Loading...
HomeMy WebLinkAboutMiscellaneous - 45 BEECHWOOD DRIVE 4/30/2018 (3) I i� I. v I M O� 1 i { UPC 10330 No. 151L HASTINGS, UN :5 VEDu • • PUBLIC HEALTH DEPARTMENT Town of North Andover Community and Economic Development Division CERTIFICATE OF COMPLIANCE As of: 10/27/16 This is to certify that the individual subsurface disposal system received a SATISFACTORY INSPECTION of the: Replacement of an On-Site Sewage Disposal System By: Rob Daigle At: 45 Beechwood Drive Map 034.0 Lot 0051 North Andover, MA 01845 ,The I§suance of this certificate shat be construed as a guarantee that the system will function satisfactorily. Michele Grant Public Health Agent 120 Main St.,North Andover,Massachusetts 01845 Phone 978.688.9540 Fax 978.688.9542 Web www.northandoverma.gov Sit 1Xj)r PUBLIC HEALTH DEPARTMENT Community Development Division TOWN OF NORTH ANDOVER SEPTIC DISPOSAL SYSTEM-INSTALLATION CE1F1qrIFICATION The undersigned hereby certify that the Sewage Disposal System(cconstructed;( )repaired; By: 0e.- � •e� (Yri t Name) Located at:_ /S f3c,FCH u/OOZ) b R I VZ (Installation Address) Was installed in conformance with the North Andover Board of Health approved plan, originally dated and last revised on �—/ S ,with a design flow of ®� gallons per day. The materials used were in conformance with those specified on the approved plan;the system was installed in accordance with the provisions of 310.CMR 15.000,Title 5 and local regulations,and the final grading agrees substantially with the approved plan.All work is accurately represented on the As-built which has been submitted to the Board of Health. RECEIVED p Bottom of Bed Inspection Date: AUG 0 y 2016 Engineer Representative %IVN OF NORTH ANDOVER IIDCh m (�1�� HEALTH DEPARTMENT And—Print Name Final Construction Inspection Date: Engineer Representative(Signature) Thl-ko Chmban� - And—Print Name Installer: (Signature) Date: And—Print Name Engineer: ` (Signature) Date: FI-1 l C l P (f HR I-S 7-1'19 A/S L-=/lam And—Print Name 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web http://www.northandoverma.gov 45 Town of North Andover — Septic System - AS-BUILT CCHECKLIST 1) 11 changes to the design plan have been reflected and noted on the as-built plan 2) As-built plan has a suitable scale; (1 inch = 40 feet or fewer for plot plans) 3) Street Address,Assessor's Map and Lot Number 4) _zLot Lines and Location of Dwellings served by the system 5) Locations,Elevations and Dimensions of As-built system components,including reserve (if applicable) 6) Ties to all tank openings,d-box,and leach area from dwelling or Permanent Structure /Setback distances are shown on the as-built plan from system components to: i Subsurface,interceptor&foundation drains Catch basins Property lines Dwellings or other structures Private water supply or irrigation wells / Watercourses or wetlands 8) -ZLocations of Wells,Drains,Wetland Resource Areas within 150 feet of system 9 Location of water,gas,electric lines cable control panel (if applicable) 10) Location of Structures within 6 Inches of Finished Grade 11) Original Stamp &Signature 12) Location and holder of any easements which could impact the system 13) 71pervious Areas;Driveways,etc 14) North Arrow 15) ZLocation &Elevation of Benchmark used 16) STATEMENT ON PLAN (NA 5.3) a. "I certify the locations, elevations, ties, cover material;exposed component covers etc., shown on this as-built substantially agree with the approved plan and have determined that the /break out elevations,if applicable,have been met." Signature