot plan showing anticipated area of testing. At this time we are anticipating removing the existing system and surrounding biomat and reconstructing a new system in approximately the same area as the existing system. We await your notice of the time and date when we can perform the testing. If you have any questions with regard to the enclosed,please feel free to contact me. Very truly yours, O'Neill Associates ..: Michael G:O'Neill,P.P.E. Enclosures as stated O'Neill Associates Civil Engineers and Land Surveyors 234 Park Street North Reading,MA 01864 (978)664-8141 Fax(978)664.8142 Email oneill.eng®verizon.net December 13,2002 r�NN OFF A RTH ANC 7/ North Andover Board of Health Be__A' OF HE LTH 120 Main Street —z North Andover,MA 01845 E DEC 19 M Attention: Ms.Sandra Starr,R.S.,C.H.O. RE: 445 Boston Street,North Andover Tom and Maureen Connolly Dear Ms.Starr: Enclosed herewith please find the following documents: 1. Three(3)copies of the Subsurface Septic Disposal System Upgrade As-Built Plan that was revised per the Board of Health's request;and 2. Town of North Andover Sewage Disposal System Installation Certification fully executed by the Engineer Representative and Installer. Once approved,would you kindly forward to this office the Certificate of Compliance when issued. If you have any questions with regard to the enclosed,please feel free to contact me. Very truly yours, O'Neill Associates -L+—E54—,—O Michael G.O'Neill,P.P.E. Enclosures as stated FORM 9A - APPLICATION' FOR LOCAL UPGRADE APPROVAL PAGE 1 OF 5 TOWN OF NORTH ANDD-'r , BOARD OF HEALTH Commonwealth of Massachusetts Massachusetts MR Application for Local Upgrade Approval �'—� Title 5, 310 CMR 15.000 DEP Approved form required by 310 CMR 15.403(1) - To be submitted to Local Approvine Authority/Board of Health: For the upgrade of a failed or nonconforming system with a design flow of <10,000 gpd. where full compliance, as defined in 310 CMR 15.404(1), is not feasible. To be submitted to DEP: For the upgrade of a failed or nonconforming system with a design flow of 10,000 up to 15,000 gpd and/or for upgrade of a state or federal facility, where full compliance, as defined in 310 CMR 15.404(1), is not feasible. NOTE: Local upgrade approval shall not be granted for an upgrade proposal that includes the addition of new design flow to a cesspool or privy or the addition of new design flow above the existing approved capacity of a system constructed in accordance with either the 1978 Code or 310 CMR 15.000. 1) Facility/system owner Name iuorlas a. D ZCC0 Cokauok-k--I Address 44S 33osToy S-ZaeT Ivo. ��+flova2 Phone l/ Address of facility qd �✓0.STJti 5, z�. T� t�+�•��no�cz 2) Applicant(if different from above) Name Address Phone H 3) Type off ility residential_commercial_school _institutional (Specify) .. "rrtovEDeoRM-Ivorns `� -- "-� n���;�g3 Y.•1� FORM 9A-APPLICATION FOR LOCAL UPGRADE APPROVAL PAGE 2 OF 5 4) Type of existing system _privy cesspools)/conventional system _Other(describe) Type of soil absorption system(trenches, chambers, pits,etc.) �a 5 5) Design flow based on 310 CMR 15.203 a)Design flow of existing system dao gpd - Approved? ✓ yes approval date _no why? b)Design flow of proposed upgraded system 44 4 gpd c) Design flow of faciliryd.4o gpd 6) Proposed upgrade of existing system is a) f Voluntary Required by order, letter, etc. (attach copy) _ Required following inspection required by 310 CMR 15.301 (provide date inspection form was submitted to the approving authority) (date) b) Describe the proposed upgrade to the system t.JE�j li 360 nF P;NS-r 'SVS—EI-I 1 c) Which of the following are applicable to the proposed upgrade? Reduction of setback(s) (list setbacks to be reduced with proposed setback distances) Z10 CMR To -r G- .5Z $PtyC_ OC SEAT.0 T1 .K 'Pta N r-yr—A tOFY• TJ HFY. Percolation rate of 30-60 minutes per-inch(state actual pert rate) Ke h1oT PcQ Fp¢s1Ej 3.1E 1,,,�> `-A,r" GQJ�1..2Dw o.TcZ ® 6tcY. 8� 2ooD DFP APPROVER)FORM•12107195 ., FORM 9A- APPLICATION FOR LOCAL UPGRADE APPROVAL PAGE 3 OF 5 _ Up to 23% reduction in subsurface disposal area design requirements (state required d- proz sed size) Relc`ation of water supply well (identify well, describe relocation) Reduction of required separation between bottom of SAS&high groundwater (specif` proposed reduction& pert rate) ZOther requirements of 310 CMR 15.000 that cannot be met(specify sections of the Code) 3i0CMRIS•164 Q2G3.FCZ l�cZ�oeF1 Q- -�cO�AC.p.�TGST 3\oC.kz 1S'4�S T-- System. System upgrades that cannot be performed in accordance Kith 310 CMR 15.404 & 15.405, or in full compliance with the requirements of 310 CMR 15.000, require a variance pursuant to 310 CMR 15.410-15.417. 7) If the proposed upgrade involves a reduction in the required separation between the bottom of the soil absorption system and the high groundwater elevation,an Approved Soil Evaluator must determine the high ground water elevation pursuant to 310 CMR 15.405(1)(i)(1). The evaluator must be a member or agent of the local approving authority: Distanx from soil absorption system to high groundwater feet As determined by: Evaluator's name Evaluator's signature Date of evaluation DU. AP7RovED rortat•..7195 FORM 9A - APPLICATION FOR LOCAL UPGRADE APPROVAL PAGE 4 OF 5 8) Notice to Abutters No application for upgrade approval in which the setback from property lines or a private water supply well is reduced shall be complete until the applicant has notified all abutters whose property or well is affected b% certified mail at least ten days before the Board of Health meeting at which the upgrade approval will be on the agenda. Such notice shall include the date, time and place where the upgrade approval will be discussed. If the Department is the approving authority, then such notice to abutters must be completed prior to the date-of submission of the application to the Department. The notices to abutters shall include a copy of the completed application form and _ shall reference the standards set forth in 310 CMR 15.402 through 15.405. List of affected Abutters: Abutter Name Date notified Address Abutter Name Date notified Address Abutter Name Date notified Address Abutter Name Date notified Address 9) Explain why full compliance, as defined in 310 CMR 15.404(1), is not feasible(each section must be completed): a) an upgraded system in full compliance with 310 CMR 15.000 is not feasible: b) an alternative system approved pursuant to 310 CMR 15.283-15.288 is not feasible: net�eeao��n ro�-�umns FORM 9A - APPLICATION FOR LOCAL UPGRADE APPROVAL PAGE 5 OF 5 c) a shared system is not feasible: ��ISTc.M ew+� !Ne'- P'5. NeAS d) connection to a sewer is not feasible: 10) An application for a disposal system construction permit, including all required attachments (e:g. plans&specifications, site evaluation forms), must accompany this application. Is the DSCP application attached?_yes_no 11) Certification "I, the facility owner, certify under penalty of law that this document and all attachments, to the best of my knowledge and belief, are we, accurate, and complete. I am aware that there may be significant consequences for submitting false information, including, but not limited to, penalties or fine and/or imprisonment for knowing violations." Facility own99s signature Date 1--tP�2<eN auD -4-1.�t-tc�S eo...]►�ol..l.�( Print Name Cb' Z'3-oZ Name of preparer Date Z-3 d— �a�✓_ �T moo¢,�.-+ ,Zc as tvG t--tfl Telephone#&address of preparer NOTE: Title 5, 310 CMR 15.403(4), requires the system owner or operator to submit to the Department a copy of the local upgrade approval upon issuance by the Board of Health and prior to commencement of construction. DFP MPROVFD FORM-1vov95 .. BOARD OF HEALTH NORTH ANDOVER,MA 01845 978-688-9540 APPLICATION FOR DISPOSAL WORKS CONSTRUCTION PERMIT DATE: 112 q01- CURRENT INSTALLER'S LICENSE# I y i- 2 LOCATION: �/�/ �j //y p p,mry LICENSED INSTALL ::�,4 ( S✓ U q SIGNATURE: TELEPHONE# CHECK ONE: p REPAIR: _ NEW CONSTRUCTION: LIQ IF NEW CONSTUCTION,PLEASE ATTACH FOUNDATION AS-BUILT. Administrative Use Only 160.00 Fee Attached? Yes L� No Project Manager Ob. Yes No Foundation As-Built? Yes No Floor Plans? Yes No Approval /9 Date: Q L_ COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION Metropolitan Boston—Northeast-RegionaGOffice JANE SWIFT4 BOB DURAND Governor 4 i AUG%2:2 2002 Secretary LAUREN A.LISS Commissioner August 19,2002 Thomas P.and Maureen Connolly 445 Boston Street North Andover,Massachusetts 01845 RE:STATEMENT OF TECBMCAL DEFICIENCY Application for BRPWP59b:-Title 5-Variance—,, ('445Bosttin St�eey North.Andover.(17-1pswich)-- DEP Transmittal No.W029553 Dear Mr.and Mrs.Connolly: The Metropolitan Boston-Northeast Regional Office of the Department of Environmental Protection has received and reviewed your application for approval of a variance pursuant to 310 CMR 15.410 and 310 CMR 15.412 with the above transmittal number. The application contained written notification,dated July 15,2002,stating that the North Andover Board of Health had,on June 27,2002,approved variance to the following provision of the State Environmental Code:310 CMR 104(4)as it relates to percolation testing. Accompanying the application were plans consisting of two(2)sheets,titled as follows: Title: Subsurface Septic Disposal System Upgrade Location: 445 Boston Street Municipality: North Andover Applicant: Thomas P.Connolly Designer: Michael G.O'Neill,P.E.(Civil)No.27916 Date(Last Revision): April 12,2002(July 19,2002) An engineer of the Department has reviewed the application and accompanying information,and it is the opinion of the Department that the request for approval of this system cannot be approved at this time for the following reason: • The Alternative to Percolation Testing Policy,BRP/DWM/PeP-P004,dated September 8,2000, requires that applications for percolation variances include the Soil Evaluator's determination, along with the written concurrence of the Board of Health,as to whether the soils are uncompacted or compacted. The Soil Evaluator's determination has been submitted. At the time / of soil testing,a consultant for the North Andover Board of Health witnessed the testing on the Thi,id—ti- bk in alternate fo tDy o19g—ADA C.rdi-w at(617)57F6m 205A Lowed st Wdnngton.MA 01887•Pnme(978)661-7600•Fax(978)681-7615•TfD$(978)661-7679 Pnnted on Recycled Paper ,i i.� s , Thomas P.and Maureen Connolly Page 2 C� August 19,2002 Board's behalf. The Department requires submittal of written documentation from the Board or it's consultant that the Board's consultant concurs on the Soil Evaluator's determination of the soil compaction. In the opinion of the Department,the requirements for the approval of this variance as specified in 310 CMR 15.410 and 310 CMR 15.412 have not been satisfied based upon the information received to date. The applicants have not proved that the same degree of environmental protection provided by a fully complying Title 5 system can be provided by the proposed system with variance at this location or that denial of the requested variance would be manifestly unjust. In accordance with 310 CMR 4.00,you have sixty(60)days from the postmarked date of this letter in which to address the listed deficiencies. Within the sixty(60)day time frame,the applicants are advised to allow for the appropriate Board of Health action on the revised submittal since the Department of Environmental Protection's subsequent action may be its final action and,therefore,any further filing in this matter would be considered a NEW application. If the applicants cannot accommodate the schedule of the Board of Health within the sixty(60)day period,or for any other reason requires additional time,the applicants may,by written agreement with this Department,extend this schedule in accordance with 310 CMR 4.04(2xf). The applicants are also advised that when the Department receives the new information,it will initiate a second technical review,and has an additional sixty(60)days to rule upon the application. Should the application be deemed to be deficient for a second time,the application will be denied. If the applicants elect to proceed on the record as it now stands,this letter constitutes a denial of this application and the requested variance. Any person aggrieved by the variance decision of the Department of Environmental Protection may request an adjudicatory hearing on that determination in accordance with 310 CMR 1.00 and M.G.L.c.30A. The enclosed Supplemental Transmittal Form should be completed and included as a cover sheet with any future submittal to the Department relating to the above matter. You need only correspond to the Northeast Regional Office at the above address. If you have any questions regarding this matter,please contact Claire A.Golden at(978)661-7743. Very truly yours, Madelyn Morris Deputy Regional Director Bureau of Resource Protection MM/CAG/cg \2002varianccs l\w029553td 1 Enclosure cc: • Sandra Starr,R.S.,Health Director,Health Department,27 Charles Street,North Andover,MA 01845 • Michael G.O'Neill,P.E.,O'Neill Associates,234 Park Street,North Reading,MA 01864 1 .t. Massachusetts Department of Environmental Protection Supplemental Transmittal Form .(to accompany supplemental material to previously submitted applications) Obtain from the:upper right hand corner of the original application's J.=Transmittal Transmittal Form:-." `_Number:: W029553 (a) Facility Name: '(b)":Facility Address.' ��Facillry;,.� Information Connolly Residence 445 Boston Street ..�- .1 c FacilityTown/Cit _ d 'Tele hone Number: b. �,° •_, North Andover 978 698-7310 r Permit ylnformation Title 5 Variance BRPWP59b s c EDEA MEPA .file# �d .Telephone-Number:'': .� 4� (a)-Respon§e to Request"` €(b)1ReSpoosettoStatemen'tofi t ;Check ° for Additional information ';Deficienc Reason For: (e)''$upplemenfal FeeLj (d) Withdrawal:.of Application K -SuubpplementalPayment ' Smission' .:. e Other leases eci below''y L ' 5. (p) Name of individual_or-firm (b) Affiliation with applicatiorij.e. Form preparing this submission:.. app licant,consultant-to applicant:.. Prepared by-, (c),.Contact Name: d Contact Tele hone Revised 11199 t 1 r COMMONWEALTH OF MASSACHUSETTS ✓ EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION Metropolitan Boston—Northeast Regional ice JANE SWIFT BOB DURADID Governor Secretary LAUREN A.LISS Commissioner September 9,2002 Thomas P.and Maureen Connolly 445 Boston Street North Andover,Massachusetts 01845 Re: Approval of Title 5 Variance for existing construction(BRPWP59b) Variance from Percolation Testing requirement 445 Boston Street,North-Andover(174pswich) DEP Transmittal No.W029553 Dear Mr.and Mrs.Connolly: Pursuant to Title 5 of the State Environmental Code,310 CMR 15.412,the Northeast Regional Office of the Department of Environmental Protection has completed its review of the above referenced application for approval of a variance granted by the North Andover Board of Health. The application contains a copy of the Board of Health's grant of a variance from the following provision of Title 5,310 CMR 15.000: • 310 CMR 15.104 Percolation Testing. Accompanying the application were plans consisting of two(2)sheets,titled as follows: Title: Subsurface Septic Disposal System Upgrade Location: 445 Boston Street Municipality: North Andover Applicant: Thomas P.Connolly Designer: Michael G.O'Neill,P.E.(Civil)No.27916 Date(Last Revision): April 12,2002(July 19,2002) Based upon its review of the application,and in accordance with 310 CMR 15.410,the Department has determined both of the following: a) The applicants have established that enforcement of 310 CMR 15.104 would be manifestly unjust, considering all of the relevant facts and circumstances of this case. A percolation test could not be performed because of high groundwater. Thu irdorm.tioo u—labte i-1—te form.,b7 oiling sur ADA Coordineter.t(617)57468TH, 205A Lowell SL Wilmington.MA 01887.Phone(978)661-7600.Fax(978)661-7615.TTD#(978)661-7679 Pnnted on RecyUed Paper 1 Thomas P.and Maureen Connolly Page 2 September 9,2002 b) The applicants have established that a level of environmental protection that is at least equivalent to that provided under 310 CMR 15.000 can be achieved without strict application of 310 CMR 15.104 and 15.105. The applicants have established equivalent environmental protection as follows: A particle-size soil analysis in conformance with the Alternative Percolation Testing Policy was performed and,along with an evaluation of soil compaction,was used to determine soil classification,the effluent loading rate,and the design of the system. The system is designed in accordance with that policy. The soil was found to bean uncompacted till comprised of loamy sand, a Class I material The soil evaluation had determined the material to be sandy loam,a Class 11 soil. The designer elected to be conservative. Based on that information,the system was designed with a Long Term Acceptance Rate of 0.33 gallons per day per square foot. The Department,therefore,approves the Board of Health's grant of a variance from 310 CMR 15.104. Additionally,the Department imposes the following conditions as part of this approval: 1) The applicants shall obtain a Disposal System Construction Permit(DSCP)from the North Andover Board of Health prior to c6ixmencement of construction ojthe system. 2) The system is not designed to accommodate a garbage disposal. As such,one shall not be used or installed at this facility. 3) There shall be no increase in design flow to the upgraded subsurface sewage disposal system.The design flow for the facilityis 440 gpd. The facility consists of a four-bedroom house. 4) At the time of construction,if groundwater has receded to a point where percolation testing is feasible in the opinion ojthe local approving authority,then confirmatory percolation testing must be conducted and,if necessary,the system design revised based on the actual percolation rate. S) A copy of the as-built plans must be submitted to the Department within 30 days of the date of issuance of the Certificate of Compliance from the North g Board of Health kl 6) Should this upgraded system jail,the owners)shall immediately notify the local Board of Health and the Department. 7) The applicants shall record in the appropriate Registry of Deeds or Land Registration Office,prior to the issuance of the Certificate of Compliance,a copy of this approval letter in the chain of title to the property to be served by the system. This variance determination is an action of the Department. If the applicants are aggrieved by this determination,they may request an Adjudicatory Hearing in accordance with 310 CMR 1.00 and M.G.L. C.30A. A request for an Adjudicatory Hearing must be made in writing and postmarked within 30 days of the date of issuance of this determination. Pursuant to 310 CAM 1.01(6),the request must state clearly and concisely the facts that are grounds for the request and the relief sought. The hearing request,along with a valid check payable to Commonwealth of Massachusetts in the amount of one hundred dollars(8100.00),must be mailed to: Commonwealth of Massachusetts Department of Environmental Protection P.O.Box 4062 / Boston,MA 02211 ``f J Thomas P.and Maureen Connolly Page 3 September 9,2002 I The hearing request will be dismissed if the fling 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 in support of the claim of undue financial hardship. Should you have any questions regarding this matter,please contact Clave A.Golden,of my staff,at (978)661-7743. Very truly yours, Madelyn Morris Deputy Regional Director Bureau of Resource Protection MM/CAG/cag \2002variancesl\w029553app cc: • Sandra Start,R.S.,Health Director,Health Department,27 Charles Strect,North Andover,MA 01845 • Michael G.O'Neill,P.E.,O'Neill Associates,234 Park Street,North Reading,MA 01864 • DEP/Watershed Permitting Progran/ritle 5 Section/Boston s Massachusetts Department of Environmental Protection Bureau of Resource Protection—Watershed Permitting Program TITLE 5 PROGRAM j Ir M.G.L.c.21§§26-53,310 CMR 15.000 1 r, S Z bdW For Reduction in Sampling or Inspection of I/A Systems ` ATTENTION: Thomas Connolly L / 11HdO 0•, General Information OWNER NAME: Thomas Connolly DEP FACILITY ID: 21762 OWNER ADDRESS: 445 Boston Street,North Andover,MA 01845 LOCATION OF I/A SYSTEM: 445 Boston Street,North Andover,MA 01845 Alternative On-Site System Sampling and Inspection The DEP,Watershed PermitSing Program records indicate that the system serving your facility is a Single Home FAST Remedial Use Approval ❑Piloting Approval ❑Provisional Use Approval ❑Certification for General Use requiring that throughout its life,the Single Home FAST system shall be under a maintenance agreement and inspected, F-1 Monthly [Quarterly pd the El influent and ED/effluent shall be monitored for EJ flow types 5k6OD ErrSS ❑Total Nitrogen ❑Other as specified in either the facility approval letter for your system or as required by the Department's IA Technology Approval. All facilities shall submit monitoring results to the Department. ApprovallDenial o Reduction in Sampling and Inspection. 