of Designer Date b. "If a STUCTURAL WALL IS PRESENT(NA 4.9)a Letter or statement on the as-built indicating the wall- was, or was not, constructed in accordance with the intended design and any manufacturer's specifications." Signature of Designer Date Revised 3/17/15 . sti���D'd4c • '��BAI'BA.A�4'lV North Andover Health Department Community and Economic Development Division ONSITE WASTEWATER SYSTEM CONSTRUCTION NOTES LOCATION INFORMATION ADDRESS: 45 Beechwood Dr. MAP: 034.0 LOT: 0051 INSTALLER: Rob Daigle DESIGNER: Phil Christiansen PLAN DATE: 4/12/16, 4/28/16 BOH APPROVAL DATE ON PLAN: 5/9/16 INSPECTIONS TANK INSPECTION: using original tank DATE OF BED BOTTOM INSPECTION: 7/18/16 DATE OF FINAL CONSTRUCTION INSPECTION: 8/9/16 DATE OF FINAL GRADE INSPECTION: I Ola6l� SITE CONDITIONS N/A Contractor reports any changes to design plan ® Existing septic tank re-used'i ® Topography not appreciably altered Comments: replacement of the leach field only DISTRIBUTION-BOX ® Installed on stable stone base ® H-20 D-Box N/A Inlet tee (if pumped or >0.08'/foot) ® Hydraulic cement around inlet & outlets ® Observed even distribution ® Speed levelers provided (not required) _ ® Schedule 40 PVC Pipe Comments: SOIL ABSORPTION SYSTEM (General) X Bottom of SAS excavated down to C soil layer, as provided on plan X Size of SAS excavated as per plan ® Title 5 sand installed, if specified on plan N/A 40 Mil HDPE barrier installed ® Laterals installed and ends connected to header (and vented if impervious material above) ® Elevations of laterals and chambers installed as on approved plan N/A Retaining wall (boulder/ concrete /timber/ block) ❑ Final cover as per plan Comments: peastone has been replace with geoteck fabric, engineer approval (B.L.), 65x32 bottom of bed FINAL GRADE Loamed Seeded Cover per plan Comments: DOCUMENTS NEEDED i X Certification of Installation Form submitted By engineer and signed and dated by Engineer and installer X As-Built Plan BM = 94.12 HR = 5.56 HI = 99.68 SYSTEM ELEVATIONS ROD AS-BLT INVERT DESIGN INVERT ELEVATION ELEV ELEV Benchmark Exist D-Box OUT 4.29 95.04 95.09 Distribution Box IN 5.20 94.13 94.12 Distribution Box OUT 5.39 93.94 93.95 Lateral 1 TOP 5.44 / 5.86 Lateral 1 INVERT 93.89 / 93.47 93.82 / 93.50 Lateral 2 TOP 5.45 / 5.86 Lateral 2 INVERT 93.88 / 93.47 93.82 / 93.50 Lateral 3 TOP 5.44 / 5.86 Lateral 3 INVERT 93.89 / 93.47 93.82 / 93.50 Lateral 4 TOP 5.44 / 5.86 Lateral 4 INVERT 93.89 / 93.47 93.82 / 93.50 Lateral 5 TOP 5.44 / 5.86 Lateral 5 INVERT 93.89 / 93.47 93.82 / 93.50 Lateral 6 TOP 5.44 / 5.86 Lateral 6 INVERT 93.89 / 93.47 93.82 / 93.50 CRITICAL SETBACK DISTANCES Mark those distances checked in the field against the design plan and regulatory setback Tank SAS Sewer ® Property line 10 10 -- ® Cellar wall 10 20 -- ® Inground pool 10 20 -- ® Slab foundation 10 10 -- ® Deck, on footings, etc 5 10 -- Waterline 10 10 101 ® Private drinking well 75 1002 50 ® Irrigation well 75 100 ® Surface Water 25 50 ® Bordering Vegetated Wetland , Salt Marsh, Inland/Coastal Bank3 75 100 ® Wetlands bordering surface water supply or trib. (in Watershed) 150 150 ® Trib. to surface water supply 325 325 ® Public well 400 400 ® Interim Wellhead Prot. Area ® Reservoirs 400 400 ® Drains (wat. supply/trib.) 50 100 ❑ Drains (intercept g.w.) 25 50 ® Drains (Other)Foundation 10(5) 20(10) ® Drywells 20 25 1 Suction line 222(2) 2 100 feet is a minimum acceptable distance and no variance is allowed for a lesser distance(NA 5.02). 