7FRe the date of issuance of this notice,you may take the following actions: t� duce sampling from four times to once per year. ❑ Reduce sampling to twice per year,once two weeks after startup and once within two weeks of shutdown of system. ❑ Reduce sampling to once per year,within two weeks of shutdown ❑ No sample reduction;system is a General Use system,sampling is not required by the Department,contact your local BOH to determine their requirements. ❑ Reduced sampling denied,continue sampling per your approval,results of sampling indicate potential problems,the system is not meeting the permit limits for the following parameters- . Contact your O&M contractor. ❑ Reduced sampling denied due to insufficient data,continue sampling per the Approval letter. ❑ Reduced sampling denied,this large alternative wastewater treatment system,with a design flow of approximately 440 gallons per day, requires inspection and effluent monitoring at least quarterly-continue sampling er the Approval letter. Continue inspections per the Approval letter. Lj Reduce inspections to twice per year,once two weeks a er startup and once within two weeks of shutdown. Submit the required inspection and sampling data by; January 31"for the previous calendar year,or ❑September 30 for the previous twelve months,or❑March 1"for the previous calendar year If the concentration of BOD and TSS(and/or TN)in the annual effluent sample from your system exceeds the 30 mg/L(or 19 mg/L) limits,then within 45 days of the annual sample,you must both have your system sampled again and submit the results to the Department. Provided that the second sample meets the 30mg/L(and/or 19 mgt)limits for BOD,TSS(and/or TN),you may resume annual monitoring of your system. However,if the second sample does not meet the 30mg/L(and/or 19 mg/L)limit for BOD,TSS(and/or TN), you must resume sampling your system four times per year. Following four consecutive samples demonstrating the system meets the 30 mg/L(and/or 19 mg/L)limits for BOD and TSS(and/or TN),the Department would favorably consider another written request to reduce monitoring.TN limits only apply to those systems located in a Title 5 defined nitrogen sensitive area All information shall be submitted to:DEP Boston Office,Title 5 Program,One Winter Street/61°Floor,Boston,MA 02108 Local Compliance Issues These changes are conditioned upon your compliance with the Approval and the requirements of this notice.Please be aware the change(s)does not apply to local requirements.You should discuss any changes from local requirements,if any apply to your system,with your local Board of Health.You should check with the local Board prior to reducing inspection,sampling and reporting to ensure that any reduction is consistent with any local requirements. If you have any questions please contact: Dana Hill at (617)292-5867 / 3/F-/oyr �� Cc5_ZZ7 DATE ISSUED: (Signature) (Title) CC:North Andover Board of Health and Wastewater Treatment Services,Inc.,44 Commerical Street,Raynham,MA 02767 1 NOTICE OF VARIANCE/DEED RESTRICTION Pursuant to 310 CMR 15.000 Title 5,and as a condition of the North Andover Board of Health Disposal Works Construction Permit#1275,dated October 4,2002,notice is hereby given that real estate located at 445 Boston Street,North Andover,Massachusetts, as described in a deed from Patrick L.Clark to Thomas P.Connolly and Maureen Foley Connolly,dated August 8, 1986 and recorded in the Essex North County Registry of Deeds in Book 2266,Page 69 is the subject ofa variance from the Town of North Andover Minimum Requirement for the Subsurface Disposal of Sanitary Sewage A1.05 and C9.01.(4). Said variance limits the maximum number of bedrooms at this dwelling to four bedrooms until such time as the dwelling may be tied-in to municipal sewer. This variance is within the jurisdiction of the North Andover Board of Health. Si ned and sealed this twenty-first day of October,2002 Thomas P.Connolly Maureen Foley o y OCT 21'02 p+1:37 COMMONWEALTH OF MASSACHUSETTS Essex,s.s. October 21,2002 Then personally appeared the above-named Thomas P.Connolly and Maureen Foley Connolly and acknowledged the foregoing instrument to be their free act and deed,before me. Not ublic My commission expires: e-�4,ee'- yr,200 CO.-NINIONWEA1.111 OFMASSAMiUSE17S J)j-,.IIAKTr,11,INT0F E NVtRONNILIWAI,Pjto,n-;c'mON R,)z rrl Off— JA ,.swirr BOB DUlLkND G-- S--y Scptcmbct 9.2002 I hennas P.and Mauna,C,)jit,0115 JAN ✓ 45 Bost Sues! Nomh Andover.Mas—hulelts 01845 R,,: Approval.f*l*Rle5V:tri e,fur.—ting const rueliou(BRVWl'59b) Vitri.—e F 'I'll Bi-e-1-1 I 445 Bom—SI,-1,N-11.A I,,-(17-1jr—id.) DlqI Transmittal N..W029553 Dear NI, and M,,Co,t-ll., Purst,asit(o')tic 5 of the State Ei—ronnieiiml Code,310 CMI(15.412.the N0,111cast Regional Offiec .1,the 1),cp"mu"I of F.,i....u-111,11 p­,cc,),j 1111s­111ploef its Icvic,v of the ahl,e referenced application for appi-:if of:i vannncc fg,a,ted by the North Ando—Bond of 1 I-Ith The appl,calm"eow,,ms a copy of,I,e 13,,;,.d of I lc,,ill,,grant nl a carinnm 1`111-It the 10111-11% of-I al.5.110 CMR 15000: 110 Oljlt 15,104 ['--Amon I 11.1ig Accompanying the application 1-1,plans co,issstingof t%vc,(2)sheets,titled as follows: Title. SO)"nfa-sc,puc Disposal S),I,,m 1:1%,& I.o.u.,445 B0,1"'t st—t Mijilicipalil.\ Noith A idovcr Appli-m Phomas P Con n.Il) Designer MidlilCl GO'Neill.P.G.(Civil)No.27916 Datc(I—iiKe—im) Apiill2,200:!(),tivl9,2002) 310 CMR 15 410.the Department has cletetmined both of the following: a) Elie applic,igas have emablislied tl.m enli-entiew ol*3 10 CMR 15.104 would be ntanilcstly unjust. considering all ol'ilic iclevant facts and circumstances of this case. A bvpe!j b......•....j/uphg • NI.—OSt till.I— ESSEX NORTH REGISTRY OF DEEDS LAWRENCE,MASS e_ 3 A TRUE COPY:ATTE—S—T-----:�� I OR 1 I '1'hopas I'.and Maureen Connolly Parc 2 Scptcmbcr 9,2002 h) 'hhc applicants have utablishcd that a.n rl of curi.unnmmnl protu,aion that is at least cyuivalenl to that provided under 31 h CMR 15.1100 cast he icliic%ed a ithuut strict application of*310 CNA It 15.104 and 15.105.The applicants have established equivalent c,naoumental pTlecticn as follows: A punie/e-sa,-,+oil anuli,,un eon/rr:wmnrr,,ah I,,,Assertions e/'ern.huior,/L•.t Policy is performed airs'.along isifh an evah+uliou r J wit cuop.uian.n¢r,nn:r!In drn•rnrirhr soil clot,feariun,Ihs,effluent/noting rare.art/dw d,:,ign of the sph-n,. 77re s)a1en.,s de.,igned in accordance 111th 11+111 pullet. The•Ind uvs/numb,)he an uuc-un+ptc,ed alit co prised of loa,ur sued, n C'hn,I rrroreridI 7Ae soil evil nu hostile mrn+i..etitle moter iul ro he xuulr loon,.n Chm If soil. The drsigerr elected rn he cun.+e....I , /Jaen/un+thinu,f mn,niun.the,peen,nn,de•.sig„ed stills, u Lang Tenn neerplancr/rale of 0.33 galInns p,•r dn,per syru,rriur. Ilic Deparancnt.therefore,approval the 60n1Ll us'IIcalth's grant ofa variance from 710 CMR 15.104. Additionally,the Dcpim cm imposes 1111:fulluming conditions nc pan ol'Ihis appnw;d I) 7h,appf+earn.,,ban nh.um n Disp,not Sli,w-h Cun.strucnon Penni/(I)SQ)fan+die Aorlh Aurinvcr hoard r fllcollh print In co n enc-enren,/cnu.lrtic lion rf iiia s)are.u. 2) '1'hc spam I.uu1 n:111 1111gidill I A.c.,uch.oar shot1 tar hu used or inslallyd m thi,fill:div. 3) ]here shall he nn inarror uh Ja,ig.r nn..or nr upgrudoJ erh,rnJnce s.­age rhy,,al s):veu+.she designfloi,fill-the/tralirois441)Rla/ 7hefs,hncod-f.,nfajour-hed,o I,hnine. ✓) A/the rime vhf nIII1II inn.J gnu ud'vol-has...wird in a/I is percnlnliw+Icsru+g„ fca,ible in the apur.....of dre•/sod opproring uurho,aj.Men eunfrmolo,r pc....ltecving nnnl he au,d+,crer/earl.i/neces.eu).rhe,))dhow Jc.,hgn c,old based on she 110-1 percnlnrion site. 5) A c,)p)of nil ,n-!,m//,plm„oast he.,rdunined n,da•Drpunnrenr still 3(/digs nJ the dare if ,..u--,,cc rf the Cernfic",•n/C'nu+pli,nn:r frau+1hc•A'an t.Reodirrg/111111x/r f if allh. 6s' .1'hould rhh.c+q;graJc,i s):,«•m Jail.rh,outer(/hull, d,ulely not Jr It,,:In, /herr i of lleallh mrd du,Drum rnnuhl. 7) The upplicmn.,slrnll rrrnrd ire he ul nrupriwc HCgI HrI'a/Urvds.n/.rand Regnmaaon OJJice.prior In dre i.+a-um,cc r,fill,!Cern/ic'are n/ pl/ince.is calm r f this oli/ (/learn err der chain of rale to the properly In he served b),the spiu,$). 7111.1.111111oe deter...lnu,lmh is III)nclionr,frli:Depmanell, /�he applicunA arc aggrieved by Ihl, deter suits.Iher•,na)•request an Ar!/udlcumry Is'..ru,g i,,oc,ordonce•uwh 311)('All?1,00 and MG.L. C.30A.A requav f r an Adjur/icaan)-HeurIng n uv he.nude in wri/ing and posmharked+whin 30 tau,)of the dale r f isluancr r f r/r.,den mInn" Pucvn'n In 310 CMR 1.01(6).are nyues1 nrr.e1 star,•clear/),and coucisrly rlre/acts 1hm ore gr'mmdv frm Ihr request nal Ilre,elirf,uuglu � Thc•hearing regmv,along with o rulid ch,rck pupohle ro(:onmu„arcullh,jf Ah—On—it.,in the mrmYnI r fate l""brat rinlla.:,($100 ho),.n...I he rrrniled In Co......,navenit,of Ma,e¢hrsr,u Depurm.ert a/linr+ro.rnnnral P, ....on :'0 liar 40151 11,••ant.AIA 022)) I I I r I I llonyu P.m4Maurcco Conno11, Pa 3 j ScpW t—9.200, 6c I 7h,/ g rcquc•v vi/!be disunesrd J rhr•Jilurg fee,.c naw paid the npp,// I ie e.aeurpt or grann'd a mu er,av de.cn ibnl he/a lr. 1 Le/ilrng lee i\nor required Jthe appellant rs rr city ar trnnr(nr nrunicipad agenc c).caruny.ordirtassnfNu,Coounann euldr fM—ochi—os.n amvnicipol hoacfng —thorn) The De/unurc"....ray,„rrirr dn:nd(adrearnrr hearing filing fcc/u-a P,,,,,,,„/so shales ihat Paying 11"J"!wdl crc«/c an ruuh,e firuurrial h—Alup d person weAing n 1-Awr nwst file•,mgethcr with the hearing requea a,pro wdr•d ab-1.as glfN o it—I,ng fnnh the fust,ir—pport of rhe cloinr nJ undue fin«nc ia(hardship. Should you Marc.my yucsliwls"8;uding this nrtllel;please contact Clans A.Gold-,of my daft,al (978)661-7747. Vera Indy coon, Madelyn Morris Delmy Regional Director I;umeo of Resource protection MM/CAG/cog Vn(12�n:inncca I N.U2YSSJnI,Ir et tinnJrn.SIOn.N.\.I!cn,lll Uirrrl.n.Il.:nli,i.a:l,y'In,rn:,2-(;Ii,ulri Slr,:rl.V,„1".,\n,!.,•,,..\In n17415 • \licli:,rl G 0'\sill.Ph.ON,.11 A..,v:i;,lc�.274 I';I, .SI­l.\cull Iti:n::nE.\1.\n!Rf.4 • I)I:I'l\r;nnsl,ed l'n.nn:nR III,g,; r,l....-e.l,edll i I I I I I � ' 's Town of North Andover,Massachusetts Form No.1 NO BOARD OF HEALTH i O� oT e1N 3a °o< ♦ L�%.�: moi_'• .19 � 1 � P APPLICATION FOR SITE TESTING/INSPECTION ,SSACNUSES t A licant / ll,C - A—,0/��•1 I� pp NAME —,� ADDRESS IELEPHONE � Site Location i Engineer! NAME ADDRESS 1 CLQ Test/Inspection Date and Time -CHAIKMAN,BOARD OF HEALTH- Fee ` a r Test No. S.S.Permit No. D.W.C.No. C.C.Date Plbg.Permit No. I Town of North Andover,Massachusetts Form No.1 i `N5 1 BOARD OF HEALTH a= °� 19 ' APPLICATION FOR SITE TESTING/INSPECTION SSACNUSE - I Applicant/�.:'U,l/i.i,�Y� �9)i, :!'X/l�e s i-/ '-9 NAME DO ESS %/ TELEPHONE Site Location ` Engineer SAME \ ADDRESS I� PHONE Test/Inspection Date and Time - I I CHAIRMAN, Fee • Test No. 1,0117 S.S.Permit No. D.W.C.No. C.C.Date Plbg.Permit No. i TO: NORTH ANDOVER,MASS 7 t 19 7X 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 L a T a-&7—C IU SITE7—CIU S7- - North Andover,Mass. LOCATION The grades and construction are as specified in mn tTecifications dated 19. A �9B i CfA�. H 1� �o qC9 £C e eg. nitarian SANIIARIPN Town of North Andover,Massachusetts F"""Wo 2 or BOARD OF HEALTH OCI aa�a f DESIGN APPROVAL FOR SOIL ABSORPTION SEWAGE DISPOSAL SYSTEM Applicant7.76-10151T /�"rpG_fJ/LCL ti 4! / Y-,t/10/��/ Test No. Site Location y� r, / Reference Plans and Specs. `n A elIJ 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 a Fee Site System Permit No. ��d Town of North Andover,Massachusetts Form No.a BOARD OF HEALTH �'b:...:•�"� DISPOSAL WORKS CONSTRUCTION PERMIT �JSACNuStt Applicant J Q CA/ J/L L/ 11 NAME ADDRESS TELEPHONE Site Location y�-j a:j Permission is hereby granted to Construct ( ) or Repair(LY—an Individual Soil Absorption Sewage Disposal System as shown on the Design Approval S.S.No. c CHAIRMAN,BOARD OF HEALTH Fee D.W.C.No. �J jv: BOARD OF HEALTH NORTH ANDOVER,MA 01845 !=y OF NORTH ANDD: 978-688-9540 BOARD OF HEALTH APPLICATION FOR SOIL TEST t FEB 2 5 2002 1 j DATE: z I`� "Z MAP&PARCEL: ..,0 LOCATION OF SOIL TESTS: 44S3c�-c ty.•a,�2`e aJ OWNER: ago , c ,�. v TEL.NO.: q-i.g - GgB--i , ADDRESS: 44-s: c�-ou �T 2ccT ENGINEER: TEL.NO.: 918 - (b4- Gia i CERTIFIED SOIL EVALUATOR Intended Use of Land: Residential Subdivision91—g—le FamilyHo Commercial Is This: Repair Testing: Undeveloped lot testing: In the Lake Cochichewick Watershed? Yes No THE FOLLOWING MUST BE INCLUDED WITH THIS FORM 1. Proof of land ownership(Tax bill,or letter from owner permitting test) 2. Plot plan&Location of Testing 3. Fee of$425.00 per lot for new construction. This covers the minimum two deep holes and two percolation tests required for each disposal area. Fee of$200.00 per.lot for repairs or upgrades. (If time is not critical,fee for repairs is$75.00) 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. Please Do Not Write Below This Line N.A.Conservation Commission Approval: p Z Date Received: Check Amount Check Date: //)�" i NOONAN & Me DOWELL, INC. 25 Bridge Street, Suite 6, Billerica, MA 01821-1023 Voice(978)667-9736 Fax(978)671-9565 Email: run at conversent.net August 28,2002 Town of North Andover Office of the Health Department 27 Charles Street North Andover,MA 01845 RE: 445 Boston Street,Jon No.: 1770/029 Dear Members of the Board The soil testing that was witnessed at the above location is an uncompact till.The soil would break off the excavation side in a massive form and would break up easily(Friable). If you have additional questions regarding the above please contact me at your earliest convenience. Sincerely z ' JhnoL.Noonan,P.L. .-P.E. C0 N>Ja\ R/off ice/letter/1770.029.doc ve v Land Surveyors Civil Engineers Environmental Planners O'NEILL ASSOCIATES LE77 E OO F 77,12 H 077QL CIVIL ENGINEERS AND LAND SURVEYORS 234 Park Street NORTH READING,MA 01864 DA7F (978)664-8141 Fax(978)664-8142 nr oN E-MAIL:oneill.eng@verizon.net nE TO44� Kms. �aH.Dva S-ra2� 2.-s v—Z (--t C.AL-,-1 ADNi, rf,5T2.,=1TJ2 COINt M. Z>c J El o ri>�EE..f-Y Z"l C1—+AZLc4 ��• ar—+noJcR o\84.5 WE ARE SENDING YOU TZE�Attached ❑ Under separate cover via the following items: ❑ Shop drawings �-.Prints &0ans ❑ Samples ❑ Specifications ❑ Copy of letter ❑ Change Order ❑ COPIES DATE NO, DESCRIPTION QTS -q - z::5 _ ? 6A o- THESE ARE TRANSMITTED as checked below: lz>� For approval ❑ Approved as submitted ❑ Resubmit copies for approval ❑ For your use ❑ Approved as noted ❑ Submit copies for distribution ❑ As requested ❑ Returned for corrections ❑ For issuance of certificate of compliance ❑ For review and comment (:::A 2Z'j,s, 3 9— ❑ FOR BIDS DUE ❑ PRINTS RETURNED AFTER LOAN TO US REMARKS N(,C-17 F=F=1 OF iawD4G. i h-1c. T.ar�� N.�..5 .�Ea�J 1ZoT.aT� s_tr- �10.� l—FAJcc Aw» n.t�5'�OIJS k��.F1�5E ci COPY TO taJ 2=ems en 6--5c, Lam/ SIGNED: It eaclosves a•e of as noted.xindry nobly usat o,ce ^ �9 O'NEILL ASSOCIATES LE;z-:7 FER (0 G 7 Gi/=;F\1)Y j7 [a- old®®T CIVIL ENGINEERS AND LAND SURVEYORS 234 Park Street E' NORTH READING,MA 01864 DATE oo vo (978)664-8141 Fax(978)664.8142 °s O 1-l SS 'iEni.^.v E-MAIL:oneillm@ziplink.net RE. TO ( y�15 c S�'c,'QL4—t lM V4 r)7.1 h WE ARE SENDING YOU ❑ Attached ❑ Under separate cover via the following items. ❑ Shop drawings ❑ Prints ❑ Plans ❑ Samples ❑ Specifications ❑ Copy of letter ❑ Change Order C CCP:ES DATE NO. DESCRIPTION I ' THESE ARE TRANSMITTED as checked below: ❑ For approval ] Approved as submitted C Resubmit copies for approval ❑ For your use ❑ Approved as noted ❑ Submit copies for distribution ❑ As requested ❑ Returned for corrections ❑ For issuance of certificate of compliance C For review and comment ❑ ❑ FOR BIDS DUE ❑ PRINTS RETURNED AFTER LOAN TO US REMARKS C- V-Q.� �L .'e -� (3�P(7i v�ml o�P_Poo-�f � f_� n�1�.•�c1) COPY TO R.f e- - SIGNED: it enciosures are not as notes.kmmy nonty us at once. i , GRAIN SIZE DISTRIBUTION TEST REPORT 10 90 e �I 80 11 1 70 z 60 L I , Z 5o I W w 40 I a30 20 I 10 I o 200 100 10.0 1 .0 0.1 0.01 0.001 GRAIN SIZE % +3" % GRAVEL I % SAND % SILT 7. CLAY USCS LL PI • 0.0 30.5 54.0 12.8 1 2.7 SM I SIEVE I PERCENT FINER SIEVE PERCENT FINER Lccation nceea size • ��m.e« • •G.\ SITE 2 100.0 04 77.5 1 .5 973' 10 69.5 1 93:.8 20. 60.2 Description: 0.75 91 .6 40 499 •LOAMY SAND 0.375 84.6 50 44..7 100 33 2 GRAIN SIZE 200 22.6 D30 o eJz U OF M16SSAC USETT ,INC. D10 o.azsa R 10 Remcrks COE=F'CIENTS B ; #203 WASP SIEVE Cc 0.65 C� 32.0 ' UTS OF MASSACHUSETTS, INC_ Project No. : 5 Richardson Lane Project: 445 BOSTON STREET. N.ANDOVER. MA Stoneham, MA 02180 Date: 9/25/2001 Scmple No 9564 SOIL.TE-M'UTUL TRIANGLE Project :445 Boston Streeto: N. Andover, MA \� Sample #9564 u V Based on the fraction passing the #10 sieve sample contains 77.74 sand, 18.42 silt, 3.92 clay, 100 (� material classified as loamy sand ,O 90 �• N� 80- �o 70 IaY � 60 �o �c 50 m� �Y O Q cl \ y i Id . 30 Cl aun cie — — nn on m .L 20 --.m Cal_ 9 1081 I ° ail to n Paan sa r �U O �0 O tp �O LU 100 O percent sand v Cly FORM 11 -SOIL EVALUATOR FORM Page 1 of 3 No. Date: '02310-)- Commonwealth 0231oZCommonwealth of Massachusetts Norte I�r�o�G� , Massachusetts Soil Suitability Assessment for On-site Sewage 04p al Perforated By: Mlchav_I O'Ne,41t) Luke Roy -Soi k&olv:0NS Date: 912-s/ol3.3/29Io2 Witnessed By: -�ohr Nopnct r pF NoUnar Q N1L�ow�il, InC.� N. Avalov" Bo}} I'� 1ae tisa.w Tl S (3osfan S1 maufe.t.N Cve\ +01I �• N,Ar+d over a..� 445 Ros}or S1-., N. Av,4ov�✓ Io7D/IDS q-78-( -731a ew Construction ❑ Repair O111ee Review Published Soil Survey Available:No Yes ❑ Year Published Publication Scale Soil Map Unit Drainage Class Soil Limitations Surftcial Geologic Report Available:No 12/ Yes ❑ Year Published Publication Scale Geologic Material(Map Unit) Landform Flood Insurance Rau Map: ,_,/ Above 500 year flood botmdary No ❑,,/Yes LSI Within 500 year flood boundary No L`JYes ❑ Within 100 year flood boundary No 12/Yes ❑ Wetland Area: National Welland Inventory Map(map unit) _ Wetlands Conservancy Program Map(map unit) Curmt Water Resource Co"tions(USGS):Month Dl', Mprch O2 Range:Above Normal ❑Normal ❑Below Normal LVJ Other References Revievmik- DW u++:ovm.Qatar-rums FORM 11 -SOIL EVALUATOR FORM Page 2 of 3 Location Address or Lot No. `FYS DOS+0I, St (/, APA 0 9,-1 On-site Review Deep Hole Number rp Date: 9-�-S-0 1 Time: Wyl Weather — Location(identify on site plan) Land Use lA�W0 Slope M — Surface Stones Gv — Vegetation cl S S Landform _ Position on landscape(sketch on the back) ,OG p(AH Distances from: Open Water Body > ZOO feet Drainage way >25 feet Possible Wet Area >100 feet Property Line >S feet Drinking Water Well 7100 feet Other DEEP OBSERVATION HOLE LOG' Depth Irom SW Horizon Soil Texture Soil Color Soil Other Surface Ilnehef) IUSDA) (Munsell) Mottling (Structwe,Stones,Soulderr.Cc-.t,stency.% Gravel( SFO (("-rbP) - - 75 O//} - 5Y22'� �Viot(01e 9 ( Pew SL_ S 6/g Fn able 1 3cl C- G,SL SY'/3 FrCa( 1e- C Py�alysts, �y Loam y r.«It,,tet.,w,o.eboid - al�trasoe� — > r39° . pentpmg STaateirgWater in"How: 12-a" Wee"fnareFwFaoe: /001' fstlnrbd Saran High CGeud water: `y" DQ ARfOVm FORM•17RiM FORM 11 -SOIL EVALUATOR FORM Page 3 of 3 Location Address or Lot No. `E+S 8014 , 31., N. Avd ovBv r- , Determination ar Seasonal Hiah Water Tajle Method Used: ❑ Depth observed standing in observation hole inches �❑,/Depth weeping from side of observation hole inches L19 Depth to soil mottles V"U inches ❑ Ground water adjustment feet Index Well Number Reading Date Index well level Adjustment factor Adjusted ground water level Depth of Naturally Occurrina 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 (C)1) (date) I have passed the soil evaluator examination approved by the epa�f 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 4 za SIM Ansforao t+oaw.ohms P 7� i� FORM 11 -SOIL EVALUATOR FORM Pace 3 of 3 Location Address or Lot No. 24S 3-f i N, Ardoye v TP— , TP— Determination for Seasonal High Water Table Method Used: ❑ Depth observed standing in observation hole inches ❑ Depth weeping from side of observation hole inches Depth to soil mottles 99,41 inches rc sP ec+ivQ(y ❑ Ground water adjustment feet 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? �eS If not, what is the depth of naturally occurring pervious material? Certification � '(1y, I certify that on (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, n Signature ..k-' J I` Date Y1231-2- 0V /123 02gar Nraovaa roaw-urates FORM 11 -SOIL EVALUATOR FORM Page 2 of 3 Location Address or Lot No. Roosiov, SI, r N, P,-,A- v- On-site Review Deep Hole Number'T?—2 Date: 3-2(-02 Time: R tr Weather Location(identify on site plan) Land Use I—�w-^ - Slope 1%) — Surface Stones — vegetation Gross Landform —.. Position on landscape(sketch on the beck) $e.4- Plo, Distances from: Open Water Body 20o feet Drainage way >25 feet Possible Wet Area > loo feet Property Line > (O feet Drinking Water Well > IOD feet Other DEEP OBSERVATION HOLE LOG' Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(Inchesl (USDA) (Munsell) Mottling (Structure.Stones,Boulders,Consistency.% Gnvell Tg P(- 10Y I Friable t 26 i✓ to G/l Fr"O1b�e to YK v6 Co Sieve Ar-ct1ySIG 1 �►yd+owtefe �' UVi GOry,pad ed .SA�o►y tit P.-fix Mater4s(oeebat14 — DepareBed odc >/2L„ StanOrO Weasr n er Hae: /O 3" Weeps, frmn Ptt Faoe: AD" Estimated Seasonal High Ground Water:_ n on Arrttovm trotaa•urr s t FORM 11 -SOIL EVALUATOR FORM Page 2 of 3 Location Address or Lot No. ��� ts�SiLr✓ �t (1 Rt�rlO e✓ On-site Review Deep Hole NumberTP`3 Date: 3-29-02- Time: A1n^ Weather Location(identify on site plan) Land Use L-PI`-' Slope(961 Surface Stones Vegetation 6r0.s S Landform Position on landscape(sketch on the back) SetL Plo,H Distances from: Open Water Body >ZOCU feet Drainage way %ZS feet Possible Wet Area ?(oo feet Property Line 1 0 feet Drinking Water Well >(oo feet Other DEEP OBSERVATION HOLE LOG' Depth from Sod Horizon Soil Texture Soil Color Soil Otter Surface(Inches) (USDA) (Munsell) Monling (Structure.Stones,aouldae.Consistency.% Greven 9 pop — 06 O/R (-S L_ ioyR21f F„r'oi�ilP 90 c. FSL. loyv--6/( Friable loye SA. amyl'' l�n co M)o act e� Prartt AAatariaf IOa�Pd — DtpasbBaaYvok: 7 9 O„ _ DoothinGrinywholorron STatdsty Water in tJe Hob: '83" Wow Mets in Foca: GO r EstYttsled Seasonal High Ground Water: `� 1 DO AFMOVM iOeM-12MIN FOR-NI 11 -SOIL EVALUATOR FOIL\I Page 2 of 3 Location Address or Lot Ido. q-4soST"t/ S T On-site Review I ( I Deep Hole Number Date: //' 01 Time: 14' Weather Location(identify on site plan) f Land Use Slope(%) ' - Surface Stones _?It-'o Vegetation Landform Position on landscape (sketch on the back) .-._ • W d:Lt_ Distances from; Open Water Body feet Drainage way 7/ feet Possible Wet Area�'feet Property Line (n/ feet Drinking Water Well /n-/feet Other H—L, -) o'V&rflEEP OBSERVATION HALE LOG* -- ----- - ,-4 L - 014 0".4t eV Dem;from Soil Horizon Sol Taav ta Sol Color Soil Other - Surr_Ilnches) (USDA) tMuncall) Mottling (Struchwe.Stones.Boulders.Consirctency.% Gravaq boa 3y/tT,1 G/J° 5' T «. ?w iQo6i r-> 7 5 91 !/c-✓ -TL 3i�t�y ^--- i'iISSt;i✓-'! vc,n n t. e C 5 L syG/� GOD/�3 4-t:S /tiR/7 f rV L�/"er� yL2 Parrot Mataryl (2—logic) amtetme.•aet: �! Depth to Groundwater• StandingWater in the How I ZOO/ Weeping Iran Pa Faoa: EMritted Seasonal High Grovel Wats 4011 * K N 5 e If OA/ VR)A I iVAI Del APPao%-rs roast-turns i FORM 11 -SOIL EVALUATOR FOIL\1 O rvCC L 77 07 9A Paec 2 of 3 Location Address or Lot Ido. civ a^c-, 3 17*,,ij01/G­r— &¢q � rr ? '— _'� ¢5 ' On-site Review trS= Deep Hole Number .77-1— Date: Ze �L Time: /0' Z 5— Weather enc Location(identify on site plan) 1 Gam' i1lJ 17 Land Use Y,/-verJ Slope(%1 Surface Stones iv aafE� Vegetation OF^" T S Landform 6410 e^— /7-/7 o 77 Position on landscape(sketch on the back) Distances from: Open Water Body7/679 feet Drainage way-2 7 feet Possible Wet Area= feet Property Line 9a feet Drinking Water Well 00 feet Other 17�� Y lac eJ �� N,a v� DEEP OBSERVATION HOLE LOG' i Oepth fromSoil Morison Sort Texture Sod Color Sod Other Suds"onchest (USDA) (Munsell) #+tattling estruttwe.stones,Boulders,Consistency,% Greven i -0-4L /o YyC71 vyFceo is",.1 7 r/ J;iULtb KtUUIMt U A it VERY PROPOSED Pavans Mneryl(geologic) I A e,d f Y 1,-/er5 / DNdtt9BaQDCh: 7 !7Z Depth to Groundwater Standing Water in the We: /,;,:i/ Weap;rq hem Pe Fede: 8 C7 Es'nrnsted seasonal -9—e,^ Mqh Cxoud weer: ori wreeov�rotes.tamm Massachusetts Department of Environmental Protection Supplemental Transmittal Form (to accompany supplemental material to previously submitted applications) 1. Obtain from the upper right hand corner of the original application's Transmittal Transmittal Form: Number W029553 2. (a) Facility Name: (b) Facility Address: Facility Information Connolly Residence 445 Boston Street c Facility Town/Cit d Telephone Number: North Andover 978 698-7310 3. rmit Code'Brom onaina aoorcaYo�_ Permit Information Title 5 Variance BRPWP59b c EOEA MEPA file#: d Telephone Number: 4. L (a) Response to Request (b) Response to Statement of Check for Additional information Deficiency Reason For (c) Supplemental Fee Lj (d) Withdrawal of Application Supplemental Payment Submission a Other leasespecify below C S. (a) Name of individual or firm (b) Affiliation with application,i.e. Form preparing this submission: applicant,consultant to applicant: Prepared by c Contact Name: d Contact Telephone#: Rcvimd 11199 �I i / FORM 11 -SOIL F\•ALL'ATOR F0R.%I / 1.7 70/<?Z 9/9 Page 2 or 3 44-S-flo Jfoiv r7' Location Address or Lot 1Jo. ,vore:> gvvyo✓d:lx - On-site Review i Deep Hole Number Date: Time: / -10 Weather Location(identify on site plan) ., 7O z n/e l7:r'- Land Use - V;'�A5P Slope(%1 '✓ Surface Stones ti O-L., Vegetation GtiA.JS Landform 4 a na! i Position on landscape(sketch on the back) Distances from: Open Water Body �O/oo feet Drainage way 7/0 feet Possible Wet Area /19-2.7 feet - Property Line fK rf-feet DrinkingWater aO-I Well 1_.._ feet Other ✓Ka jcO.K,, 11 DEEP OBSERVATION( HALE LOGO (f L NooNr+trV Depth from Soil Horizon Soa Texture Sod Coto, Soil Other Surfau onches) 4USDr4 (M-14 "will-p (Structure,Stones Soutdws,Consiziency.% Grave4 0 — CJ. Se- /ore relmaew-t__ /axcL�I fork•;/8' tvc<< vezoyno�e L oW .rte ir/l5 i v t-=- rJ/Z ^7 e_-4'17r4- S fio-t- J PROPOSED \ ►•rant Matsriai(peeioOO /A-�/,r U-i 77,7,N-t=, +m DePead4 o :_ / Depth to Groundwater: Slandinp Water in the Mote: !r'1 :J Wa rSP Piro hom►it F•a: Estimated Seasonal Hwh Gourd water: DFP APPXG%IM FORM.t2W,91 1 TP. i GRAIN SIZE DISTRIBUTION TEST REPORT 00 ` n =n s 1 - - o- 90 I 80 70 W 60 LL z 50 LJ U O W 40 a 30 20 10 0 200 100 10.0 1.0. 0.1 0.01 0.001 GRAIN SIZE - mm 7 +3" % GRAVEL % SAND %-SILT 7. CLAY USCS LL PI • 0.0 30.5 54.0 12.8 2.7 SM SIEVE PERCENT FINER SIEVE PERCENT FINER Location: ne�ea umber a"` • a�z� • •OV SITE 2I 100.0 4 77.5 1 .5 97.3 10 69.5 1 93.8 20 60.2 Description: 0.75 91 .6 40• '49.9 *LOAMY SAND 0.375 84.6 50 44.7 100 33.2 GRAIN SIZE 200 22.6 D60 a 837 30 U OF M SSAC USE ,INC. D10 o.asso R IEW Rem rks: COEFFICIENTS g #200 WASH SIEVE Cc 0.65 Ca 32.0 UTS OF MASSACHUSETTS, INC_ Project No. : 5 Richardson Lane Project: 445 BOSTON STREET. N.ANDOVER, MA Stoneham, MA 02180 (Dote: 9/25/2001 Samole No 9564 I A SOIL.TEXTURAL TRIANGLE Project :445 Boston Streets N. Andover, MA Sample 49564 n�V Based on the faction passing the 410 sieve sample �. contains 77.7& sand, 18.4% silt, 3.9% clay, material classified as loamy sand 90 tib . 80 / �o 70 lay 50 �r Q sa U� 40- cl . y 30 — uun cln J cl�n20 ,� Ork <L / y San Iola i ° eil to n 3.`\% Clc.. 10 - Gan SaU O �� DO w0 r0 �O percent sand cr , .. �..,� TP-2 GRAIN SIZE DISTRIBUTION TEST REPORT - o 90 I i 80 D 70 I I Wi z 60 I i L z 50 X11 I u I I U I . :.1 40 I 1 a 30 2C I 1c 0 I I 200 100 10.0 1 .0 0.1 0.01 0.001 GRAIN S'ZE - mm % +3'• % GRAVEL % SAND % SILT % CLAY USCS P • 0.0 3.2 156.9 I 36.0 3.9 SM .SIEVE PERCENT F.,�ER SIEVE PERCENT FINE?. Location* ,.nee- *ON SITE 0.75 100.0 c 98,2 0.375 99.4 10 96.8 20 92,7 Description: 40 85.6 *SANDY SCAM 50 81 .4' 10C 68.3 GRAIN SIZE 200 48.5. D60 0.11� D30 D10 0.0108 Remarks: COEFFICIENTS #200 WASH SIEVE Cc 0.97 C� 10.3 I I U OF MASSACHUSETTS, INC. Project No. Rich IProlect: 445 BOSTON STREET, NORTH AN30VER, MA 5 ardson Lone Stoneham, MA 02180 �JlDoe 3/29/2002 Sample No. 7356 ...�Oa ''mob mak' R .... , project: 445 boston street, N. andover sample no: 7356 SOIL TEXTURAL TRIANGLE Based on the fraction passing the no.10 sieve sample contains 58.8% sand, 37.2% silt, and 4.0% clay material classified as sandy loam. lQ0 k 90 �o u� 80 CV �o 70 lay 60 50 m Cy a Q AO Be �o i cl Ity 30 aan cla o do 20 / 10 — San loaf I ° sil to n sat CPI a sa cP CIO � jCJ _a O O Ib DO 00 'O O per ent sand O L v 1 1 Lot & Street Map/Parcel CONSTRUCTION APPROVAL Has plan review fee been paid: NO Permit# Plan Approval: Date: h116 Z— Approved by: Designer:_ �/�( 1�C Plan Date: Conditions: f'es�OlGc�Y� Water Supply: Town Well Well Permit: Driller: Well Tests: Chemical Date Approved Bacteria I Date Approved Bacteria II Date Approved Plumbing Sign-Off: Wiring Sign-off: 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 Certification? YES NO Other? YES NO Any Variance Needed? YES NO FINAL BOARD OF HEALTH APPROVAL: DATE: APPROVED BY: i r' s e v SEPTIC SYSTEM INSTALLATION CONDITIONS: � j� Is the installer licensed? NO Type of Construction: NEW AI 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: YES NO DWC Permit Paid? YES NO I DWC Permit# Installer: JGG 4 -S Begin Inspection: YES NO Excavation Inspection: Needed: Passed: By: Construction Inspection: Needed: s Ht�Plan Satisfactory: YES: Approval of Backfill: Date: By: Final Grading Approval: Date: By: Final Construction Approval: Date: By: Certificate of Compliance: Approval: Date: a rf I 44 Commercial Street Raynham, MA 02767 Tel: (508)880-0233 NppVER 09 10 Of DP�jM�NT Fax: (508)880-7232 N��!" March 15, 2017 North Andover Board of Health 1600 Osgood Street North Andover, MA 01845 .. i I Attention: Health Agent Reference: FAST® Wastewater Treatment System - Serial Number: 21762 I Attached please find the Field Inspection & Service Report with field test results for services performed on 3/2/17 at the property of Anand Kulkarni located at 445 Boston Street,North Andover, MA. Please call if you have any questions or require additional information. Sincerely, Wastewater Treatment Services, Inc. Service Department Enclosures I Copy to: Anand Kulkarni Massachusetts DEP i I I / I I" f C-_0 N PYO,A A�T E D 8450 Cole Parkway, Shawnee, KS 66 227 Phone 913-422-0707 Fax 913-422-0808 , e-mail:onsite anbiomicrobics.com,www.biomicrobics.com,800-753-FAST(3278) MASSACHUSETTS FIELD INSPECTION & SERVICE REPORT For Bio-Microbics FAST°Systems 28121 INSTALLATION AUTHORIZED SERVICE PROVIDER Installation Address: 445 Boston Street Name: Wastewater Treatment Services,Inc. North Andover,MA 01845 Owner Name: Anand Kulkami Mail Address: 445 Boston Street Mail Address: 44 Commercial Street North Andover,MA 01845 Raynham,MA 02767 Phone: Fax: e-mail: Phone: (508)880-0233 Fax: (508)880-7232 e-mail: INSTALLATION INFORMATION '- Model No. Serial No. Startup Date Date of last pump out MicroFAST.5 21762 1/6/2003 8/26/14 Approval Type () General () Provisional () Piloting (x)Remedial () General Denite Seasonal Residence ()Yes (x) No EQUIPMENT YES NO MAINTENANCE PERFORMED AND COMMENTS i Electrical Panel(s) Visual Alarm Operating x Audio Alarm Operating x (if present) Blower(s) Air Inlet Filter Clean x Blower Hood Vents Clear x Excessive Noise x Excessive Vibration x Treatment unit(s) Unusual Odor x Settleable Solids Test Performed Pump out Required x I` Primary Settling Zone Sludge Depth 14" Aerobic Treatment Zone Sludge Depth 18" Thickness of Scum Layer 011" Sludge Level Distance to Outlet M I I i Depth of Ponding Within SAS Visual Observation Comments: Measurement Comments: EFFLUENT LIMIT RESULT Estimated Daily Flow 440 gpd pH(Standard Units) 6 to 9 7 Turbidity <40 NTU 7.88 Dissolved Oxygen >2 Mg/L 4.65 Color Clear Clear Temperature Odor Not Septic Earthy Effluent Solids (x)None Q Some Effluent Samples Taken: Influent: ()pH ()BOD OCBOD ()TSS OTKN ()Nitrate ()Nitrite O Total Nitrogen()Phosphorus()Spec.Cond. ()Ammonia ()Alkalinity O Oil/Grease OVOC ()Fecal Coliform Effluent: ()pH ()BOD OCBOD ()TSS OTKN ()Nitrate ()Nitrite O Total Nitrogen()Phosphorus()Spec.Cond. ()Ammonia ()Alkalinity ()Oil/Grease OVOC ()Fecal Coliform Description of any maintenance performed since previous inspection&during this inspection: Cleaned Filter,Checked Splash Recycle,Pump(s) Inspected,Float(s)Inspected Notes and Comments: Pumps and floats have been inspected and are operational. CERTIFIED OPERATOR NAME CERTIFICATION NUMBER SERVICE DATE John Medeiros 17549 3/2/17 OPERATOR SIGNATURE . = r i i i I � r . ICommonwealth of Massachusetts Title 5 Official Inspection Formc,�`��° Subsurface Sewage Disposal System Form-Not for Voluntary Assessments GSM SvayOv 445 Boston Road Property Address Arnand Kulkarni Owner Owner's Name information is required for every North Andover Ma 01845 5/4/17 page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When A. General Information filling out forms 1 on the computer, use only the tab 1. Inspector: key to move your cursor-do not Kevin Usilton use the return Name of Inspector key. Wastewater Treatment Services y Company Name 44 Commercial Street Company Address Raynham Ma 02767 City/Town State Zip Code 508-880-0233 S113528 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000). The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further ion by the Local Approving Authority //7�� 5/4/17 Inspectg's Signatbre' Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system 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. ""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. t5ins•3/13 Title 5 Official Inspection Fonn:Subsurface Sewage Disposal System•Page 1 of 17 ' I Commonwealth of Massachusetts _ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments I 445 Boston Road Property Address Arnand Kulkarni Owner Owner's Name information is North Andover Ma 01845 5/4/17 required for every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: I i B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will 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. ❑ Y ❑ N ❑ ND,(Explain below): I t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 • Commonwealth of Massachusetts u u Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments < GSM ,•�'' 445 Boston Road Property Address Arnand Kulkarni Owner Owner's Name information is required for every North Andover Ma 01845 5/4/17 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed Y 0 N ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water I ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 i Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 4M 445 Boston Road Property Address Arnand Kulkarni Owner Owner's Name information is required for every North Andover Ma 01845 5/4/17 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: i i D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No i I ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than %day flow t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 ' Commonwealth of Massachusetts W Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments i 445 Boston Road Property Address Arnand Kulkarni Owner Owner's Name information is required for every North Andover Ma 01845 5/4/17 page. Citylrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. 11 ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet j from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence j of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ® the system is within 400 feet of a surface drinking water supply ❑ ® the system is within 200 feet of a tributary to a surface drinking water supply ❑ ® the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered"yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins-3/13 Title 5 official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 17 ' Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments �M SVBy',W 445 Boston Road Property Address Arnand Kulkarni Owner Owner's Name information is required for every North Andover Ma 01845 5/4/17 page. CitylTown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no"as to each of the following: Yes No i ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? i ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on thero er maintenance of subsurface sewage disposal systems? p p 9 P Y The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) 310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 4 Number of bedrooms (actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440gpd I t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 i ' Commonwealth of Massachusetts G Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ;M 445 Boston Road Property Address Arnand Kulkarni Owner Owner's Name information is North Andover Ma 01845 5/4/17 required for every I page. Cit /Town State Zip Code Date of Inspection D. System Information Description: The system is designed for 440gpd. The system includes a 1500 gallon 2 compartment septic tank with a I/A technology(FAST)system in the 2nd compartment for treatment. The treated effluent flows by gravity to a pump chamber that inicudes a pump and 3 floats with a alarm panel located in the basement. Number of current residents: 1+ Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ® Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 years usage d est.50gpd Detail: system is under the design flow of 440gpd Sump pump? ❑ Yes ® No current Last date of occupancy: Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 • Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 'c �M 5 445 Boston Road Property Address Arnand Kulkarni Owner Owner's Name information is required for every North Andover Ma 01845 5/4/17 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: n/aDate Other(describe below): I General Information Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons I How was quantity pumped determined? Reason for pumping: Type of System: ❑ Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ® Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 ' Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 445 Boston Road Property Address Arnand Kulkarni Owner Owner's Name information is required for every North Andover Ma 01845 5/4/17 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: 15 years Were sewage odors detected when arriving at the site? ❑ Yes ® No i Building Sewer(locate on site plan): Depth below grade: 3+ feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments(on condition of joints, venting, evidence of leakage, etc.): All piping looks good, no signs of leakage and venting is good. Septic Tank(locate on site plan): Depth below grade: COTfeet i Material of construction: i ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) The septic tank has access covers to grade for inspection and pump out. If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No I Dimensions: 1500 gallon Sludge depth: 81--811 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 ' Commonwealth of Massachusetts F Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M °r 445 Boston Road Property Address Arnand Kulkarni Owner Owner's Name information is North Andover Ma 01845 5/4/17 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle Scum thickness i Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? sludge judge Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): No pumpout recommended, the structural integrity of the septic tank is good. No signs of leakage or infitration. The liquid level is at operating level throughout the system. The FAST unit is operating as designed. Grease Trap(locate on site plan): I Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 ' Commonwealth of Massachusetts Title 5 Official Inspection Form at Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 445 Boston Road Property Address Arnand Kulkarni Owner Owner's Name information is required for every North Andover Ma 01845 5/4/17 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): i Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): it Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 I i 'Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 445 Boston Road Property Address Arnand Kulkarni Owner Owner's Name information is required for every North Andover Ma 01845 5/4/17 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 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.): i i Pump Chamber(locate on site plan): Pumps in working order: ® Yes ❑ No* Alarms in working order: ® Yes ❑ No* Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): The pump chamber is in good condition with no signs of leakage or infiltration. The pump,floats and alarm were all tested. * If pumps or alarms are not in working orders stem is a conditional ass. p P 9 Y p Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 • Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments wM 445 Boston Road Property Address Arnand Kulkarni Owner Owner's Name information is required for every North Andover Ma 01845 5/4/17 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ® leaching fields number, dimensions: 1 -34'x40' i ❑ 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 signs of breakout of hydraulic failure. The vegatation looks normal. Cesspools (cesspool must be pumped as part of inspection) (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 ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts o Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 445 Boston Road Property Address Arnand Kulkarni Owner Owner's Name information is required for every North Andover Ma 01845 5/4/17 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): I I Privy(locate on site plan): I Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): I I t5ins•3/13 Title 5 Official Inspection Foam:Subsurface Sewage Disposal System•Page 14 of 17 ' Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments WJv 445 Boston Road Property Address Arnand Kulkarni Owner Owner's Name information is required for every North Andover Ma 01845 5/4/17 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately 1 4 4 i `ib �- a 5 l I i,1 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17 ' Commonwealth of Massachusetts u W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments GSM 445 Boston Road SVBy Property Address Arnand Kulkarni Owner Owner's Name information is required for every North Andover Ma 01845 5/4/17 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: 4+' feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: 2002Date ❑ 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 how9 ou established the high round water elevation: Y 9 Established ground water from the design plan on record with the Board of Health. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts N Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments G ,M s 445 Boston Road Property Address Arnand Kulkarni Owner Owner's Name information is required for every North Andover Ma 01845 5/4/17 e. CityTrown State Zi Code Date of Inspection Pa9 P I E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file 1 I i i I k i l5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 44 Commercial Street Raynham, MA 02767 Tel: (508)880-0233. Fax: (508)880-7232 March 15 2017 North Andover Board of Health 1600 Osgood Street North Andover, MA 01845 Attention: Health Agent Reference: FAST®Wastewater Treatment System - Serial Number: 21762 Attached please find the Field Inspection & Service Report with field test results for services performed on 3/2/17 at the property of Anand Kulkarni located at 445 Boston Street,North Andover, MA. Please call if you have any questions or require additional information. Sincerely, Wastewater Treatment Services, Inc. Service Department Enclosures Copy to: Anand Kulkarni Massachusetts DEP 8450 Cole Parkway, Shawnee, KS 66227, Phone 913-422-0707, Fax 913-422-0808 e-mail:onsitec@biomicrobics.com,www.biomicrobics.com,800-753-FAST(3278) MASSACHUSETTS FIELD INSPECTION & SERVICE REPORT For Bio-Microbics FAST Systems 28121 INSTALLATION AUTHORIZED SERVICE PROVIDER Installation Address: 445 Boston Street Name: Wastewater Treatment Services,Inc. North Andover,MA 01845 Owner Name: Anand Kulkami Mail Address: 445 Boston Street Mail Address: 44 Commercial Street North Andover,MA 01845 Raynham,MA 02767 Phone: Fax: e-mail: Phone: (508)880-0233 Fax: (508)880;7232 e-mail: INSTALLATION INFORMATION Model No. Serial No. Startup Date Date of last pump out MicroFAST.5 21762 1/6/2003 826/14 Approval TvH () General () Provisional () Piloting (x)Remedial () General Denite Seasonal Residence ()Yes (x) No EQUIPMENT YES NO MAINTENANCE PERFORMED AND COMMENTS Electrical Panel(s) Visual Alarm Operating x Audio Alarm Operating x (if present) Blower(s) Air Inlet Filter Clean x Blower Hood Vents Clear x Excessive Noise x Excessive Vibration x Treatment unit(s) Unusual Odor x Settleable Solids Test Performed Pump out Required x Primary Settling Zone Sludge Depth 14" Aerobic Treatment Zone Sludge Depth 18" Thickness of Scum Layer 0"" Sludge Level Distance to Outlet i Depth of Ponding Within SAS Visual Observation Comments: Measurement Comments: EFFLUENT LIMIT RESULT Estimated Daily Flow 440 gpd pH(Standard Units) 6 to 9 7 Turbidity <40NTU 7.88 Dissolved Oxygen >2 Mg/L 4.65 Color Clear Clear Temperature Odor Not Septic Earthy Effluent Solids (x)None 0 Some Effluent Samples Taken: Influent: ()pH ()BOD OCBOD ()TSS OTKN ()Nitrate ()Nitrite O Total Nitrogen()Phosphorus()Spec.Cond. ()Ammonia ()Alkalinity ()Oil/Grease ()VOC ()Fecal Coliform Effluent: ()pH ()BOD ()CBOD ()TSS ()TKN ()Nitrate ()Nitrite ()Total Nitrogen()Phosphorus()Spec.Cond. ()Ammonia ()Alkalinity OOil/Grease OVOC ()Fecal Coliform Description of any maintenance performed since previous inspection&during this inspection: Cleaned Filter,Checked Splash Recycle,Pump(s) Inspected,Float(s)Inspected Notes and Comments: Pumps and floats have been inspected and are operational. CERTIFIED OPERATOR NAME CERTIFICATION NUMBER SERVICE DATE John Medeiros 17549 3/2/17 OPERATOR SIGNATURE !' �/ G •r �GyC� �Cr s i .44 Commercial Street Raynham, MA 02767 Tel: (508) 880-0233 INSPECTION AND TESTING AGREEMENT Fax: (508) 880-7232 Agreement entered into by and between Wastewater Treatment Services,Inc. (herein called WTS)and the FAST®System OWNER(herein called OWNER)for the inspection by WTS of certain equipment of OWNER which is described below. Upon acceptance of this agreement at WTS's office,WTS will render the following services only: Equipment will be inspected at least 2 times per year that this Agreement remains in effect,with the first inspections beginning . These inspections will include: 1) Testing of the sludge depth in the septic tank. 2) Inspection,power testing and clean/replace intake filter of the air blower. 3) Inspection of the alarm system. 4) Inspect overall condition of FAST®System. 5) Notify OWNER of any problems encountered. 6) Service other than routine maintenance will be billed at an hourly rate,plus travel and parts. WTS shall notify the local Board of Health and Department of Environmental Protection in writing within 24 hours of a system failure or alarm event including corrective measures that have been taken. OWNER will be billed standard WTS charges for any parts used in repairs or maintenance. Any additional labor time will be billed to the OWNER at current labor rates of$78.00 per hour. Emergency service between regular inspections will be provided at standard labor rates during normal business hours; at time and one-half after 5:00 PM and on Saturdays; and at double time on Sundays and holidays. Emergency service charges will include a minimum four(4)hours of labor, plus standard WTS charges for parts, plus mileage and travel charges. The annual rate includes routine maintenance,but does not include repairs required for damages caused by abuse, accident,theft, acts of third persons,forces of nature, or alterations made to the equipment. WTS shall not be responsible for failure to render the agreed services if caused by strikes,labor disputes,non-cooperation by OWNER,or other factors beyond the control of WTS. OWNER understands and agrees that WTS is not responsible for special,incidental or consequential damages, including but not limited to loss of time,injury to person or property,or equipment failure. OWNER agrees that WTS may enter OWNER's property and have acceptable access to all areas deemed by WTS to be necessary or appropriate for WTS to perform its duties hereunder. Current WTS practice is to send OWNER approximately 10 days before expiration of the term of the current contract an invoice for one year of service. It is OWNER's responsibility to timely return the payment. WTS must receive the payment before expiration of the current contract year to assure continuous contract coverage. MANUFACTURER MODEL,NO. SERIAL NO. LOCATION ANNUAL RATE PERMIT Bio-Microbics MicroFAST 21762 North Andover,MA $370.00 Remedial Includes Field Testing EQUIPMENT OWNER �, "°`'' Wastewater Treatment Services,Inc. *Signed by OWNER: Anand Kulkarni ,:' ��V Signed:/;Z-) *Address: ri 445 Boston Street 44 Commercial Street Raynham,MA 02767 Tele: (508)880-0233 *City: State: Zip: Fax:(508)880-7232 North Andover MA 01845 / Telephone Ci -7. {, R'Ll0 F psP__`_ Effective Date of Agreement E-mail address: A,J J1'j S-3 2-1 C- Y A•1-16-161 OWNER understands that(1)ANNUAL RATE payment is for one year only commencing on the effective date set forth above and is non-refundable;and(2)Current DEP Regulations require OWNER to maintain a service agreement for the life of the FAST'System. I HAVE READ AND UNDERSTAND THE FOREGOING. 1 ,v *Signed by OWNER: A-4'!,- Field Testing Onsite testing performed 1 time per year will be used to demonstrate that the systems are operating at a secondary treatment standard of 30 mg/L of BODS and TSS. The following will be performed: 1) Visual examination of the effluent for color,turbidity and effluent solids. 2) Settleable solids observation/measurement 3) Effluent pH to determine if the waste water is between 6 and 9 standard units. 4) Dissolved Oxygen,2mg/L or more,to ensure that the system is operating. 5) Turbidity, less than or equal to 40 NTU. If the effluent does not meet effluent quality standards,a grab sample will be collected for laboratory analysis. Results sent to state and local Agencies as well as the OWNER. OWNER is responsible for providing acceptable access to effluent for field testing and/or to enable a grab sample to be taken for laboratory testing performed. If such laboratory sample is required, OWNER will be responsible for charges incurred. IF REQUIRED,THE COST FOR THIS ADDITIONAL TESTING WILL B,E..$190.00/VISIT. *Approval for Additional Testing if Required; - .' Owner's Signature Operator assigned: Michael Moreau Telephone: (508)989-2744 i of 00RTM, 7891 3:•�' 0 • Town of North Andover s�'•,,,,o.• HEALTH DEPARTMENT �SS�cNust< CHECK#:J/QEL DATE: LOCATION: p H/O NAME: Au/60,zn i CONTRACTOR NAME: f�Q_k6h 05,,' 110n Type of Permit or License: (Check box) ❑ Animal $ ❑ Body Art Establishment $ ❑ Body Art Practitioner $ ❑ Dumpster $ ❑ Food Service-Type: $ ❑ Funeral Directors $ ❑ Massage Establishment $ ❑ Massage Practice $ ❑ Offal(Sepi`ic)Hauler $ ❑ Recreational Camp $ ❑ Sun tanning $ ❑ Swimming Pool $ ❑ Tobacco $ ❑ Trash/Solid Waste Hauler $ ❑ Well Construction $ SEPTIC Systems: ❑ Septic-Soil Testing $ ❑ Septic-Design Approval $ ❑ Septic Disposal Works Construction(DWC) $ ❑ Septic Disposal Works Installers(DWI) $ � ❑j Title 5 Inspector $ 4�l Title 5Report 1� P ❑ Other. (Indicate) $ HekjLh Agent Initials White-Applicant Yellow-Health Pink-Treasurer C3 < , Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments I s•�''y 445 Boston Street Property Address Thomas Connolly Owner Owner's Name information is required for North Andover MA 01845 5/23/13 every page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important: A. General Information When filling out forms on the computer,use 1. Inspector: only the tab key p to move your Benjamin C. Osgood, Jr. R9CEIVED cursor-do not use the return Name of Inspector key. none Company Name 24 Julie Ave TOWN OF NORTH ANDOVER Company Address DEPARTMENT Salem N H 03079 City/Town State Zip Code 508-328-4633 870 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 5/23/13 Inspector's ignature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system 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. ****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. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments i , 445 Boston Street Property Address Thomas Connolly Owner owner's Name information is North Andover MA 01845 5/23/13 required for every page. Citylrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® 1 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. I Comments: i i i I, B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be ' replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. i *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. ❑ Y ❑ N ❑ ND (Explain below): i it I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments I 445 Boston Street Property Address Thomas Connolly j Owner Owner's Name information is required for North Andover MA 01845 5/23/13 � every page.a e. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): I C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation b the Board of Health in order to determine if q Y 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 I 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: I ❑ 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 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 445 Boston Street Property Address Thomas Connolly Owner Owner's Name information is required for North Andover MA 01845 5/23/13 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: I I I I i D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than Y2 day flow I Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ' M 445 Boston Street Property Address Thomas Connolly Owner Owners Name information is North Andover MA 01845 5/23/13 required for every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. I ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ 2 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. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® 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. j E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ® the system is within 400 feet of a surface drinking water supply ❑ ® the system is within 200 feet of a tributary to a surface drinking water supply El ® 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 C system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 445 Boston Street Property Address Thomas Connolly Owner Owner's Name information is required for North Andover MA 01845 5/23/13 every page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes"or"no"as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms(design): 4 Number of bedrooms(actual): 4 440 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 445 Boston Street Property Address Thomas Connolly Owner Owners Name information is required for North Andover MA 01845 5/23/13 every page. Cityfrown State Zip Code Date of Inspection D. System Information Description: i i i i Number of current residents: 3 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available(last 2 years usage(gpd)): Detail: t Sump pump? ® Yes ❑ No Last date of occupancy: CurrentDate i Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: j Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 445 Boston Street Property Address Thomas Connolly Owner Owner's Name information is North Andover MA 01845 5/23/13 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date I Other(describe below): I General Information Pumping Records: Source of information: Pumped 4-18-13 Per owner Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system I ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ® Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. El Other(describe): Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 445 Boston Street Property Address Thomas Connolly Owner Owner's Name information is required for North Andover MA 01845 5/23/13 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: System installed in 1984 per as built on file at BOH i Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): 2' Depth below grade: feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: N/A feet Comments(on condition of joints, venting, evidence of leakage, etc.): Pipe looks good in basement Septic Tank(locate on site plan): Depth below grade: 1.0 feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) I If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1500 gallons 011 Sludge depth: Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M , 445 Boston Street Property Address Thomas Connolly Owner Owner's Name information is required for North Andover MA 01845 5/23/13 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) I Distance from top of sludge to bottom of outlet tee or baffle N/A Fast System Scum thickness Distance from top of scum to top of outlet tee or baffle N/A Distance from bottom of scum to bottom of outlet tee or baffle N/A How were dimensions determined? measure tape I Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank in good condition. Fast tank appears to be operating properly. �I I I i I Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date I. ' I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 445 Boston Street Property Address Thomas Connolly Owner Owner's Name information is required for North Andover MA 01845 5/23/13 f every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date I Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No i i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 445 Boston Street Property Address Thomas Connolly Owner Owners Name information is required for North Andover MA 01845 5/23/13 everypage. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 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.): r i i I Pump Chamber(locate on site plan): Pumps in working order: ® Yes ❑ No Alarms in working order: ® Yes ❑ No Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Pump chamber clean and in good operating condition i i Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: k i Commonwealth of Massachusetts i Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 445 Boston Street Property Address Thomas Connolly Owner Owner's Name information is required for North Andover MA 01845 5/23/13 ` every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ® leaching fields number, dimensions: 1 Field 34'x40' ❑ overflow cesspool number: ® innovative/alternative system Type/name of technology: FAST Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of M vegetation, etc.): Area of system looks normal. No ponding, damp soil, or unusual vegetation. No observation port present in pressure dosed system so probed into field to inspect stone. Stone appeared clean and dry indicating normal operation. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer i Depth of scum layer Dimensions of cesspool Materials of construction i Indication of groundwater inflow ❑ Yes ❑ No i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 445 Boston Street Property Address Thomas Connolly Owner Owner's Name information is required for North Andover MA 01845 5/23/13 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): r I Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 445 Boston Street Property Address Owner Thomas Connolly information is owner's Name required for North Andover MA 01845 3/13 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks, Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below [] drawing attached separately DtsJ�+N(FS A-T+jl{ 3c ,y' �( 8(Z 8--TAAJ1{ 1c..3' /�- P�Mh Ife�`i' G•pl.Lc i s7' 7 K �a.ao (yfIC�.ON Qt7 e � ! 7 l.tNCf a j _a I r �+►Awff� � 3y' Commonwealth of Massachusetts UW, Title 5 Official Inspection Form 5. Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 445 Boston Street ` Property Address Thomas Connolly Owner Owner's Name I information is North Andover MA 01845 5/23/13 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: i ® Check Slope ® Surface water ® Check cellar ® Shallow wells 2' Estimated depth to high ground water: feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: 4/12/2002 Rev to 9/30/02 Date I ❑ Observed site(abutting property/observation hole within 150 feet of SAS) I ❑ Checked with local Board of Health-explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: I i You must describe how you established the high ground water elevation: System designed 2 feet above ESHGW as determined by soil evaluator Micheal O'Neill on 9/25/2001. M Before filing this Inspection Report, please see Report Completeness Checklist on next page. I I V Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments Sve;. 