3 As defined in 310 CMR 10.55, 10.32, 10.54,and 10.30,respectively,pursuant to 15.211(3),also by NA wetland bylaws V •' Commonwealth of Massachusetts Map-Block-Lot --s ----------------------- BOARD OF HEALTH Permit No BHP-2016-0217 �a North Andover ---------- FEE �rknr $350.00 DISPOSAL WORKS CONSTRUCTION PERMIT i Permission is hereby granted Daigle-Enterprises, Inc. to(Upgrade)an Individual Sewage Disposal System. atNo -4-5-BEECH-WOOD-DRIVE------------------------------------------------------------------------------------------------------------- a 5BEECHWOODDRIVE------------------------------------------------------------------------------------------------------------- as shown on the application for Disposal Works Construction Permit No. BHP-2016-021 Dated June-28-,-20-16 FE_ k; ' ��„� ---' Issued On: Jun-28-2016 ©ARD lOF HEALTH a �r . • Application for Septic Disposal System TODAY'S DATE Construction Permit - TOWN OF $3 E-co -Full Rep�ent NORTH ANDOVER, MA 01845 $1 Important: Application is hereby made for a permit to: When filling out ❑C nstruct a new on-site sewage disposal system* forms on the computer,use Repair or replace an existing on-site sewage disposal system* only the tab key to move your E] Repair or replace an existing system component-What? cursor-do not use the return A. Facility Information key. Address or Lot# XxItAvir City/Town /e°°" 2.-*TYPE OF SEP IC SYSTEM*: ➢ ❑ Pump Gravity(choose one) ***If pump sy m, attach copy of electrical permit to application*** ➢ conventional System (pipe and stone system) ➢ ❑ Infiltrator or Biodiffuser(Gravel-Less) (Attach a copy of your certification to install this type of system.) ➢ ❑ Pressure Distribution S.A.S.(No D-Box) ➢ ❑ Pressure Dosed(D-Box Present)S.A.S. ➢ BDoes the system require an effluent filter? Yes No If yes, does plan specify make and model of filter? YES =(no further info, needed) NO=(installer must specify brand of filter before DWC issuance) W115at is the Make? What is the Model. 2. Owner Information 'Name Addressfferent from above) V' , a�� /9 A" o /rYh City/Town State Zip Code Email address Telephone Number 3. Installer Information f � Name N me of Company IN Address / City/Town State Zip Code 078 6933 Telephone Number(Cell Phone#if possible please) 4. Designer Inform% ion Elll L.4.�+ '•c,+ny�-a9 (J��IW , �.�� 011-e-e Name Name of Company Addregs, City/Town i State Zip Code 313 (11VO Telephone Number(Best#to Reach) Application for Disposal System Construction Permit•Page 1 of 2 Application for Septic Disposal System TODAY'S DATE , .k Construction Permit — TOWN OF $350.00-Full Repair NORTH ANDOVER, MA 01845 $175.00-component PAGE 2OF2 A. Facility Information continued.... 5. Type of Building: ❑Residential Dwelling or mmercial B. Agreement The undersigned agrees to ensure the construction and maintenance of the afore-described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code, as well as the Local Subsurface Disposal Regulations for the Town of North Andover. I understand that until a final Certificate of Compliance has been issued by this Boar f Health the "ns led system is not approved. Na Date G fV Ap i tion r By: (Board of Health Representa "ve) , a Date ppf ation Disapproved for the following reasons: For Office Use Only: 1. Fee Attached? Yes No 2. Project Manager Ohligation Form Attached? Yes_ No 3. Pump S sy tem? If so,Attach copy of Elect—ri—ObiZermit Yes No Applicant received copy of "Electrical Inspection Notes for Septic Systems" YesNo Handout? 4. Reviewed approvalletter, all paperwork received? Yes No Missing: 5. Foundation As-Built?