445 Boston Street Property Address Thomas Connolly Owner Owner's Name information is required for North Andover MA 01845 5/23/13 every page. City/Town State Zip Code Date of Inspection I E. Report Completeness Checklist I ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems)completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file I i I i Town of North Andover f AOR 11 Office of the Health Department O p Community Development and Services Division # 27 Charles Street '' • ''q(x North Andover, Massachusetts 01845 SSS"CHUSE� Sandra Starr Telephone(978)688-9540 Health Director Fax(978)688-9542 TOWN OF NORTH ANDOVER BOARD OF HEALTH CERTIFICATE OF COMPLIANCE DATE OF COMPLIANCE 10/25/2002 This is to certify that the individual components Q, entire (X) subsurface disposal system constructed (), repaired (X), or upgraded () by Jack Sullivan at 445 Boston Street has been installed in accordance with the provisions of 310 CMR 15.00 (Title 5), North Andover Board of Health septic system regulations, and the design plan approval #1188 dated October 11, 2002. The Issuance of this certificate shall not be construed as a guarantee that the system will function satisfactorily. Post-W Fax Note 7671 Date/d p Of h, To �/y�,�� From � el Co./Dept. Co. � �, Board of Health Inspector Phone# Phone# Fax#4/J¢� i/ Q�//�/I Fax# BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 NURSE 688-9543 PLANNING 688-9535 Acknowledgement RE: FAST System Property Address: 445 Boston Street, North Andover, Massachusetts I, Anand A. Kulkarni,the Buyer of the above-referenced property, have been informed by the Sellers, Thomas P. Connolly and Maureen Foley Connolly,that there is an alternative sewage disposal system on the property-the FAST system-and that as the owner of the property I must maintain an operation and maintenance contract with a Massachusetts certified operator. I acknowledge receipt of the following items from the Sellers: A copy of"Standard Conditions for Secondary Treatment Units Approved for Remedial Use" A copy of"Revision of Approval for Remedial Use" Title V report The current operation and maintenance contract with Wastewater Treatments Services, Inc. A copy of the latest inspection by Wasterwater Treatment Services, Inc. FAST system Owner's Manual FAST system Service Manual FAST system Installation Manual A copy of the Notice of Alternative Sewage Disposal System recorded with the Essex North Registry of Deeds("the Registry")at Book 13943 page 340. A copy of Variance/Deed restriction recorded with the Registry at Book 7184 Page 125. i A copy of the Department of Environmental Protection approval letter recorded with the Registry at Book 7425 Page 192. r f Rk 13943 Ps340 -'WR-17495 08-11-2014 a 03 : 29P is Notice of Alternative Sewage Disposal System M.G.L.c.21A,§ 13 and 310 CMR 15.0287(10) iThis Notice to be recorded and/or filed for registration in the chain of title of the Property served by an Alternative Sewage Disposal System{'Alternative System l-I NAME(S)OF OWNER OFPROPERTY SERVED BY ALTERNATIVE SYSTEM/: –7koIL,�}S' CyN,+vy/ji., }i•'� 11L4 vA2t''i�'N %�`�l t Nlvulfc�,_ C ADDRESS OF PROPERTY SERVED BY ALT TIVE SYSTEM: _ iJ �� j'j a,4-hs h 0 vel tyVP.v� )U TITLE REFERENCE FOR PROPERTY SERVED BY ALTERNATIVE SYSTEM[check and complete ea cp that appliesl: Deed recorded with theRegistry of Deeds in Boo0o .6,page rr _ _Certificate of Title No. issued by the Land Registration Office of the Registry District Sftfcc'of title other than by deed [If Alternative System Owner(s)is other than Property Owner(s),complete the following:[ A Iternative System(Xvner Name: Alternative System Owner Address: WHEREAS,Section 15.280 of Title 5 of the State Environmental Code("Approval of Alternative Systems"), provides for the Massachusetts Department of Environmental Protection(the"Department")to approve or certify,as appropriate,all proposals to construct;upgrade or replace on-site sewage disposal systems using alternative systems; WHEREAS,owners and/or operators of approved or certified alternative systems are subject to general conditions,as specified in Section 15.287 of Title 5 of the State Environmental Code,310 CMR 15.287,and may be subject to special conditions,as specified in the Department's approvals or certifications;such general and special conditions potentially including,without limitation,requirements relating to the use of trained operators,periodic inspections,maintenance,sampling,reporting and/or recordkeeping; WHEREAS,Section 15.287(10)of Title 5 of the State Environmental Code,310 CMR 15.287(10), requires that"prior to obtaining a Certificate of Compliance for installation of anew or upgraded system,the system owner shall record in the chain of title for the property served by the alternative system in the Registry Page 1 of 3 r is 4 1' of Deeds-and/or Land Registration Office,as applicable,a Notice disclosing both the existence of the alternative r on-site system and the Department's approval of the system.The system owner shall also provide evidence of such recording to the local Approving Authority ff and WHEREAS,the Property is served by an alternative sewage disposal system. NOW,THEREFORE,Notice of an alternative sewage disposal system is hereby given for the above-referenced Property,as follows: 1.Existence.An alternative system has been installed as a new or upgraded alternative sewage disposal system,on or i". adjacent to the Property,.and serves the Property.The trade name and model number(s)of the alternative system are as follows: Trade name of technology: Manufacturer Name: Model number(s): t C.t^st i✓ie 6fi ' 2. Approval/Certification.On (date!,the Department,pursuant to its authority under the section below,a ppro ed or certified the technology used in the above-referenced alternative system, of Title 5 as specified under MassDEP Transmittal Number d 17fransmittat Number of approval or certification!. [ eck one of the following,as applicable:) Approved for-remedial use under 310 CMR 15.284 Approved for piloting under 310 CMR 15.285 Provisionally approved under 310 CUR 15286 ^_Certified for general use under 310 CMR 15288 A copy of the Department's Approval/Certification is available from the Department in person or online at the Department's website:littn•l/www.mass.eov/deg. WITNESS the execution hereof under seal this { day of /G}u ��( 20 1Y made by the above-named Alternative System Owner(s). (Alternative System Owaer(s I Print Wame(s): 71 f o tv, s P- rry l►v j2.cN 'c7 COMMONWEALTH OF MASSACHUSETTS ss On this ay o 20-�before me,the undersigned notary public,personally appeared of document signer),proved to me through satisfactory evidence of identifi tion,which were to be the person whose name is signed on the preceding or attached document,and acknowledged to me that(he)(she)signed it voluntarily for its stat purpose. i (offici signature and seal ry) PATRICIA E SIFFMO 9 NOTARY PUBIC 0M,,10NtvEALTH OF MASSACHUSETTS my Comm.Expires NOV.8,2017 Page 2 of 3 i i i Y i t [Complete the following Property Owner(s)Conscut if Alternative System Owners)is other than the Property Owaer(s):{ CONSENTED TO: I [Property Owner(s)]. _ Print Name(s): Date: i COMMONWEALTH OF MASSACHUSETTS ss On this day of ,20before me,the undersigned notary public,personally appeared (name of document signer),proved to me through satisfactory evidence of identification, which were ,to be the person whose name is signed on the preceding or attached document,and acknowledged to me that(he)(she)signed it voluntarily for its stated purpose. ` (official signature and seat of notary) Upon recording,return to: [Name and address orProperty Owner(s)] i, Page 3 of 3 i a WITNESS my hand and seal this 29th day of August, 2014. Anand A. Kulkarni COMMONWEALTH OF MASSACHUSETTS ss. On this 29th day of August, 2014 before me,the undersigned Notary Public, personally appeared Anand A. Kulkarni and proved to me through satisfactory evidence of identification which was to be the person whose name is signed on the preceding or attached document,and acknowledged he signed it voluntarily for its stated purpose I VASILIOS B. KOTSIRIS Notary Public Notary Public COMMONWEALTH OF MASSACHUSETTS My commission Expires My Commission expires: October 28.2016 i r �* Blackburn, Lisa From: Sawyer, Susan Sent: Tuesday, August 12, 2014 8:58 AM To: Blackburn, Lisa Subject: FW: RE: RE: RE: FAST system Attachments: Recorded Notice of Alternative System.pdf PIs print out and just put in the health folder for this address. Not sure if it is still out. I have been working with this homeowner. You can put this email trail in as well. It kind of explains why she did this now. thx From: maureenfconnolly@verizon.net mailto:maureenfconnoll verizon.net YC� [ Y@ ] Sent: Monday, August 11, 2014 5:03 PM To: Sawyer, Susan Subject: Re: RE: RE: RE: FAST system Susan, Attached is a copy of the recorded Notice form for your records. Thanks again for all of your help. Maureen I On 08/11/14, Sawyer, Susan<ssawyerta7_townofnorthandover.com>wrote: You did great. I am sure your buyer will appreciate your thoroughness. Susan From: maureenfconnollyO)verizon.net [mailto:maureenfconnoily(abverizon.net] Sent: Monday, August 11, 2014 11:58 AM To: Sawyer, Susan Subject: Re: RE: RE: FAST system i Susan, According to Claire the DEP does not maintain a list of operators for the FAST system. The company who supplies the system maintains a list of approved operators. I have given the buyer's attorney the name of the company that we have used since our system was installed. I will record the Notice of Alternative Sewage Disposal System at the Registry of Deeds and forward a copy to you and the buyer's attorney. At the closing I will give the buyer a copy of -Standard Conditions for Secondary Treatment Units Approved for Remedial Use i -Revision of Approval for Remedial Use 1 w -Operations and Maintenance Agreement with Wastewater Treatment Services p -the most recent inspection report by Wastewater Treatment Services Also, I will hand over all manuals we have on the FAST system. And I understand that we should have the buyer aknowledge receipt of all the items we hand over to him. If there is anything else that we need to do to comply with the regulations regarding the FAST system, please let me know. Thank you for your help. Maureen On 08/11/14, Sawyer, Susan<ssawyer _townofnorthandover.com>wrote: It is good that you spoke to Claire Golden and you can now pass that on if you are questioned. NA does not have an additional requirement; I was merely pointing out to you that this is the current rule and that the buyer's agent might be looking for something, but I did say that"the main key is for all the information to be given to the new owners,so they know all about it". I I hope she was able to answer the question about"whom" can do the testing of the system. If so, I would appreciate knowing her response. go to Claire about"everything septic"so you found the right person to ask. Susan From: maureenfconnollv@verizon.net [ma iIto:maureenfconnolly@verizon.net] Sent: Thursday, August 07, 2014 1:29 PM To: Sawyer, Susan Subject: Re: RE: FAST system Thanks Susan. I could not find the deed template on the state website. So will this type of form you attached satisy North Andover requirements? 2 I spoke to ClaireGolden in the Wilmington DEP office. She told me that for state DEP requirements I do not need the deed disclosure since our system was installed before that requirement came into effect. But she told me local boards of health may have additional rules so I needed to talk to you and go through the steps needed for my sale to satisfy North Andover requirements. f E Please let me know if I need to come in and meet with you to go over the North Andover requirements for my sale or if your office has some sort of checklist I need to go through.The closing date is August 29th, so I want to be sure we take care of everything needed before then. i Thank you for your help. Maureen On 08/07/14, Sawyer, Susan<ssawyer townofnorthandover.com>wrote: http://www.hingham-ma.gov/health/Documents/Septic IA Deed%20Restriction.pdf something more like this. Your deed restriction is mostly about bedrooms and BOH approval. This form I found on Hingham's website is a state form and makes it clear; what the system is etc. I believe the main key is for all the information to be given to the new owners, so they know all about it; maintenance, testing, etc. ,i I know you asked about who can do the testing, but I ended focusing on disclosure; I believe that information can be found in the approval documents. I i From:Sawyer, Susan Sent: Tuesday, August 05, 2014 4:33 PM To: 'maureenfconnolly@verizon.net' Subject: FAST system I I Maureen, I do not see anything in the file in regards to you placing a notice of disclosure on the deed,though current rules require it. This could be an issue with the buyer. However, please see a couple of references below. It is clearly the owners responsibility to pass on the information. I would expect that the new owners should be provided the information regarding responsibilities that they will need at minimum, as the Health Department will be looking 3 for the new contract. I would recommend speaking with the inspector; if he is terminated, he will notify this office. It is a violation of the DEP code for them not to continue...: (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: Certification of Operators of Wastewater Treatment Facilities, or otherwise with a person qualified to operate and maintain the system in accordance with the Department's written approval. FYI other references are the Standard Conditions for Secondary Treatment http://www.mass.gov/eea/docs/dep/water/wastewater/o-thru-v/standrem.pdf i see first page and the first bullet 310 CMR 15.287(5) (5) Prior to the transfer of any ownership interest in an alternative system, or of any right or responsibility to operate an alternative system, the owner or operator shall provide written notice to the proposed 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. In addition, the owner shall include either a copy in full or a reference to the notice I of the alternative system described in 310 CMR 15.287(l 0), and the recording information for that notice, in the instrument of transfer of any such ownership interest. In the event of the transfer of any such right or responsibility without a transfer of ownership interest,the owner or i operator shall include a copy in full or a reference to the notice of the alternative system described in 310 CMR 15.287(l 0), and the recording information for that notice, in the agreement transferring such right or responsibility. There is a lot to read on this. Sorry if I confused you even more. Susan 4 ( 1 . - Susan Sawyer Public Health Director Town of North Andover 1600 Osgood Street Suite 2035 North Andover,MA 01845 Phone 978.688.9540 Fax 978.688.8476 Email mailto:ssaMeratownofnorthandover.com Web www.TownofNorthAndover.com x it I I i 5 O'Neill Associates Civil Engineers and Land Surveyors 234 Park Street North Reading,MA 01864 (978)664-8141 Fax(978)664-8142 Email: oneillm@ziplink.net June 11, 2002 T't)d,+iv-OF NORTH ANDD,,. 'al - BOARD OF HEALTH North Andover Board of Health JUN 13 2002 27 Charles Street North Andover, MA 01845 Attention: Sandra Starr, R.S., C.H.O. RE: Subsurface Septic Disposal System Upgrade 445 Boston Street, North Andover Map 1070, Parcel 108 Dear Members: On behalf of the applicant, Thomas P. and Maureen Connolly, we are requesting placement on the Board's next meeting agenda to discuss several variances from 310 CMR 15.211(1) and 310 CMR 15.104 for the septic system upgrade referenced above. The requested variances are as follows: 1. Reduction of the required 50 foot setback from a disposal field to the bordering vegetated wetlands to 33'per 310 CMR 15.405(1)(f). 2. Reduction of the required 10 foot setback from a septic tank to a building foundation. The provided setback is 8 feet. 3. The last variance involves the use of a laboratory derived percolation rate for design of the disposal system rather than the field.method defined in 310 CMR 15.104 & 15.105. When the last deep observation hole (T-4) was completed (1/14/02), the groundwater was too high to perform a percolation test. In accordance with the 9/8/00 MA DEP Policy#BRP/DVRWPeP-P00-4 (Title 5 Alternative to Percolation Testing Policy for System Upgrades), a soil sample was collected and sent to a testing laboratory for analysis. Based on this analysis and the procedures described in the DEP policy, an estimated percolation rate was established for design purposes. As part of this policy, the applicant is required to request the appropriate variance from both the local Board of Health and the DEP. i i North Andover Board of Health Attention: Sandra Starr Re: 445 Boston Street, North Andover Page 2 Should you have any questions concerning this matter,please do not hesitate to contact us at (978) 664-8141. Very truly yours, O'Neill Associates i Michael G. O'Neill, P.P.E. I I I NORTI/ TOWN OF NORTH ANDOVER °:t•``° •:'"o HEALTH DEPARTMENT A p 27 CHARLES STREET NORTH ANDOVER,MASSACHUSETTS 01845 �,s�,�°•Eta SACHUS Sandra Stan Telephone(978)688-9540 Public Health Director FAX(978)688-9542 July 15, 2002 Michael O'Neill O'Neill Associates 234 Park Street North Reading,MA 01864 Re: 445 Boston St. Dear Mr. O'Neill: This letter comes to confirm that at their regularly scheduled meeting on June 27, 2002,the North Andover Board of Health granted the following variances for the repair of the septic system at 445 Boston Street, North Andover: • Variance to percolation test under the Alternative To Percolation Testing Policy—310 CMR 15.104 • Distance to wetlands from 50 feet down to 33 feet- 310 CMR 15.405(1)(b) • Distance of septic tank to the foundation from 10' to 8'— • Although not exactly a variance,please add a note to the plan that the leach area is 2' to groundwater with a FAST system in place. These variances were approved on condition that a restriction be placed on the deed limiting the dwelling to the number of rooms currently existing, or until tie-in to municipal sewer. This statement should be placed on the plan before final approval. In addition,the existing well shall be appropriately abandoned by a licensed well driller. If the existing well is to be used,there shall be no connection at the house. All plumbing for the well must remain outside of the house to prevent cross connections and contamination. Should you have any questions,please call the Health Department at 978-688-9540, Monday through Friday between the hours of 8:30 and 4:30. Sincerely, Sandra Starr, R.S., C.H.O. Health Director Cc: Conley File TOWN OF NORTH ANDOVER SEWAGE DISPOSAL SYSTEM INSTALLATION CERTIFICATION The undersigned hereby certify that the Sewage Disposal System constructed; ( ) repaired; by TO Rfq A SLJWVArJ 7tL- -/ -TyVS_t,a 1FF located at yf,T 60STO v 11-9 CT was installed in conformance with the North Andover Board of Health approved plan, System Design Permit#127y, plan dated 5-//Z/oz with a design flow of Cyd gallons per day. The materials used re in conformance with those specified on the approved plan; the system was installed in accordance with the provisions of 310 CYIR 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: �J 0/4)/1O-L (s N Engineer Representative Final inspection date: 10 1 ��Loz__ Engineer Representative Installer: Lic.#: 1-51-2 Date: it 16 oz- Engineer: z- Engineer: �•�.� Date: iZ— i3--oZ U MICHAEL yG� .l G. O'NEILL N No.27918 CIVIL p RF�I STEAD ry\"SIC7k�EE� I i O'Neill Associates Civil Engineers and Land Surveyors 234 Park Street July 26, 2001 North Reading,MA 01864 (978)664-8141 Fax(978)664-8142 Email: oneillm@ziplink.net Ms. Sandra Starr, R.S., C.H.O. Town of North Andover Board of Health Community Development and Services Division 27 Charles Street North Andover, MA 01845 RE: 445 Boston Street North Andover Septic System Replacement O'Neill Project#01-155 Dear Ms. Starr, On behalf of the homeowners, Maureen and Tom Connolly, we are requesting an appointment be scheduled for soils testing at the above-referenced location. Enclosed herewith please find the following: 1. Completed application for soils test. 2. Proof of land ownership- 2001 Real Estate tax bill. 3. Check# 527 in the amount of$200 for upgrade. 