(new construction only): Yes No (Same scale as approved plan) 6. Floor Plans?(new construction only): Yes_ No Application for Disposal System Construction Permit•Page 2 of 2 SEPTIC SYSTEM INSTALLER PROJECT MANAGEMENT OBLIGATIONS As the North Andover licensed installer for the construction for the septic system for the property at: (Address of septic system) For plans by to . . (Engineer) Relative to the application of (Installer's name) And dated ! �j L(UnMAI ate Dated � � � �.� o ay s ate With revisions dated 49 L-(, (Last revi ed date) I understand the following obligations for management of this project: 1. As the installer,I am obligated to obtain all permits and Board of Health approved plans prior to performing any work on a site. I must have the approved plans and the permit on site when any work is being done. 2. As the installer, I must call for any and all inspections. If homeowner, contractor,project manager, or any other person not associated with my company schedules an inspection and the system is not ready,then item three shall be applicable. 3. As the installer, I am required to have the necessary work completed prior to the applicable inspections as indicated below. I understand that requesting an inspection,without completion of the items in accordance with Title 5 and the Board of Health Regulations may result in a$50.00 fine being levied against me and/or mY company. a. Bottom of Bed-Generally,this is the first (VS inspection unless there is a retaining wall,which should be done first. The installer must request the inspection but does not have to be present. b. Final Construction Inspection—Engineer must first do their inspection for elevations, ties, etc. As-built of verbal OK (or e-mail to: healthdeptntownofnorthandover.com) from the engineer must be submitted to the Board of Health, after which installer calls for an inspection time. Installer must be present for this inspection. With a pump system,all electrical work must be ready and able to cause pump to work and alarm to function. c. Final Grade—Installer must request inspection when all grading is complete. Installer does not have to be on-site. 4. As the installer, I understand that only I may perform the work (other than simple excavation)and I am required to complete the installation of the system identified in the attached application for installation. I further understand that work done byothers unlicensed to install septic systems in North Andover can constitute reasons for denial of the system and/or revocation or suspension of my license to operate in the Town of North Andover, significant fines to all persons involved are also possible. 5. As the installer, I understand that I must be on-site during the performance of the following construction steps: a. Determination that the proper elevation of the excavation has been reached. b. Inspection of the sand and stone to be used. c. Final inspection by Board of Health staff or consultant. d. Installation of tank, D-Box,pipes, stone, vent,pump chamber,retaining wall and other components. 