4. Plot plan showing anticipated area of testing. At this time we are anticipating removing the existing system and surrounding biomat and reconstructing a new system in approximately the same area as the existing system. We await your notice of the time and date when we carp perform the testing. If you have any questions with regard to the enclosed,please feel free to contact me. Very truly yours, O'Neill Associates Michael G. O'Neill, P.P.E.' I Enclosures as stated i i O'Neill Associates Civil Engineers and Land Surveyors 234 Park Street North Reading,MA 01864 (978)664-8141 Fax(978)664-8142 Email:oneill.eng@verizon.net I December 13, 2002 North Andover Board of Health ; --- eft r 120 Main Street P ~ North Andover, MA 01845 DEC 19 Attention: Ms. Sandra Starr,R.S., C.H.O. RE: 445 Boston Street, North Andover Tom and Maureen Connolly Dear Ms. Starr: Enclosed herewith please find the following documents: 1. Three (3) copies of the Subsurface Septic Disposal System Upgrade As-Built Plan that was revised per the Board of Health's request; and 2. Town of North Andover Sewage Disposal System Installation Certification fully executed by the Engineer Representative and Installer. Once approved, would you kindly forward to this office the Certificate of Compliance when issued. i If you have any questions with regard to the enclosed, please feel free to contact me. I Very truly yours, O'Neill Associates - Michael G. O'Neill, P.P.E. Enclosures as stated FORM 9A - APPLICATION FOR LOCAL UPGRADE APPROVAL PAGE 1 OF 5 TOWN OF NORTH ANDOV.:.'s! i BOARD OF HEALTH Commonwealth of Massachusetts MassachusettsCD 0 Application for Local Upgrade Approval ' Title 5, 310 CMR 15.000' DEP Approved form required by 310 CMR 15.403(1) - - To be submitted to Local Approving Authority/Board of Health: For the upgrade of a failed or nonconforming system with a design flow of < 10,000 gpd. where full compliance, as defined in 310 CMR 15.404(1), is not feasible. To be submitted to DEP: For the upgrade of a failed or nonconforming system with a design flow of 10,000 up to 15,000 gpd and/or for upgrade of a state or federal facility, where full compliance, as defined in 310 CMR 15.404(1), is not feasible. NOTE: Local upgrade approval shall not be granted for an upgrade proposal that includes the addition of new design flow to a cesspool or privy or the addition of new design flow above the existing approved capacity of a system constructed in accordance with either the 1978 Code or 310 CMR 15.000. 1) Facility/system owner Name j1-40Has acv "AJ' tZeeo C0WQ0 k-L--I Address 44-5 3os�o►.� �;ZC,�-r . `vo. ��N�ovE2 Phone # -z' Address of facility z t-Azz�. 3>0QeZ 2) Applicant (if different from.above) Name Address Phone # 3) Type of f ility residential _ commercial _ school _ institutional (Specify) DFP APPROVED FORM-12M19S i FORM 9A - APPLICATION FOR LOCAL UPGRADE APPROVAL i PAGE 2 OF 5 4) Type of existing system 1 _privy cesspools)/conventional system Other (describe) Type of soil absorption system (trenches, chambers, pits,etc.) G �a5 5) Design flow based on 310 CMR 15.203 a) Design flow of existing system ddo gpd Approved? ✓ yes approval date s �„ no why? b) Design flow of proposed upgraded system 444 A.gpd c) Design flow of facilitydd a gpd 6) Proposed upgrade of existing system is a) f Voluntary Required by order, letter, etc. (attach copy) Required following inspection required by 310 CMR 15.301 (provide date inspection form was submitted-to the approving authority) (date) b) Describe the proposed upgrade to the system a w1 r-t�e2�-F�►s�r ��s et,-t c) Which of the following are applicable to the proposed upgrade? j Reduction of setback(s) (list setbacks to be reduced with proposed setback distances) s e T 3 c vc O �� �.c ,-�.►4c a a t r X70 H 1c:> F-r• Tc) Percolation rate of 30-60 minutes per.inch (state actual perc rate) s,�v 3E7 5e-s> aN Z!>IE P 'bU.cti .8e'P f 3>w M Pe P- poa-4 2- DEP DEP APPROVM FORM-12/07195 { FORM 9A - APPLICATION FOR LOCAL UPGRADE APPROVAL I PAGE 3 OF 5 s i Up to 25% reduction in subsurface disposal area design requirements (state required & pro-:,osed size) Relocation of water supply well (identify well, describe relocation) i i i Reduction of required separation between bottom of SAS & high groundwater (specify' proposed reduction & perc rate) ✓ Other requirements of 310 CMR 15.000 that cannot be met (specify sections of the Code) 3ioCMe24�• 3�oCK2 tS •do5 �►�j �� 2f9�cG ���.�E�c% ���T, �Zc+--� '3v,'+tif .. I System upgrades that cannot be performed in accordance with 310 CMR 15.404 & 15.405, or in full compliance with the requirements of 310 CMR 15.000, require a variance pursuant to 310 CMR 15.410-15.417. ' 7) If the proposed upgrade involves a reduction in the required separation between the bottom of the soil absorption system and the high groundwater elevation, an Approved Soil Evaluator must determine the high ground water elevation pursuant to 310 CMR 15.405(1)(i)(1). The evaluator must be a member or agent of the local approving authority: Distance from soil absorption system to high groundwater � feet As determined by: Evaluator's name Evaluator's signature Date of evaluation i DFS APPROVED FORM-12/07/95 1 1 - FORM 9A - APPLICATION FOR LOCAL UPGRADE APPROVAL PAGE 4 OF 5 8) Notice to Abutters No application for upgrade approval in which the setback from property lines or a private water supply well is reduced shall be complete until the applicant has notified all abutters whose property or well is affected by certified mail at least ten days before the Board of Health meeting at which the upgrade approval will be on the agenda. Such notice shall include the date, time and place where the upgrade approval will be discussed. If the Department is the approving authority, then such notice to abutters must be completed prior to the date of submission of the application to the Department. J '� The notices to abutters shall include a copy of the completed application form and shall reference the standards set forth in 310 CMR 15.402 through 15.405. List of affected Abutters: Abutter Name Date notified Address Abutter Name Date notified Address Abutter Name Date notified Address Abutter Name Date notified Address 9) Explain why full compliance, as defined in 310 CMR 15.404(1), is not feasible (each section must be completed): a) an upgraded system in full compliance with 310 0MR 15.000 is not feasible: ZJUG T'zi Wk.��JS b) an alternative system approved pursuant to 310 CMR 15.283-15.288 is not feasible: Ogg DEF APPROVED FORM-12/07!95 FORM 9A - APPLICATION FOR LOCAL UPGRADE APPROVAL t PAGE 5 OF 5 t I C) a shared system is not feasible: d) connection to a sewer is not feasible: t� orJ t`-- v A,L AR 1..�' 10) An application for a disposal system construction permit, including all required attachments (e.g. plans & specifications, site evaluation forms), must accompany this application. Is the DSCP application attached? _yes_no 11) Certification— ' "I, the facility owner, certify under penalty of law that this document and all attachments, to the best of my knowledge and belief, are true, accurate, and complete. I am aware that there may be significant consequences for submitting false information, including, but not limited to, penalties or fine and/or imprisonment for knowing violations." Facility own(Os signature Date I V--(PQ RcEty r�tit� i t-dol-l�S Cd�1,Ol_l `( Print Name Name of preparer Date V--)0 Q Telephone # & address of preparer NOTE: Title 5, 310 CMR 15.403(4), requires the system owner or operator to submit to the Department a copy of the local upgrade approval upon issuance by the Board of Health and prior to commencement of construction. DFP ArPROVM FORM-12/07/95 BOARD OF HEALTH NORTH ANDOVER, MA 01845 978-688-9540 APPLICATION FOR DISPOSAL WORKS CONSTRUCTION PERMIT 2 q101- DATE: CURRENT INSTALLER'S LICENSE# LOCATION: Y yY 60 fiw ,f iMT LICENSED INSTALL : C Sly u l SIGNATURE: TELEPHONE# /20C CHECK ONE: REPAIR: NEW CONSTRUCTION: IF NEW CONSTUCTION, PLEASE ATTACH FOUNDATION AS-BUILT. I Administrative Use Only 160.00 Fee Attached? Yes No Project Manager Ob. Yes No Foundation As-Built? Yes No Floor Plans? Yes No Approval Date: /9 Q COMMONWEALTH OF MASSACHUSETTS F EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS " = DEPARTMENT OF ENVIRONMENTAL PROTECTION Metropolitan Boston—Northeast Regional Office t JANE SWIFT .J 2002 BOB DURAND Secretary Governor LAUREN A LISS Commissioner August 19,2002 Thomas P.and Maureen Connolly 445 Boston Street North Andover,Massachusetts 01845 RE: STATEMENT OF TECBMCAL DEFICIENCY Application for BRPWP59b Title 5 Variance 445 Boston Street,North Andover(17-Ipswich) DEP Transmittal No.W029553 Dear Mr.and Mrs.Connolly: The Metropolitan Boston-Northeast Regional Office of the Department of Environmental Protection has received and reviewed your application for approval of a variance pursuant to 310 CMR 15.410 and 310 CMR 15.412 with the above transmittal number. th An The application contained written notification,dated002, ting attheNo provision the state dover Board of Health had,on June 27,2002,approved variance to the following Environmental Code:310 CMR 104(4)as it relates to percolation testing. Accompanying the application were plans consisting of two(2)sheets,titled as follows: Title: Subsurface Septic Disposal System Upgrade Location: 445 Boston Street Municipality: North Andover Applicant: Thomas P.Connolly Designer: Michael G.O'Neill,P.E.(Civil)No.27916 Date(Last Revision): April 12,2002(July 19,2002) An engineer of the Department has reviewed the application and accompanying information,and it is the opinion of the Department that the request for approval of this system cannot be approved at this time for the following reason: • The Alternative to Percolation Testing Policy,BRP/DWM/PeP-P00-4,dated September 8,2000, requires that applications for percolation variances include the Soil Evaluator's determination, along with the written concurrence of the Board of Health,as to whether the soils are of soil or compacted.fortthe North Andover Board of Health witnessed the testing on e Soil Evaluator's determination has been submitted. At there of soil testing,a consultant This information is available in alternate format by calling our ADA Coordinator at(617)574-6872. 205A Lowell St. Wilmington,MA 01887 • Phone(978)661-7600 • Fax(978)661-7615 • TfD#(978)661-7679 ��'� Printed on Recycled Paper Thomas P. and Maureen Connolly Page 2 August 19,2002 Board's behalf. The Department requires submittal of written documentation from the Board or _ it's consultant that the Board's consultant concurs on the Soil Evaluator's determination of the soil compaction. In the opinion of the Department,the requirements for the approval of this variance as specified in 310 CMR 15.410 and 310 CMR 15.412 have not been satisfied based upon the information received to date. The applicants have not proved that the same degree of environmental protection provided by a fully complying Title 5 system can be provided by the proposed system with variance at this location or that denial of the requested variance would be manifestly unjust. In accordance with 310 CMR 4.00,you have sixty(60)days from the postmarked date of this letter in which to address the listed deficiencies. Within the sixty(60)day time frame,the applicants are advised to allow for the appropriate Board of Health action on the revised submittal since the Department of Environmental Protection's subsequent action may be its final action and,therefore,any further filing in this matter would be considered a NEW application. If the applicants cannot accommodate the schedule of the Board of Health within the sixty(60)day period,or for any other reason requires additional time,the applicants may,by written agreement with this Department,extend this schedule in accordance with 310 CMR 4.04(2)(f). The applicants are also advised that when the Department receives the new information,it will initiate a second technical review,and has an additional sixty(60)days to rule upon the application. Should the application be deemed to be deficient for a second time,the application will be denied. If the applicants elect to proceed on the record as it now stands,this letter constitutes a denial of this application and the requested variance. Any person aggrieved by the variance decision of the Department of Environmental Protection may request an adjudicatory hearing on that determination in accordance with 310 CMR 1.00 and M.G.L. c.30A. The enclosed Supplemental Transmittal Form should be completed and included as a cover sheet with any future submittal to the Department relating to the above matter. You need only correspond to the Northeast Regional Office at the above address. If you have any questions regarding this matter,please contact Claire A.Golden at(978)661-7743. Very truly yours, Madelyn Morris Deputy Regional Director Bureau of Resource Protection MM/CAG/cg \2002variances l\w029553tdl Enclosure cc: • Sandra Starr,RS.,Health Director,Health Department,27 Charles Street,North Andover,MA 01845 • Michael G.O'Neill,P.E.,O'Neill Associates,234 Park Street,North Reading,MA 01864 i t Massachusetts Department of Environmental Protection Supplemental Transmittal Form (to accompany supplemental material to previously submitted applications) ' . Obtain from the upper nght`hand corner of the original applrcation's F Trnsmitta[ " Transmit#al Form. Nuymber W029553 2 (a) "'Facility Facility Address Facility r Information ; Connolly Residence 445 Boston Street 7 : r- c :Facili Town/Cit (d) Tele hone"Number :7 777 North Andover (978) 698-7310 3e lal,";P:e mit:N`am:e:", (blPermi.t.Code: (from oriainali:aoolication) -'- . Permit ,Inform`ation Title 5 Variance BRPWP59b c : EOEA MEPA;=file# d Telephone,;Number, 4 [ r; a Response to"Request ® (b) Response to;;Statement of Check for Additional rnfomi'aton. Deficiency n Reason�For � [ (c) Supplemental Fee ❑ : (d). .Withdrawal of Application Su:ppiementai ;l?a rnent Submrss�on Otherci Ceases,:ebelow :. 5. a Name of tnd�vidual ar fi`rm O (h) Affiliation With apptteatioh Form re" arra this submissron: a ; licant, consultarit.to a." l cant git,Prepared by k Contact:""Narne d, Contact Tele hone#k , i Revised 11/99 r COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS b r DEPARTMENT OF ENVIRONMENTAL PROTECTION Metropolitan Boston—Northeast Regional Office , •1 5�9 JANE SWIFT Governor BOB DUR.AND Secretary LAUREN A.LISS Commissioner September 9,2002 Thomas P.and Maureen Connolly 445 Boston Street North Andover,Massachusetts 01845 Re: Approval of Title 5 Variance for existing construction(BRPWP59b) Variance from Percolation Testing requirement 445 Boston Street,North Andover(17-Ipswich) DEP Transmittal No.W029553 i Dear Mr.and Mrs.,Connolly: Pursuant to Title 5 of the State Environmental Code,310 CMR 15.412,the Northeast Regional Office of the Department of Environmental Protection has completed its review of the above referenced application for approval of a variance granted by the North Andover Board of Health. The application contains a copy of the Board of Health'.s grant of a variance from the following provision of Title 5, 310 CMR 15.000: • 310 CMR 15.104 Percolation Testing. Accompanying the application were plans consisting of two(2)sheets,titled as follows: Title: Subsurface Septic Disposal System Upgrade Location: 445 Boston Street Municipality: North Andover Applicant: Thomas P.Connolly Designer: Michael G.O'Neill,P.E.(Civil)No.27916 Date(Last Revision): April 12,2002(July 19,2002) I Based upon its review of the application,and in accordance with 310 CMR 15.410,the Department has determined both of the following: a) The applicants have established that enforcement of 310 CMR 15.104 would be manifestly unjust, considering all of the relevant facts and circumstances of this case. A percolation test could not be performed because of high groundwater. This information is available in alternate format by calling our ADA Coordinator at(617)574-6872. i 205A Lowell St. Wilmington,MA 01887 • Phone(978)661-7600 • Fax(978)661-7615 . TTD#(978)661-7679 0 Printed on Recycled Paper � I Thomas P. and Maureen Connolly Page 2 i �~ September 9,2002 b) The applicants have established that a level of environmental protection that is at least equivalent to that provided under 310 CMR 15.000 can be achieved without strict application of 310 CMR 15.104 and 15.105. The applicants have established equivalent environmental protection as follows: A particle-size soil analysis in conformance with the Alternative Percolation Testing Policy was performed and, along with an evaluation of soil compaction, was used to determine soil classification, the effluent loading rate, and the design of the system. The system is designed in accordance with that policy. The soil was found to bean uncompacted till comprised of loamy sand; a Class I material. The soil evaluation had determined the material to be sandy loam, a Class 11 soil. The designer elected to be conservative. Based on that information, the system was designed with a Long Term Acceptance Rate of 0.33 gallons per day per square foot. The Department,therefore,approves the Board of Health's grant of a variance from 310 CMR 15.104. Additionally,the Department imposes the following conditions as part of this approval: 1) The applicants shall obtain a Disposal System Construction Permit(DSCP)from the North Andover Board of Health prior to commencement of construction of the system. 2) The system is not designed to accommodate a garbage disposal. As such, one shall not be used or installed at this facility. 3) There shall be no increase in design flow to the upgraded subsurface sewage disposal system. The design flow for the facility is 440 gpd. The facility consists of a four-bedroom house. 4) At the time of construction, if groundwater has receded to a point where percolation testing is feasible in the opinion of the local approving authority, then confirmatory percolation testing must be conducted and, if necessary, the system design revised based on the actual percolation rate. 5) A copy of the as-built plans must be submitted to the Department within 30 days of the date of issuance of the Certificate of Compliance from the North g Board of Health. U 6) Should this upgraded system fail, the owner(s)shall immediately notify the local Board of Health and the Department. 