6. As the installer, I understand that I am solely responsible for the installation of the system as per the a1212roved 121ans. No instructions b the homeowner n ral co tractor or any other 12ersons shall absolve me of this obligation. Undersigned Licensed Septic Installer: (Today's Date �b �61 ' , v ' dj� Z011 J ame—Print) am — igne •^SG�TL'ED l6y6 • North Andover Health Department (ommunity and Economic Development Division May 9, 2016 Albacado Limited Partnership P.O. Box 334 North Andover, MA 01845 Re: 45 Beechwood Drive(Map 34,Lot 51) To Whom It May Concern: I The proposed wastewater system design plan for the above site dated April 12, 2016 with a final revision date of April 28, 2016 and received on May 2, 2016 has been approved. The design plan has been approved for use in the construction of a new on-site septic system for an industrial building without a cafeteria utilizing a gravity leach field system. This design plan approval is valid until May 9, 2018. During this time, a licensed septic system installer must obtain a permit and complete this work, and a Certificate of Compliance be endorsed by the installer, designer and the Town of North Andover. In the event an imminent health problem, such as sewage backup into the dwelling is j occurring, the North Andover Board of Health may reduce the time period for which this plan is valid. This approval is also subject to the following conditions: 1. If site conditions are found in the field to be different from those indicated on the design plan and/or soil evaluation,the originally issued Disposal System Construction Permit is void, installation shall stop, and the applicant shall reapply for a new Disposal Systems Construction Permit(3 10 CMR 15.020(1)). Page 1 of 2 North Andover Health Department, 1600 Osgood Street, Suite 2035 North Andover, MA 01845 Phone: 978.688.9540 Fax: 978.688.8476 45 Beechwood Drive May 9, 2016 2. It is the responsibility of the applicant and/or the applicant's septic system designer, septic system installer or other representative to ensure that all other state and municipal requirements are met. These may include review by the Conservation Commission, Zoning Board, Planning Board, Building Inspector, Plumbing Inspector and/or Electrical Inspector. The issuance of a Disposal System Construction Permit shall not construe and/or imply compliance with any of the aforementioned requirements. 3. A test pit shall be conducted on the northern side of the proposed leach field at the time of construction to confirm the soil conditions are consistent with the soil test pit data from 1996. Please feel free to contact the office with any questions you may have. We look forward to working with you to obtain a wastewater treatment and dispersal system which will be in compliance with all regulations and assure protection of public health and the environment of North Andover. Sincerely, B ian J. LaGrasse, CEHT irector of Public Health Encl. Installers list cc: Philip Christiansen, P.E. File Page 2 of 2 North Andover Health Department, 1600 Osgood Street, Suite 2035, North Andover, MA 01845 Phone: 978.688.9540 Fax: 978.688.8476 8/5/2016 Town of North Andover Mail-45 Beechwood Drive N 0 R1 It f OVER Massachus s ,. Brian LaGrasse <blagrasse@northandoverma.gov> 45 Beechwood Drive 1 message Dan O'Connell <dano@csi-engr.com> Wed, Aug 3, 2016 at 11:24 AM To: Brian LaGrasse <blagrasse@northandoverma.gov> Cc: Phil Christiansen <phil@csi-engr.com> Hi Brian. Rob Daigle brought in a sample of a geotextile fabric he would like to use in place of the 2" layer of peastone over the top of the leaching field. As the use of geotextile fabric is allowed under 15.247(b)we find the geotextile fabric acceptable pending your approval. Rob is going to bring you a sample of the material. Let me know if you have any questions. Best regards, Daniel J. O'Connell, P.E. CHRISTIANSEN &SERGI, INC. PROFESSIONAL ENGINEERS AND LAND SURVEYORS 160 Summer Street Haverhill, MA 01830 Tel. 978-373-0310 Fax 978-372-3960 E-mail: dano(@csi-enar.com www.csi-engr.com