7) The applicants shall record in the appropriate Registry of Deeds or Land Registration Office,prior to the issuance of the Certificate of Compliance, a copy of this approval letter in the chain of title to the property to be served by the system. This variance determination is an action of the Department. If the applicants are aggrieved by this determination, they may request an Adjudicatory Hearing in accordance with 310 CAM 1.00 and M.G.L. C.30A. A request for an Adjudicatory Hearing must be made in writing and postmarked within 30 days of the date of issuance of this determination. Pursuant to 310 CAM 1.01(6), the request must state clearly and concisely the facts that are grounds for the request and the relief sought. The hearing request, along with a valid check payable 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 �I Boston, MA 02211 . I Thomas P. and Maureen Connolly Page 3 September 9,2002 s The hearing 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 in support of the claim of undue financial hardship. Should you have any questions regarding this matter,please contact Claire A.Golden,of my staff,at (978)661-7743. Very truly yours, Madelyn Morris Deputy Regional Director Bureau of Resource Protection MM/CAG/cag \2002variances 1\w029553 app cc: Sandra Starr,R.S.,Health Director,Health Department,27 Charles Street,North Andover,MA 01845 • Michael G.O'Neill,P.E.,O'Neill Associates,234 Park Street,North Reading,MA 01864 • DEP/Watershed Permitting Program/Title 5 Section/Boston I i Massachusetts Department of Environmental Protection Bureau of Resource Protection— Watershed Permitting Program d TITLE 5 PROGRAM ` M.G.L. c.21 §§26-53,310 CMR 15.000 For Reduction in Sampling or Inspection of I/A Systems i L ,V 6 Z Edo! ATTENTION. Thomas Connolly General Information OWNER NAME: Thomas Connolly DEP FACILITY ID: 21762 OWNER ADDRESS: 445 Boston Street,North Andover,MA 01845 LOCATION OF UA SYSTEM: 445 Boston Street,North Andover,MA 01845 Alternative On-Site System Sampling and Inspection The DEP, Watershed Permitting Program records indicate that the system serving your facility is a : Single Home FAST [i�Remedial Use Approval ❑Piloting Approval ❑ Provisional Use Approval ❑ Certification for General Use requiring that throughout its life,the Single Home FAST system shall be under a maintenance agreement and inspected, ❑Monthly [t*Quarterl�y �a d the El influent and �ffluent shall be monitored for -❑ flow �H ©tOD E�,1 SS ❑ Total Nitrogen ❑ Other as specified in either the facility approval letter for your system or as required by the Department's IA Technology Approval. All facilities shall submit monitoring results to the Department. [pprovaLDenial o Reduction in Sampling and Inspection. Fro the date of issuance of this notice,you may take the following actions: 0 Reduce sampling from four times to once per year. ❑ Reduce sampling to twice per year,once two weeks after startup and once within two weeks of shutdown of system. ❑ Reduce sampling to once per year,within two weeks of shutdown ❑ No sample reduction;system is a General Use system,sampling is not required by the Department,contact your local BOH to determine their requirements. ❑ Reduced sampling denied,continue sampling per your approval,results of sampling indicate potential problems,the system is not meeting the permit limits for the following parameters- Contact your 0&M contractor. ❑ Reduced sampling denied due to insufficient data,continue sampling per the Approval letter. ❑ Reduced sampling denied,this large alternative wastewater treatment system,with a design flow of approximately 440 gallons per da , requires inspection and effluent monitoring at least quarterly-continue sampling er the Approval letter. Continue inspections per the Approval letter. ❑ Reduce inspections to twice per year,once two weeks after startup and once within two weeks of shutdown. Submit the required inspection and sampling data by; January 31"for the previous calendar year,or ❑ September 30`x'for the previous twelve months,or❑March I"for the previous calendar year If the concentration of BOD and TSS (and/or TN)in the annual effluent sample from your system exceeds the 30 mg/L(or 19 mg/L) limits,then within 45 days of the annual sample you must both have your system sampled again and submit the results to the Department. Provided that the second sample meets the 30mg/L(and/or 19 mg/L)limits for BOD,TSS (and/or TN),you may resume annual monitoring of your system. However,if the second sample does not meet the 30mg/L(and/or 19 mg/L)limit for BOD,TSS(and/or TN), you must resume sampling your system four times per year. Following four consecutive samples demonstrating the system meets the 30 mg/L(and/or 19 mg/L)limits for BOD and TSS(and/or TN),the Department would favorably consider another written request to reduce monitoring. TN limits only apply to those systems located in a Title 5 defined nitrogen sensitive area All information shall be submitted to: DEP Boston Office,Title 5 Program,One Winter Street/6th Floor,Boston,MA 02108 Local Compliance Issues These changes are conditioned upon your compliance with the Approval and the requirements of this notice. Please be aware the change(s) does not apply to local requirements. You should discuss any changes from local requirements, if any apply to your system,with your local Board of Health. You should check with the local Board prior to reducing inspection, sampling and reporting to ensure that any reduction is consistent with any local requirements. If you have any questions please contact: Dana Hill at (617)292-5867 a f/- 0-,I- 4z��///, , C-(r-ZZ7 DATE ISSUED: {Signature} {Title} CC:North Andover Board of Health and Wastewater Treatment Services,Inc.,44 Commerical Street,Raynham,MA 02767 NOTICE OF VARIANCEIDEED RESTRICTION Pursuant to 310 CMR 15.000 Title 5, and as a condition of the North Andover Board of Health Disposal Works Construction Permit# 1275, dated October 4, 2002,notice is hereby given that real estate located at 445 Boston Street,North Andover, Massachusetts, as described in a deed from Patrick L. Clark to Thomas P. Connolly and Maureen Foley Connolly, dated August 8, 1986 and recorded in the Essex North County Registry of Deeds in Book 2266, Page 69 is the subject of a variance from the Town of North Andover Minimum Requirement for the Subsurface Disposal of Sanitary Sewage A1.05 and C9.01.(4). Said variance limits the maximum number of bedrooms at this dwelling to four bedrooms until such time as the dwelling may be tied-in to municipal sewer. This variance is within the jurisdiction of the North Andover Board of Health. Signed and sealed this twenty-first day of October, 2002 r t Thomas P. Connolly Maureen Foleyo y COMMONWEALTH OF MASSACHUSETTS Essex, s.s. October 21 2002 Then personally appeared the above-named Thomas P. Connolly and Maureen Foley Connolly and acknowledged the foregoing instrument to be their free act and deed, before me. Not ublic My commission expires: { c ! r COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS I c DEPARTMENT OF ENVIRONMENTAL PROTECTION ! Metropolitan Boston—Northeast Regional Of�iee I o„ JANE SWIFT BOB DURAND Governor Secretary LAUREN A.LISS Commissioner I September 9,2002 i I I Thomas P.and Maureen Connolly J 445 Boston Street - - - North Andover,Massachusetts 01845 t , Re: Approval of Title 5 Variance for existing construction(BRPWP59b) i Variance from Percolation Testing requirementuirement � I 445 Boston Street,North Andover(17-Ipswich) DEP Transmittal No.W029553 Dear Mr.and Mrs.Connolly: Pursuant to Title 5 of the State Environmental Code,310 CMR 15.412,the Northeast Regional Office of the Department of Environmental Protection has completed its review of the above referenced application for approval of a variance granted by the North Andover Board of Health. i The application contains a copy of the Board of Health's grant of a variance from the following provision of"title 5,310 CMR 15.000: • 3 10 CMR 15.104 Percolation Testing. j � I I I Accompanying the application were plans consisting of two(2)sheets,titled as follows: Title: Subsurface Septic Disposal System Upgrade j Location: 445 Boston Street Municipality: North Andover i Applicant: Thomas P.Connolly Designer: Michael G.O'Neill,Y.L.(Civil)No.27916 Date(Last Revision): April 12,2002(July 19,2002) Based upon its review of the application,and in accordance with 310 CMR 15.410,the Department i has determined both of the following: f a) The applicants have established that enforcement ol'310 CMR 15.104 would be manifestly unjust, considering all of the relevant facts and circumstances of this case. A percolation test coi.ticl riot be pel- i-ii7ed becaatse of liigh groundtivater. j Phis information is available in alternate for inaI by ra IIing our ADA Coordinntor at(617)i74-6972. 205A Lowell St. Wilmington,MA 01887 Phone(978)661-7600 • Fax(978)661-7615•TTD#(978)661-7679 G�4 Printed on Recycled Paper I ESSEX NORTH REGISTRY LAWRENCE, MASS. •F DEEDS A TRUE COPY: �-d� ATTEST. i S REt31STER OR p" r Thomas P.and Maureen Connolly Page 2 September 9,2002 I b) The applicants have established that a level of environmental protection that is at least equivalent to that provided under 310 CMR 15.000 can be achieved without strict application of 310 CMR 15.104 and 15.105. The applicants have established equivalent environmental protection as follows: j A particle-size soil analysis in conformance with the Alternative Percolation Testing Policy was performed and,along with an evaluation ofs•oil compaction,was used to determine soil classification,the effluent loading rale,and the design of the system. The systema is designed in accordance with that policy. The soil w ] y as found to bean tnrcompacted till comprised of loanry sand, a Class 1 material. The soil evaltialion had determined the material to be sandy loam,a Class 11 soil. The designer elected to be conservative. Based an that information, the system was designed with a Long Term Acceptance Rate of 0.33 gallons per day per square foot. i The Department,therefore,approves the Board of Health's grant of a variance from 310 CMR 15.104. Additionally,the Department imposes the following conditions as part of this approval: i 1) The applicants shall obtain a Disposal System Construction Permit(DSCP)from the North Andover Board of Health prior to commencement of construction of the system. 2) The system is not designed to accommodate a garbage disposal. As such, one shall not be used or installed at this facility. i I 3) There shall be no increase in design./low to the upgraded.subsurface sewage disposal system. The design flow for the facility is 440 gpd The jacility consists of a four-bedroom hoose. i I 4) At the lime of construction, if groundwater has receded to a point where percolation lesling is feasible in the opinion of the local approving authority, then confirmatory percolation testing must be conducted and, if necessary, the system design revised based on the actual percolation rate. i .i) A copy of the as-built plans must be 6ubmined to the Department within 30 days of the date of issuance oj'the Certificate of Cormplicmce from the North Reading Board of Health. i 6) Should this upgraded system jail, the orvrrer(s),shult immediately notify the local Board of Health and the Dc:ncu•[nrent. i 7) The applicants shall record in the appropriate Registry of.Deeds or Land Registration Off ice,prior to the issuance of the Certificate of Compliance, a copy of this approval letter in the chain of title 10 the property to be served by the system. This variance delermination is an action of the Department. If the applicants are aggrieved by this determination,they may request an Adjudicatory Hearing in accordance with 310 CM?1.00 and M.G.L. C.30A. A request for an Adjudicatory Hearing must be made in writing and postmarked within 30 days of the date of issuance of this determtinalion. Pursuant to 310 CMR I.0l(6),the request must state clearly and concisely the facts that are grounds for the request and the relief sought. The hearing request,along with a valid cheek payable to Commonwealth oj'Massachusetts in the amount of one hundred dollars($100.00),must be mailed lo. � I Commonwealth ofMassachuseas Department of Environmental Protection P.O.Box 4062 Boston,AM 02211 i i i r ! I Thomas P.ancLMaureen Connolly Page 3 a September 9,2002 i The hearing request will be dismissed if the filing fee is not paid, unless the appellant is exempt or granted a waiver,as described beloii. 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 cn undue financial hardship. A person seeking a waiver must file,together with the hearing request cis provided above,an affidavit setting forth the facts in support of the claim of undue financial hardship. I Should you have any questions regarding this matter,please contact Claire A.Golden,of my staff,at (978)661-7743. Very truly yours, Madelyn Morris Deputy Regional Director Bureau of Resource Protection M M/CAG/cag \2002variances I\w029553app cc: • Sandra Starr,R.S.,Iicalth Director,health Department,27 Charles Street.North Andover,MA 01845 i • Michael G.O'Neill,P.E.,O'Neill Associates,234 Park Street,North Reading,MA 01864 • DEP/Watershed Perrnitting Program/Title 5 Section/Boston j I f i I i I I I i I j I I 1 t I I i I I I � I Town of North Andover, Massachusetts Form No. 1 ptORTH � BOARD OF HEALTH .1 LED ,64'ItrQ 3� C� 0 - 19 O ^ ��4°°°°,« °��'' APPLICATION FOR SITE TESTING/INSPECTION �SSACHUS���� s , 1 • Applicant NAME ADDRESS TELEPHONE Site Location n f Engineer •�i `lCl�rt %. r..�;-, l /ti NAME ADDRESS TELEPHONE Test/Inspection Date and Time i - 'CHAIRMAN,BOARD OF HEALTH r Fee .L' 'c '� ,� Test No. I S.S. Permit No. D.W.C. No. C.C. Date Plbg. Permit No. - i Town of North Andover, Massachusetts Form No. 1 i NORTH d BOARD OF HEALTH TED APPLICATION FOR SITE TESTING/INSPECTION 4°RA ^PP �y �SSACHUS�� e Applicant r '•{ A r % i' J, , r. V-,•`rt' NAME ADDRESS, r`J TELEPHONE Site Location Engineer rr NAME ADDRESS TELEPHONE Test/I nspection Date and Time CHAIRMAN,BOARD OF HEALTH Fee Test No. 4V t S.S. Permit No. D.W.C. No. C.C. Date Plbg. Permit No. TO: NORTH ANDOVER, MASS �``� 19 `fie 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 ej c, S 7` North Andover Mass. SITE LOCATION The grades and construction are as specified in m� o� tAl ecifications dated 19 9 � Z M 0 i q eg. nitarian Sgw1TAR1AN Town of North Andover, Massachusetts Form No.2 NORrti BOARD OF HEALTH O � •i- _ DESIGN APPROVAL FOR ss"CMSE` SOIL ABSORPTION SEWAGE DISPOSAL SYSTEM Applicant/ &-11Q151T Ctyr-' _e N L�,o Test No. ; Site Location Reference Plans and Specs. ` )! e/// • 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. /0.c/�-� : CHAIRMAN,BOARD OF HEALTH �Fee f �� Site System Permit No. ' I Town of North Andover, Massachusetts Form No.3 e NQR,H, BOARD OF HEALTH L O p DISPOSAL WORKS CONSTRUCTION PERMIT SSACMUSE Applicant Q C /'� 11 a- / VW NAME ADDRESS TELEPHONE Site Location 4 /Ij Permission is hereby granted to Construct ( ) or Repair ( an Individual Soil Absorption Sewage Disposal System as shown on the Design Approval S.S. No. CHAIRMAN,BOARD OF HEALTH Fee D.W.C. No. i i BOARD OF HEALTH NORTH ANDOVER, MA 01845 of NOR7 AH NDO'"'"'% 978-688-9540 BOARD OF HEALTH APPLICATION FOR SOIL TESTS FB 2 5 2002 DATE: MAP &PARCEL: LOCATION OF SOIL TESTS: 44-x , OWNER:_ tam.; L TEL. NO.: �r� �� , — `z ADDRESS: 4� ENGINEER: CERTIFIED SOIL EVALUATOR: Intended Use of Land: Residential SubdivisionSing e Family Hom Commercial Is This: Repair Testing: V Undeveloped lot testing: In the Lake Cochichewick Watershed? Yes No THE FOLLOWING MUST BE INCLUDED WITH THIS FORM 1. Proof of land ownership (Tax bill, or letter from owner permitting test) 2. Plot plan & Location of Testing 3. Fee of$425.00 per lot for new construction. This covers the minimum two deep holes and two percolation tests required for each disposal area. Fee of$200.00 per lot for.renairs or qpgrades. (If time is not critical, fee for repairs is$75.00) GENERAL INFORMATION L 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"A 00') 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. Please Do Not Write Below This Line N.A. Conservation Commission Approval: c 3p Z C�Jx Date Received: Check Amount: Check Date: i NOONAN & Mc DOWELL, INC. 25 Bridge Street, Suite 6, Billerica, MA 01821-1023 Voice (978) 667-9736 Fax (978) 671-9565 Email: nm@conversent.net August 28, 2002 Town of North Andover Office of the Health Department 27 Charles Street North Andover, MA 01845 RE: 445 Boston Street, Jon No.: 1770/029 Dear Members of the Board The soil testing that was witnessed at the above location is an uncompact till. The soil would break off the excavation side in a massive form and would break up easily (Friable). If you have additional questions regarding the above please contact me at your earliest convenience. Sincerely z John L. Noonan, P.L.9.-P.E. (0 0 t4 Floffice/letter/1770.029.doc ' Land Surveyors Civil Engineers Environmental Planners f O'NEILL ASSOCIATES LETTER DIP VRAHO H OTTQLL, CIVIL ENGINEERS AND LAND SURVEYORS 234 Park Street NORTH READING, MA 01864 DATE JOB NO. (978) 664-8141 Fax (978) 664-8142 G— ATTENTION E-MAIL: oneill.eng@verizon.net RE: TO K�5 pt ►. Pk 4-4z& i N ADNi t N► S—t-e:-1T�2 et-j; - 2'1 E, -s WE ARE SENDING YOU Attached ❑ Under separate cover via the following items: ❑ Shop drawings Prints Plans ❑ Samples ❑ Specifications ❑ Copy of letter ❑ Change Order ❑ COPIES DATE NO. DESCRIPTION �TS GI -t2—o2 J�vL3"rJvtZF4�CC c� z=!� l 1`ltJ CX— THESE _THESE ARE TRANSMITTED as checked below: For approval ❑ Approved as submitted ❑ Resubmit copies for approval ❑ For your use ❑ Approved as noted ❑ Submit copies for distribution ❑ As requested ❑ Returned for corrections ❑ For issuance of certificate of compliance ❑ For review and comment 2c\j t S` -3> •- 31-'---�—©2 ❑ FOR BIDS DUE ❑ PRINTS RETURNED AFTER LOAN TO US REMARKS _err- --tc5o � COPY TO �a,�Z,=-=� �N�oL�—t w SIGNED: It enclosures are not as noted,kindly notify us at once. OWEILL ASSOCIATES LIEcTUER OF IMMO MU77ate i CIVIL ENGINEERS AND LAND SURVEYORS 234 Park Street NORTH READING, MA 01864 DATE ,oBNo. (978) 664-8141 Fax (978) 664-8142 ATTENTION E-MAIL: oneillm@ziplink.net RE: TO S�-naa:ly,\ e Im(4 r) WE ARE SENDING YOU ❑ Attached ❑ Under separate cover via the following items: ❑ Shop drawings ❑ Prints ❑ Plans ❑ Samples ❑ Specifications ❑ Copy of letter ❑ Change Order ❑ COPIES DATE NO. DESCRIPTION THESE ARE TRANSMITTED as checked below: ❑ For approval ❑ Approved as submitted ❑ Resubmit copies for approval ❑ For your use ❑ Approved as noted ❑ Submit copies for distribution ❑ As requested ❑ Returned for corrections ❑ For issuance of certificate of compliance ❑ For review and comment ❑ ❑ FOR BIDS DUE ❑ PRINTS RETURNED AFTER LOAN TO US REMARKS �'y.-�,�ri�ec� �� C�� �a�.�..�cy.. v.�G•� 2..�� ��.K� of �. (�, (MI P(`_yV'm1 oC_P_ POo-1_t COPY TO SIGNED: If enclosures are not as noted,kindly notify us at once. i GRAIN SIZE DISTRIBUTION TEST REPORT _ c cC 04 - - - _ _ t � Co 0 0 10 co M M M a a a s 90 80 70 z 60 z 50 LJ U w 40 30 20 10 0 200 100 10 .0 1 .0 0 . 1 0.01 0.O01 GRAIN SIZE - mm % +3" % GRAVEL % -SAN D % SILT % CLAY USCS LL PI • 0 . 0 30 . 5 54.0 12 . 8 2 . 7 SM SIEVE PERCENT FINER SIEVE PERCENT FINER Lccation : inches number size • size • SON SITE 2 100.0 4 77 .5 1 .5 97.3 10 69 .5 1 93 .8 20 60 .2 Description : 0 .75 91 .6 40 49 .9 • LOAMY SAND 0.375 84.6 50 44.7 100 33 . 2 GRAIN SIZE 200 22. 6 D60 0.832 D 30 U OF MASSACF USET f 30, ING. D10 o.o2so REVIEW Remarks : COEFFICIENTS BY: #200 WASH SIEVE Cc0 . 65 T,� Cu 32 .0 UTS OF MASSACHUSETTS, INC. Project No. : 5 Richardson Lane Project : 445 BOSTON STRE=T, N.ANDOVER, MA Stoneham, MA 02180 Date : 9/25/2001 Sample No . 9564 SOIL TEXTURAL TRIANGLE Project :445 Boston Streets: N. Andover, MA Sample 49564 ' • �� Based on the fraction passing the 410 sieve sample .oma contains 77.77, sand, 18.4% silt, 3. 9% clay, 100 material classified as loamy sand ,O 00 f: J 80 '�10 70 17 � GoCJ .� w�Ci 50 f` Y �U- 19a �o f c( — .�... - Y 30 ,c'_ _ Ball cla „ ��.,", Oa ?_0 San /iota l a Oil 10 n CP 10 -. � _1.,_._ a sift Q �yaan sa �v cO rp O percent sand � A 7. a ' �'no FORM 11 - SOIL EVALUATOR FORM Page 1 of 3 No. Date: Commonwealth of Massachusetts Nlor+tl (-Wover , Massachusetts Soil Suitability Assessment for On-site Sewage D3j=Sa ..... . ......... , eke ray - s01'(-T 6„0, g(2-S/o, 312q/0 Performed By: i.ch�tP( Nei ifS Date: Witnessed By: Ja.Hv�....1Jopn� r 07 Noonav- 'ZmG aw6li, IrC , ...N..A-04ovQ,r .go{ Lam on nddms or t q s QOStvY) S1 QfM� 4� fl(�tLV f (/�,.�Oool Ns Pr nj ov e r Tel , 445 Bos ny, St., N. Av►d C)V�ev • Io-7D/toy °!��`6��--�31 � ew construction El Repair j Office Review Published Soil Survey Available: No Yes ❑ Year Published Publication Scale Soil Map Unit Drainage Class ............ Soil Limitations ................ Surficial Geologic Report Available: No U Yes ❑ Year Published Publication Scale Geologic Material (Map Unit) — ...... . . . ......... Landform ` Flood Insurance Rate Map: Above 500 year Rood boundary No ❑Yes IE( Within 500 year flood boundary No 12Yes ❑ Within 100 year flood boundary No [2/Yes ❑ Wetland Area: National Welland Inventory Map(map unit) ................. .............................................................V----— Wetlands Conservancy Program Map(map unit) ................................._.................................---..-............._.... Current Water Resource Conditions(USGS): Month �� '.°�- O I Worth L 2 Range:Above NwW ❑Normal ❑M(w Normal d Other References Reviewed: _— DEP APMVM FORM-LIMI" FORM 11 - SOIL EVALUATOR FORM Page 2 of 3 Location Address or Lot No. `F`f"s ga&+0 A-PA 0y'e/v On-site Review Deep Hole Number "rP.— Date: -2s - 0 ( Time: Wyl Weather Location (identify on site plan) Land Use . J.