htt ://mail. le.com/mail/ca/u/O/?ui=2&ik=2c94973612&view= t&search=inbox&th=1565101fbdMff6&siml=156510ifodMff6 Ps 9�J P 1/1 I -ba t 145 Dayton Sand &Gravel Co.,Inc. 926 Goodwin Mills Road,Dayton,Maine 04005-7352 Ago* 1-800.339-2700 or 1.207-499-2306 Fax:1-207.499.7102 Project: Bentley Warren Date: Monday,July 18,2016 Customer: Bentley Warren Tested By: M.Stone&D.McKenzie Material Source: Dayton Sand&Gravel Co.,Inc. Material Description: Washed Sand Material Location: Stockpile Specification: C33(El 1)Fine Aggregate(Modified) O N O V N `D O O O O 0 OO O O O 100 _-m....._ __— ----�. 90 — --- _— — _-- — 80 70 60 — — — — 50 -- _ __ --_---_— a. T— --— — — T —✓-- I — 40 30 20 - -- - - _ Q =�- _— -- — — --—- _-r_ ---- ------! 100 101 r 0.1 Sieve Size Gradation Analysis Inch Sieve Size MED Passing Specification Note(s) --. --- --- --- -- 1/2" 12.5 100.07/16" 11.2 100.0 —-"----- ----- -3/8" 9.S 100.0 100 — ---- 1/4" 6.3 100.0 #4 4.75 100.0 95 - 100 i — #8 2.36 93.1 80 - 100 #16 1.18 79.9 50 - 85 — !— #20 0.85 69.7 `L—430 0.6 55.3 2qO #50 0.3 25.1 #100 0.15 5.5#200 0075 0_y0 -- ---- r CHRIS I IAItlSE & SERGI, INC. PROFESSIONAL ENGINEERS AND LAND SURVEYORS 160 SUMMER STREET,HAVERHILL,MA 01830 tel:978-373-0310 www.csi-engr.com fax 978-372-3960 April 28, 2016 Ms..Michele Grant Health Inspector RECEIVE® North Andover Health Dept. MAY U 2 2016 1600 Osgood Street, Suite 2035 North-Andover,.MA 01845 TOWN OF NORTH ANDOVER HEALTH DEPARTMENT Re: Subsurface Sewage Disposal System Repair Plan for 45 Beechwood Drive (Map 34,.Lot__51) Dear Ms. Grant: We have revised the plan to address your 4/25/2016 comments. To facilitate the-review of-this information we have reproduced your comments, and our responses follow each comment in blue italics. 1. A Local Upgrade Approval is required for only one test pit within the proposed system area (310 CMR 15.405(k)). We disagree that the Local Upgrade Approval is required for this repair system design. A total of 4 test pits were performed for the 1996 septic system design plan. The tests pits indicated stratified sands throughout the area of the site where the primary and reserve areas were proposed. The perc test results of less than 2 minutes per inch were consistent with what would be expected given the soil profiles. Then Health Director Sandy Starr determined that these tests adequately characterized the soils in the primary and reserve areas. The leaching area for the curent)Yproposed repair system lies in the same location as the reserve area shown on the 1996 plan. Title 5 requires that system designs include a reserve area sufficient to replace the primary soil absorption system. The approval of the 1996 plan confirms the adequacy of the then proposed primary and reserve areas, and therefore that testing is adequate for the current repair design. 2. According to the soil evaluation results for TP 96-3,the C2 horizon is unsuitable and must be removed. This needs to be clearly shown in the profile views and indicated on the design plan. We have revised the plan to include the phrase "including the C2 horizon encountered in Test Pit 96-3"to the reference to the removal of unsuitable soils on the Site Plan, Cross- Section, and Profile views of the system. We have also revised the line showing the approximate limits of removal of unsuitable soils on the Cross-Section and Profile views to more properly reflect the 3-foot+/-depth of the unsuitable C2 horizon. f `_ I F r April 28,2016 1 trust that this response and the revisions made to the plan fully address all of your comments. Please contact me if you have any questions. Very truly y urs, Ch ' i en S c. - Ph' istiansen 0 Page 2 No. THE COMMONWEALTH OF MASSACHUSETTS FEE BOARD OF HEALTH FO 14) of Wye k' IgP0t APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to Construct ( ) Repair (11--u"pgrade ( ) Abandon ( ) - ❑Complete System h idual Components A L16 ACA-I�a 4 P Pd .Rwner' Name Map/Parcel# Address Lot# Telephone# Installer's Name Deng is Dame l�C7 SI1I11 �� 1� %Z� 61,?3 Address � ddress ?X -3 73 b %� Telephone# Telephone# Type of Building: Lot Size r She ` Dwelling—No.of Bedrooms Garbage Grinder ( ) Other—Type of Building No.of persons /60f n Showers ( ), Cafeteria ( ) Other fixtures Al U c¢1 FE L Design Flow(min.required) 15'406 gpd Calculated design flow gpd Design flow provided �.SC4pd Plan: Date 41-f 2 (�, umber of sheets 2- Revision Date Titleii art f?zfad ONSi q-n 4-<!Zm /a�a/ �`nnn °�45id Description of Soil(s) M ^C- Soil Evaluator Form No. tAJ 0 Name of Soil Evaluator Date of Evaluation DESCRIPTION OF REPAIRS OR ALTERATIONS WC'-llSe SwA,-c 4,4'1 k O�- b -13,04 Rewlare j tccA The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further agrees not to place the system in operation until a Certificate of Compliance has been issued by the Board of Health. Signed Date Inspections FORM 1 - APPLICATION FOR DSCP DEP APPROVED FORM 5/96 No. THE COMMONWEALTH OF MASSACHUSETTS FEE BOARD OF HEALTH CERTIFICATE OF COMPLIANCE Description of Work: ❑ Individual Component(s) ❑Complete System The undersigned hereby certify that the Sewage Disposal System;Constructed( ),Repaired( ),Upgraded( ),Abandoned( ) by: at has been installed in accordance with the provisions of 310 CMR 15.00 (Title 5) and the approved design plans/as-built plans relating to application No. dated Approved Design Flow (gpd) Installer Designer: Inspector Date The issuance of this certificate shall not be construed as a guarantee that the system will function as designed. FORM 3 - CERTIFICATE OF COMPLIANCE DEP APPROVED FORM 5/96 4/28/2016 Town of North Andover Mail-Fwd:Message from"ComDev-Health-Ricoh" NO WAN IVER Massachus s. Michele Grant<mgrant@northandoverma.gov>. Fwd: Message from "Com Dev-Health-Ricoh" 1 message Michele Grant <mgrant@northandoverma.gov> Wed, Apr 27, 2016 at 3:28 PM To: phil@csi-engr.com Michele E. Grant Public Health Agent Town of North Andover 1600 Osgood St I Suite 2035 North Andover, MA 01845 Phone 978.688.9540 Fax 978.688.8476 Email mgrant@northandoverma.gov Web www.NorthAndoverma.gov - R�QRereu�Q�� --- Forwarded message From: Michele Grant<mgrant@northandoverma.gov> Date: Wed, Apr 27, 2016 at 3:01 PM Subject: Fwd: Message from "ComDev-Health-Ricoh" To: phiI@csi-engineeting.com Cc: Brian LaGrasse <blagrasse@northandoverma.gov>l Lisa Hadge <lhadge@northandoverma.gov> Hi Phil, Attached, please find 45 Beechwood Drive (Map 34, Lot 51)disapproval letter. Please call with any questions you may have. Best Regards :. Michele E. Grant - Public Health Agent - Town of North Andover 1600 Osgood St (Suite 2035 North Andover, MA 01845 Phone 978.688.9540 Fax 978.688.8476 Email mgrant@northandoverma.gov Web www.NorthAndoverma.gov https://mail.google.com/mail/ca/u/0/?ui=2&ik=d4458df3d9&view=pt&search=sent&th=1545931a9O49edb7&sim1=1545931a9O49edb7 1/2 + a ` 4 �kATED A4¢ North Andover Health Department Community and Economic Development Division April 25,2016 Philip Christiansen,EE. Christiansen and Sergi,Inc. 160 Summer Street r Haverhill,MA 01830 Re:45 Beechwood Drive(Map 34,Lot 51) Dear Mr.Christiansen, The proposed wastewater system design plan for the above site dated April 12,2016 and received on April 20, 2016 has been reviewed. Unfortunately,the plan cannot be approved until the following items are corrected. The specific section in Title 5: 310 CMR 15.000,orNorth Andover regulation that is not met by this design follows each item where applicable. 