-0-L W y%:..:.. Slope M Surface Stones --- Vegetation Landform _ ....... _.. Position on landscape (sketch on the back) e-*;ee- ►�,. Distances from: Open Water Body -> 2-00 feet Drainage way >Z5 feet Possible Wet Area > f 00 feet Property Line 7�S feet Drinking Water Well 1150 feet Other DEEP OBSERVATION HOLE LOG' Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(Inches) (USDA) (Munsell) Mottling (Structure,Stones, Boulders, Co;xistency, % Grsvel) 40 — p/p, -- 5`/f22' FSIbt e r �w PC Fri able C� 'SY '/3 =v1'ccj�IP . ���s`s, v�Co�►faccc,�eCi� Loamy Parent Material toeObgid _ aaran.aeea� — > 13'7 peam a mawater water in the Hob: Weeping from Pit Fam: /00 c; Estirrood seasonal High Cxound water: YQ r' DV APPWVED FORM-UM19S FORM 11 - SOEL EVALLiATOR FORM Page 3 of 3 Location Address or Lot No. 4+S BOS:6vi Si, , N, AodWy '7-('— 1 Determina&n for Seasonal High Water Table Method Used: ❑ Depth observed standing in observation hole ....... inches ❑,/Depth weeping from side of observation hole inches L�1 Depth to soil mottles V-U inches ❑ Ground water adjustment feet Index Well Number Reading Date Index well level Adjustment factor ..._ .... Adjusted ground water level Death 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? Q If not, what is the depth of naturally occurring pervious material? Certification Alp I certify that on z99S (date) I have passed the soil evaluator examination approved by the apartment 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 z3 nQ Atnvm waw-UMM e FORM 11 - SOEL EVALUATOR FORM Pale ; of 3 Location Address or Lot No. `f`f 8c)<,J-6 •, N. Ar d oyp ,, TP-2 Determination for Seasonal High Water Table Method Used: ❑ Depth observed standing in observation hole inches ❑ Depth weeping from side of observation hole . ... . inches Depth to soil mottles '48,'41 "inches ras p,?_C,+1v6J El Ground water adjustment feet y Index Well Number ....... Reading Date . Index well level Adjustment factor Adjusted ground water level Death 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? Ye_ <> i If not, what is the depth of naturally occurring pervious material? Certification ri r� I certify that on (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. SignatureDate t2--3 1CO2 i i DV A"FLOVM roam-UMM FORM ii - SOEL EVALUATOR FORM Page 2 of 3 Location Address or Lot No. '-t4,1; PBa cioh St, N, Pr K, (o a v- On-site Review Deep Hole Number'-TIP— 'l Date: 3.~. ���2- Time: A m Weather " Location (identify on site plan) Land Use ...... . Slope (%) Surface Stones Vegetation G.ra f Landform ...:.-7._:._.....:..�.:.. Position on landscape (sketch on the back) S e- PI Distances from: Open Water Body '> 'Loo feet Drainage way >2S feet Possible Wet Area > I oo feet Property Line > (0 feet Drinking Water Well �, I!OD feet Other DEEP OBSERVATION HOLE LOG' Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(Inches) (USDA) (Munsell) Mottling (Structure, Stones, Boulders, Consistancy, % Gravel) �o Fill I'afol'4 l 26 P�; (- roy �l Fr�'cti�l t: S►ev2 �`��v FIv�J�>IS l +Ey4vow '�'►.j, [Mvy Parent Maoarial loeolooicf ~— p�gy�; , 126 `r Death m Groundwater: Stw dm Water in the Hole: /U `' Weeping trop►Pit Face- L> bZYn4bd Seasonal High Ground Water: i DEF srMOVED>I"01111M-UM19S FORM 11 - SOIL EVALUATOR FORM Page 2 of 3 Location Address or Lot No. `f� 5��� �t N, Av,r�(o�C ✓ On-site Review Deep Hole NumberTf - 3 Date: �- 2?-02 Time: A7V� Weather Location (identify on site plan) Land Use L779�Vv h:..:.. Slope M Surface Stones Vegetation Gras Landform ._ . _. Position on landscape (sketch on the back) S e9- h Distances from: Open Water Body >Z00 feet Drainage way 12—S feet Possible Wet Area ;> 1 nv feet Property Line > ID feet Drinking Water Well ?100. feet Other DEEP OBSERVATION HOLE LOG' Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(Inches) (USDA) (Munsell) Mottling (Structure, Stones, Boulders, Consistency, % Gravel) 9 Top ` �f I r-I. �o 0/pt L- loyR-7/1 Fv-I'0Lb{P 90 G F S L ioW-b/( Fri MW e loy�s/� Ptrertt MaterisF Ipeobpid — DegtM>wa8edrodc: , Death=CimmmhNow. StwWv Water m the Hole: d 3 " Wesp"fmm Pit Faoe: COG " EsOmatad seasonal High Ground Water: Da I►rMVED roar-UMI" FOIL1i 11 - SOIL EVALUATOR FORM ` Noe 2 of 3 : Location Address or Lot r4o. I-4y T1 7. On-site Review _ Deep Hole Number Date: Time: Weather GGropwz_ Location (identify on site plan) Land Use _ L—/1�-✓ 'V' Slope M °" Surface Stones Vegetation Landform Position on landscape (sketch on the back) • W . Distances from: Open Water Body feet Drainage Nay feet t Possible Wet Area 100 t feet Property Line feet Drinking Water We 11 L""2 feet Other o av . s. ......._._... yp tMomw ��p' 'r'' `�- °•,� IEEP OBSERVATION HOLE LOG L - ov 00 -0o Depth from Soil Horizon Sol Texture Sod Color Soil Other Surface(inches) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency, % Graven - f 7 �1 5 L- yG� c�a�3/G t= 5�t./l,rov, �j ti• 2-RoZLS REOLI[RED AT EVERY PRO POSED DISPOSAL ARLA Parent Material(geologic) OepCttoBedoc#. 3J Death to Groundwater: .Standing Water in the Hole: I Z O Weeping from Pit face: / 00 Estimated Seasonal High Lound Water: ' 1� 6/3 S t.IJ O Al 001! f A IVOO ! /V /.)A P r c,.rC o-v a Y -2-1 C;,. DFP APPROVED FORM-DAMS - i FORM n - S01L EVALUATOR FORM °RwCI. I'aac 2 of 3 .riga It-q t . Location Address or Lot No. ,N o oz 1 �-✓- /1-r�l�oy�->Z � 'sf On-site Review >�- f+s Deep Hole Number �-G a • Date: Time: / Z Weather c Location (identify on site plan) 's"��. AYE ✓ Land Use _ Y.t�p Slope (°.6) Surface Stones Vegetation S ,7 Landform 67 JC7'—off Position on landscape (sketch on the back) . , ... Distances from: Open Water Body 7/n9 feet Drainage way feet Possible Wet Area -Q 0 N feet Property Line 30 feet Drinking Water Well 0a '' feet -Other Y47e,l` v i 4 v 0 �Q y DEEP OBSERVATION HOLE LOG' ✓C On/�4,rJ iDepth from Soil Horizon Sol Texture Sol Color Sol Surface finches) Other iUSDA) (Munsell) Mottling (Structure.Stones,Boulders.Consistency, % Graven VA ? 117 [_ 76 —I Z6 � �.'1L taYel v /F%sG� Patent Material(geologic) e- A c/r cl t 7 lel DEPORD R , M d 1. > Z is Depth to Groundwater Standing Water in the Hole: /,V, i Weeping from Pit face: Estimated Seasonalh wfl Ground Water: DET APPROVED FORM-1Z/0719S Massachusetts Department of Environmental Protection Supplemental Transmittal Form (to accompany supplemental material to previously submitted applications) 1 Obtain from the-upper right hand corner of the original application's Transmittal Transmittal Form: Number W029553 2-. (a) Facility Name: (b) Facility Address:Facilliv " Information Connolly Residence 445 Boston Street i (c) Facility Town/Cit (d) Telephone Number: North Andover _ (978) 698-7310 3. (a) Permit Name: (b) Permit Code: (from original anolication) � Pelrrnit Information T itle 5 Variance Br;PVVP59b (c) EOEA MEPA file #: (d) Te!ephone Nu, ber: 4. [ (a) Response to Request ® (b) Response to Statement of Check for Additional information Deficiency Reason For. [ (c) Supplemental Fee ❑ (d) Withdrawal of Applications Supplemental Payment Submission e Other leasespecify below): C 5. (a) Name of individual or firm` (b) Affiliation with application, i.e. Form preparing this submission: applicant, consultant to applicant:,. Prepared by c Contact Name: d Contact Telephone#: Revised 11/99 i i FORM 11 - SOIL EVALUATOR FoRm Page 2 of 3 i Location Address or Lot Ido. y a v Es-C- On-site -cOn-site Review _ Deep Hole Number _ Date: Time: / 0 % & —Weatherc Location (identify on site plan) t=t= Z Land Use � � Slope (%) z_- Surface Stones ^j ory 4:" _s Vegetation ?o Landform L i9 r' rt 0 Position on landscape (sketch on the back) . Distances from: Open Water Body 7 J QO feet Drainage way ��"� feet Possible Wet Area /94 z feet Property Line y'f�� feet Drinking Water Well AW-f. feet Other I /nCQa DEEP OBSERVATION HOLE LOG' I Depth from Soil Horizon Sol Texture Sol Color Sol Other Surface lincheS) NSDAI Munsell) MotkGng (Structure.Scones,$outders,Consistency, !6 ( Graven S 4— J 4 jt— re--G-r� c0v!$?45 rQ 1pYet 6 lv1-4. 1- 12a 'r 0Y--// « i v L r- /P- e`7 Parent Material(geologic) / '4' T e" C Depth to Groundwater. Standing Water in the Hole: Weeping from Pit face: vl EstimateE Seasonal High Ground Water: 4--1 DEP APPROVEZ FORM-I WItS GRAIN SIZE DISTRIBUTION TEST REPORT _ < < '< < C C - - v N OD 100 N 0 N 90 I 80 70 w z 60 I L z 50 w U w 40 30 I I 20 10 j 0 200 100 10.0 1 .0. 0, 1 0.01 0.O01 GRAIN SIZE - mm +3" % GRAVEL % SAND %' SILT % CLAY USCS LL PI • 0 . 0 30 . 5 54.0 12 .8 2 . 7 SM SIEVE PERCENT FINER SIEVE PERCENT FINER inches Location : size • number size • *ON SITE 2 100.0 4 77.5 1 .5 97.3 10 69.5 1 93.8 20 60.2 Description: 0.75 91 .6 40 49.9 • LOAMY SAND 0.375 84. 6 50 44.7 100 33.2 GRiR E 200 22.6 D60 0.832 30 L OF MASSAC� USETT , INC. 010 0.0260 lEW Remo rks COEFFICIENTS B #200 WASH SIEVE _ Cc 0 . 65 CU 32 .0 UTS OF MASSACHUSETTS, INC. Project No. : 5 Richardson Lane Project : 445 BOSTON STREET, N.ANDOVER, MA Stoneham, MA 02180 Date: 9/25/2001 Sample No. 9564 j'1� SOH TEXTURAL TRIANGLE Project :445 Boston Streetr, N. Andover, MA / Sample #9564 Based on the fraction passing the #10 sieve sample contains 77.71 sand, 18.4% silt, 3.97 clay, 100 material classified as loamy sand ,.0 00 ry0 , 80 �O 70 ' `m 60 G Co <�Qc 50 �(D Y �� 110- sa ct � Y ci 30 Cla" km m n n� o LIo 20 �L 0 10 san I= 1 0 ail 10 TI a UU san sa rr .� � �O O �L7 �a O 'O U percent sand M^rtr Y' • y�i, .i.. :7 i TP am 2. _ GRAIN SIZE DISTRIBUTION TEST REPORT _ c cc C C CN \ C' N 0 O O 100 M N .� r\j M N � .� O on 61 son Nam, 90 T7 80 111 L II 70 w z 60 LL z 50 w U w 40 n. 30 20 10 0 ' 0 200 100 10 .0 1 .0 0. 1 0.01 0 .001 GRAIN SIZE - mm +3" % GRAVEL % SAND % SILT % CLAY USCS LL PI • 0 . 0 3 . 2 56 . 9 36 . 0 3 . 9 SM SIEVE PERCENT FINER SIEVE PERCENT FINER. Location : inches number size 0size *ON SITE 0 . 75 100 .0 4 98.2 0.375 99 . 4 10 96 .8 20 92 .7 Description : 40 85. 6 *SANDY LOAM 50 81 .4 100 68.3 GRAIN SIZE 200 48 .5 D60 0.111 D 30 D10 0.0108 Remarks : COEFFICIENTS #200 WASH SIEVE Cc 0 . 97 Cu 10 . 3 UTS OF MASSACHUSETTS, INC_ Project No. : 5 Richardson Lane Project : 445 BOSTON STREET, NORTH ANDOVER, MA Stoneham, MA 02180 Date : 3/29/2002 Sample No . 7356 project: 445 boston street, N. andover sample no: 7356 SOIL. TEXTURAL TRIANGLE Based on the fraction passing the no. 10 sieve sample contains 58.8% sand, 37.2% silt, and 4.0% clay material classified as sandy loam. 100 -� 90 80— - 70 0 ray e�. 60 50 CO �(D Y Cls Y 30 O cl � Ban cla 20 0 san locu I B sil 10 n rp 10 ' CAW- .,_ sat a sa `Po o �o per dent sand 0,111 c 4' A a 06,/13/2002 14:30 19786648142 0 NEILL PAGE 02 PRESSURE DISTRIBUTION NETWORK COMPUTATIONS SYSTEM VARIABLES DISTRIBUTION LATERAL FLOW LATERAL INSIDE DIAMETER (IN) 1.00 ORIFICE ORIFICE SEGMENT LATERAL LENGTH EACH LATERAL(FT) 30 NO. FLOW GPM VELOCITY FLOW NUMBER OF LATERALS 7 (GPM) (FPS) (GPM) MANIFOLD INSIDE DIAMETER (IN) 3.00 7 1.28 3.85 8.93 MANIFOLD LENGTH (FT) 34 NUMBER OF MANIFOLD ORIFICES 0 FORCE MAIN INSIDE DIAMETER (IN) 3.00 MIN. SYSTEM FLOW 63.82 GPM FORCE MAIN LENGTH (W/FIGS) (FT) 45 ORIFICE SIZE (IN) 0.25 ORIFICE SPACING(FT) 5 LATERAL RESIDUAL HEAD(FT) 3 F.M. HIGH POINT-DISPOSAL FIELD 97.00 PUMP OFF ELEVATION 92.00 HAZEN-WILLIAMS COEFFICIENT 150 WEEP HOLE SIZE(0 IF NONE) 0.25 PRESSURE DISTRIBUTION SYSTEM CURVE COMPUTATION SYSTEM LATERAL FRICTION LOSS NETWORK STATIC DYNAMIC FLOW FLOW FORCE MAIN LOSS LOSS`" HEAD (GPM) (GPM) (Hrl100') (H{) (Hf) (H,) (TDH) 10.00 1.43 0.03 0.01 3.93 8.00 11.94 15.00 2.14 0.07 0.03 3.93 8.00 11.96 20.00 2.86 0.12 0.05 3.93 8.00 11.98 25.00 3.57 0.18 0.08 3.93 8.00 12.01 30.00 4.29 0.25 0.11 3.93 8.00 12.04 35.00 5.00 0.34 0.15 3.93 8.00 12.08 40.00 5.71 0.43 -0.19 3.93 8.00 12.12 45.00 6.43 0,53 0,24 3.93 8.00 12.17 50.00 7.14 0.65 0.29 3.93 8.00 12.22 55,00 7,86 0.77 0.35 3.93 8.00 12.28 60.00 8.57 0.91 0.41 3.93 8.00 12.34 65.00 9.29 1.06 0.47 3.93 8.00 12.40 70.00 10.00 1.21 0.54 3.93 8.00 12.47 75.00 10.71 1.38 0.62 3.93 8,00 12.55 80.00 11,43 1.55 0.70 3.93 8.00 12.63 85.00 12.14 1.73 0,78 3.93 8.00 12,71 90.00 12.86 1.93 0.87 3.93 8.00 12.80 "" Static loss=difference between lateral and'off float"elevations+ lateral residual pressure • . r ■■i■Miss■a■■■■■i■■■■■■■■■■■■■■a■rt■ ■■t■■■■■■■i■■■!■■■r■■Err■�■■■■a■■■■ ■■arsaaEwlsl■Mwwii■aalEa■■■■■aai■■■■■ STANDARD IMPELLER SIZE !■aw■■■■a■■■w■■!aw■■a■ ■ ■■E■■■a■ Pump HP Imp.Dia. ■ ■a■■■SOMME■■■■■a■x■am: MW ■ Uri!■■t■■■saatrlrra■■■■■■■■aa■ ' ■■.�■w■wssw EwwsalMME■■■■■■■■w■■■sM■s aww.\aw■wwwEw■!■w■wwwM■■■■■■■■E■aaa ■��a■■■i■■Mai■■sir■■■!a■■■■■■■■■ s' ■■►\■■aaa■■Ew■■■Mw■■E■■wE■■■Ea ■■►�■■■■■■:w■■■aaa■■aaa■■s■■r■i■■■■■■■sir■■■a■■a■■■■■arra■■■ ■■■■■►�■ti i■ilii■■■ria■a■■aaa■■■■■■■■■■■■■■a■■■■■■■ N�■a � ■Mars:\r■ssi�■i■■■■ri■/■■■aaa■■■aaa■■■as■■■■■■■■rr■ita■ !ti■■if�r■aa■.-r■■■■■■a■■■■a■■■s■■■1 r■tAi■a■a■■■a■■as111■i �r�!rR■a/ri■rt:�■■■■►fir■sir■■■lir■■■rUra!a■■■■■■■r■r■�■■■■r ■■■■.�■aaa■■■s:�■E■■►tea■■sw■■w■sM■■■■s■EEa■■s■aaas ■w■l,w ■■/■!■►\■asses/■f.-\■■sw�w■■■■■■■■■■■■■■MEEr1■ss■■s■aw■■M■s■■o ■ !a►��a■a■■■■►�■■a■.•■■■■■t■■■■r■■t■■■a■■a■■aaa!■■■ii■■h ►�■■■■■■■■�►fir■■■■r►�■■!►�■■■■■at!■■t■■■■t■■■■■sirEwa■■alst■■ a■:\sass■s■■►�■■■aa■■�\■■!r►r■ii■■a■■■■■■■■■■■■■a■■■at■■NO■a itr/►'ra■■■!■a■►\a■/Oa■f:�a!■fes■a■■■■!a■■■■■Nf■!!ra■ ■■err■■Y ■1■iir�\■r■■■■ifs■■■■■aa.�■■■i.�r■■■i■■■■■■■■tri■ ■■■■■■■■V rr■r=r■r:•■■■rrrt.\■rtr■■.`r■■r.�■■■r■■■■r■■■■rrr� ■■■■■i■■■■ tr■■ ■■■■r:.■■r■■■ \ •■■■rtr. ■■■.r■ri■■�i■■■■■r■r■rrrrt=rrra ■■■■■■t■■■■iia a■■■E.� 001-4-M5•: !sa►'r■Mr1-' 5 zrrE■■■aaa■EE■■a■/ alums ■■■■ :,■■tr■►\■all■i:4r■r►m■■■■■■■ru■■■■ a ■■■■i ■■■■ai■■■■■■■■■a■i■■■it■■■rr■■t:\t■■■►�■II■■r.�■ii►�■■■■■■■■■■a■i■■■ ■■■n swMww sws/�l w/■■w E■■■■►�E■■a�\11■■■a.�■sa►ww w■■sw■aa■■i■■a■■■aN ��■■�■■■■■■■sirs■■t■■■■►`�sralr�■■■■i a•■■■►�■■■■r■tAi■ arrr■lass■■■■■i■■saa■■■■!■w.�l■■■.w■i■a.•■■�\ss■■■sw■■/a■■■■a ■■■■■■ss■■■■■■E■■M■a■�■■■saws.��MM��s■■s.�■■�\■sr■asE■■■■■■rwa E■■■■s■■■■a■■■■a■■■EE■■■■■■rH■■►\■A\\was\\■■►•■■a■■a■■ aa■ ■■■■■Ea■■■a■■■■■■■■■awa■i■■■Ila■■f�a■i:1/A■\�■■\■■a/■ ■■■ wS/■w■■■■■w■ll■■■ ■■af■■ ■!w■11s■i■■.�■■■\a■■\\■f.\■■!w■ ■■■MUSE ■MwwE wwws■w■sM■s■■■■■■■■r!■■I I■sws■■.sw■.�■■a��■��■!EM■■E Ea/■■ ■■■■■■■■■t■■t■i■■■■■■■■■■■■■11■■Mar■■►`1■■�■■■i\■►1■t■t■t■■■■� r■■■■■■■■i Atli■■/■■■■■■tr!■■11■■■■Err ar►t■1\■■■►V\`�■■■ nowmrn■rr%Emma noses annommmmllsMEMIN&mmomic WIME low. ■■■aa■■■■Es//Ei■a■■■■sa■ai■■Ilr■■■a■■r■■i�lrfa■■a►�rm■ta■ ■■■■■i■■■■■■■tti■■■■r■■rrr■■ili■■■■i■■■■tt.r■�n■■.•t��■ r■■� ■r■ri■■■■■■■■■i it■■■■■■ti rrrl Ir■■■■■■■it■rr►�r■►N■■.�■..�■sur i�iiiiiiiiaiiiiiiii�iiiiiiiiiiiiiiiiriiiiiiiw.�i■�t.�i�a►t �ii . r • • • • •_ • • 1 (i �: • di • • Co (,n W FN in the shaded areas,revise as needed --- ESCA tv CS) CS) DESIGN FLOW(in gallonstday)? 440 ry Elevation of the PUMP OFF SWITCH,in feet? 92 Elevation of the upper LATERAL,in feet? 97 A DELIVERY PIPE distance,,from pump to manifold, in feet? 25 W DELIVERY PlfE diameter,in indms(if nol 2'—use 2"min)? 3 m Design DISTAL PRESSURE,in feet(if not 2.5)?(hd) 3 IS MANIFOLD CENTER-FED&SYMETRICAL(yes or no)? yes YES r, Haw many orMoes In the MANIFOLD? 0 Lo MANIFOLD ORIFICE diameter,in Itches(If not 5M6") 0.25 0.25 00 MANIFOLD DIAMETER(if not 2"—use 2"min)? 3 3 m TOTAL LENGTH OF-MANIFOLD 36 A Does MANIFOLD drain to FIELD after dose(yes or nor ao no �-' How many LATERALS? 7 rAi Pumping chamber weep hole stze(usually.25") 0 USE 0 IF FORCE MAIN DOES NOT DRAIN PROGRAM WILL CALCULATE UP TO 26 LATERALS AND UP TO 50 ORIFICES PER LATERAL Your HIGHEST elevation ialenal MUST be LATERAL 1: (first orifioe from lateral 102 of orifice spading) Lateral 1: Lateral 2: Lateral 3: Lateral 4: Lateral 5: Lai ml 6: L atmi 7: Length of each LATERAL,in feet? 30 30, 30 30 30 30 30 Diameter of each LATERAL,in Inches(1.5"min)? 1 1 1 1 1 1 1 Elevation of each LATERAL,in feet? 97 97 97 97 97 97 97 Number of ORIFICES per lateral 7 7 7 7 7 7 7 Distance from Manifold tD closest Ortfice,In feet 0 0 0 0 0 0 0 0 ORIFICE SPACING,in feet 5 5 5 5 5 5 5 Z Diameter of ORIFICES,in ?(0) 025 0.25 025 0.25 0.25 025 0.25 H Square feet of leachfldd per laterals(can ignore) 248 248 248 248 248 248 248 r Maximum number of orifioes In any one lateral 7 Minimum lateral diameter 1 D M CS) A FRICTION CALCULATIONS(using Hazen Williams friction R=Ld((3.55Qm1CK(Dd"2.63))x1.85) PRESSURE CALCULATIONS(using orifice dischage equation Q=11.79 D112 hd^.5 m cn Lateral 1: Lateral 2, Lateral 3: Lateral 4: Lateral 5: Lateral e: Lateral 7: LATERAL DISCHAGE(fest approximation) 6.93 8.93 8.93 8.93 8.93 e.93 8,93 w MANIFOLD ORIFICE DISCHARGE ( 00 N TOTAL SYSTEM DISCHAGE(first approximation) 62.54 m G) N TOTAL DISCHARGE PER LATERAL 9.05 9.05 9.05 9.05 9.05 9.05 9.05 p DISCHARGE PER SQUARE FOOT OF LEACHFIELD 0.036`503301 0.036503301 0.0365033 0.0365033 0.0365033 0.0365033 0.0365033 w ORIFICE MAXIMUM DISCHARGE BY LATERAL 1.32 1.32 1.32 1.32 1-12 1.32 1.32 m ORIFICE MINIMUM DISCHARGE BY LATERAL 1.28 1.28 1.28 1.28 1.28 1.28 t-M ORIFICE%DIFFERENCE DISCHARGE within LATERAL 3.4% 3.4% 3.4% 3.4% 3.4% 3.4% 3.4% 0.0% 0.0% 0.0% MAXIMUM DISCHARGE LATERAL 9.05 '- w MINIMUM DISCHARGE LATERAL 9.06 --1 00 MAXIMUM DISCHARGE PER SQUARE FOOT 0.04 m INIMUM DISCHARGE PER WU 0.04 A %DIFFERENCE GE for SYSTEM by orifice umin system °moo 9G DIFFERENCE DISCHARGE for SYSTEM by Iaterl3lS 0.096 as percent Of maximum lateral ins p N ERE Y as percent of mu are bat in system WEEP HOLE DISCHARGE(usually a 1/4"weep holo) 1.90 weep hole= 0.25 inch VOID VOLUME IN DELIVERY PIPE 9.18 VOID VOLUME IN MANIFOLD 1322 VOID VOLUME IN EACH LATERAL 1.22 1.22 122 1.22 1.22 1.22 1.22 0.00 0.00 0.00 TOTAL LATERAL VOID VOLUME 8.57 Z m MINIMUM DOSE VOLUME(based on void volume) 4284 to 86.67 MIN ►-� r ACTUAL MINIMUM IS BASED ON DAILY DESIGN FLOW r (weep fide,usually 1/4',not oounted for dose,eMuent is repurnped during process and not counted for frbtkm,except as fitting headtoss) TOTAL HEAD LOSS IN EACH LATERAL 0.85 0.85 0.85 0.85 0.85 0.85 085 MAXIMUM TOTAL LATERAL HEADLOSS IN SYSTEM 0.85 MANIFOLD HEADLOSS(center-fed unless manKold design) 0.10 DELIVERY PIPE HEADLOSS 0.25 wl delivery 3 Inch diameter FITTING LOSS Qmdk)ss`.15) 0.45 add extra head K fittings are more than absolute minimum DISTAL PRESSURE HEAD 3.00 STATIC HEAD(OFF-SWITCH TO HIGH LATERAUMANIFOLD) 5.00 HEADLOSS PUMP TO WEEPHOLE(assurne 3'run) 0.03 PUMP MUST BE AISLE TO PASS SOLIDS AT 65.27 G.P.M 9,69 FEET OF HEAD GPM=all laterals plus.nanUold orifices plus weep hate or head is sum of static head and headbse shown After OTIS(network losses=1.3'dlstal head) 65.27 G.P.M. 12.21 FEET OF HEAD head is stent head,de*vwy tosses and network[owes D M CS) cn 05/13/2002 14:30 19786648142 0 NEILL PAGE 01 WWII Associates Civil Engineers and Land Surveyors 234 Park Street FAX TRANS ,I SII 01864 / 'T r A L North Reading, 66 -8142 (978) 664-8141 Fax(976)664-8142 Date: 1 I T— Time: ❑ A.MM, Number of Pa es (including Cover�aga} NOTE: If you did not receive all papas or have any que0ons, pleats Cal}(978)684.8141 TO: ==6 n ►vooY�a.n From: ; 20;2> Remarks: 4kr- C C,o�1�/'QJ�Ci`�j on Iw5 mor'n,n5 Of f layl Mlf�""j1 r. `�r��r�-, �:J rte, has beer-, p�p� � ►�-�.nu�a�- rte �gjmP �?wv2,S . s' ►�-, ©�' T,^S ipon'1-+ V)z✓tJS�NN ��Ol'>nt C u��Ti S. F'jA r1 S L'UJI1 C J i rne(� 1 on `'c f mP, Z• 4-, alb, Wx•S aw;LDr„-,)„e 4%.e- '04r rcw C:\prOJects\Folms\Fax Form.doc r y OSe Cor " rri-2 I FORK 12 - PERCOLATION TEST 1 Location Address or Lot No. r ? �a l n 7- ,9 9 4 ` t3 o.3 Ao"/ S /V 0 p V COMMONWEALTH OF MASSACHUSETTS Massachusetts s Percolation Test Date: V Time:, /O ®!- Observation Hole # N 0A) F-:- Depth of Perc 5 A- 7 U -5v t Start Pre-soak W 14. t..- rC)OV X0'7 r' 7—Q End Pre-soak Time at 12" Time at 9" elf=- 5 y S ? Time at 6" Time (9"-6") Rate Min./Inch Minimum of 1 percolation test must be performed in both the primary area AND reserve area. Site Passed ❑ Site Failed ......................................................................... Performed By: ej►,, e., Witnessed By: '00� Comments: DFP APPROVED FOR.41-12/07/95 u Qq SANIjF�`P r v. f I co E �'xlSpiN G ht o A PPR o.x -r,j 1 { t b � 4 BOOK 1846; PAGE 94 — N 33015'24"E 150.00' G �Z /Acz LOT B PARCEL 1 p8 04 - wetland flag# 1A - flag#3A - - - flag ~0:43 97,46 SN�p flag#4A 1 98,99 flag#5A 100.17 Nwetland (NELL,00.00 �cb ►v �'•�` W 900.20 �0 ti-4, 2.19 Z 7� .31 •flan#sA ag .'j .t..... 0 r ... X,00 35. ...3 700 4r i^ETa .C';•,,,,. • i6 ,a.. 100 1,0042 , LOT C Existing bulkhead / ti—so NO B�t�D � PARCEL 109 i PARCEL 47 102 Porch 10095 (//.` *0"STREET 10075 "��I O1.47 MAP 107.0 PARCEL 109 =.T. JOSEPH — !01.84 1.47 \, 443 BOSTON STREET ,LDEN,TRS MONGELL,JOHN JMOLLEEN J. \ 2; PAGE 232 00.60 Existing' Building BOOK 5132 PAGE 23 25 NO CUT 104.031Hs # 5 7G - 00. 101.78 , EXISTING ENTR NCE -nag#4B flag;1 58 a i i SipPRO POSED ENC wetl nd OSURE 103.78"' 03 ) I0I @ ' = / PLAN OF LAND oft LOCATED IN / NORTH ANDOVER \ 101.04 I I flag" 3B F 1 Bag#2q _� l DRAWN'1Fdh k MAUREEN CONNEL ' z wetland/, 0 SCALE: 1"=20' DATE: 41 163.00 I S 33°15'24"W N flag#1B 12"R.C.P.DRAIN '" 0' 2o' 4o' 101.72 1 I 150.00' +--- ,01.06 edge_road edge r ad. SCOTT L. GILES, P.L.S FRANK S. GILES BOSTON`` NORTH ANDOVER, MP •- `— REPT (978) 683-2645 1 OWNER : APPLICANT MAP 107.D PARCEL 108 445 BOSTON STREET k CONNOLLY, THOMAS P. "t '�.P S rt c� c {->o ,•, ,.r G MAUREEN FOLEY BOOK 2266; PAGE 69 SEE PLAN#7569 @ N.E.R.D. This plan is drawn for submission of a"Request For Determination". x g 13972 �- DRG: i o '�►u uMal A