1. A Local Upgrade Approval is required for only one test pit within the proposed system area(3 10 CMR 15.405(k)). 2. According to the soil evaluation results for TP 96-3,the C2 horizon is unsuitable and must be removed. This needs to be clearly shown in the profile views and indicated on the design plan. Please feel fiee to contact the office or Mill River Consulting at 978-282-0014 with any questions you may have. We look forward to working with you to obtain a wastewater treatment and dispersal system which will be in compliance with all regulations and assure protection of public health and the environment of North Andover. Minrely Michele Grant Health Inspector cc: Albacado Limited Partnership File Page 1 of 2 North Andover Health Department, 1600 Osgood Street, Suite 2035, North Andover,MA 01845 Phone: 978.688.9540 Fax: 978.688.8476 4/20/2016 Town of North Andover Mail-Fwd:Message from"ComDev-Health-Ricoh" NUR VER s Lisa Hadge <Ihadge@northandoverma.gov> MaSsachusefts:. : ----- Fwd: Message from "Com Dev-Health-Ricoh" 1 message Lisa Hadge <Ihadge@northandoverma.gov> Wed, Apr 20, 2016 at 9:26 AM To: Dan Ottenheimer<dano@millriverconsulting.com>, Isaac Rowe <irowe@millriverconsulting.com>, Pam Lally <plally@millriverconsulting.com> Cc: Michele Grant<mgrant@northandoverma.gov>, Brian LaGrasse <blagrasse@northandoverma.gov> Good Morning, Attached is the paperwork and septic plan for 45 Beechwood Dr. ------ Forwarded message ---------- From: <spiceworks@northandoverma.gov> Date: Wed, Apr 20, 2016 at 9:38 AM Subject: Message from "ComDev-Health-Ricoh" To: "Hadge, Lisa" <Ihadge@northandoverma.gov> This E-mail was sent from "ComDev-Health-Ricoh" (Aficio MP C3002). Scan Date: 04.20.2016 09:38:46(-0400) Queries to: spiceworks@northandoverma.gov Lisa Hadge Health Department I Town of North Andover 1600 Osgood Street, Suite 2035 North Andover, MA 01845 Phone 978-688-9540 Fax 978-688-8476 Email Ihadge@northandoverma.gov Web www.northandoverma.gov 2 attachments 201604200938.pdf 1297K 45 Beechwood Dr..pdf 555K https://mail.google.com/mail/ca/u/O/?ui=2&ik=46857787dO&view=pt&search=sent&th=15433d983f6bea77&siml=15433d983f6bea77 1/2 TOWN OFi\'01 Tflzk 1� 1N-J)0\7.l:JZ Office of*COMAI UN HNA)i�',VEAG0111)All__ENNT XNID S 1`11Z VI C["s 1600 OSGOOD SITIA.:11-: SUITF, 2035 NORM Ai\`D0V'F.R., !N,1ASSAC11'USF.TTS 01845 97*8,-688,9540-I'lione 978.6S$,S476-I-YkX NNIEBSITF: SEPTIC PLAN SUBMITTAL FORM RECEIVED I � n d 1'�a� li l� � APR 1. 9 2016 Date of Submission: TOWN OF NORTH ANDOVER Site Location: OEit—(fm tU00.0 Dl-z I L16HEALTH DEPARTMENT — Engineer: Cj41Zj51-714kj5E -9 Se New Plans? Yes $2Z/Plan Check# .(includes Is' submission and one re- review only) Revised Plans?Yes $75/Plan Check# Site Evaluation Forms Included? Yes No Local Upgrade Form Included? Yes No Telephone M R 2 73 -,Q 3/b Fax#: E-mail: F� 0:5& iftl� C-0 Homeowner Name: OFFICE USE ONLY When the su7b ' sion is complete (including check): Date stamp plans and letter > LX Complete and attach Receipt > -Copy File; Forward to,Consultant ➢ Enter on Log Sheet and Database Summary Record Card generated on 2WO161:31:33 PM by Karen Hanlon page 1 Town of North Andover Tax Map # 210-034.0-0051-0000.0 Parcel Id 10065 45 BEECHWOOD DRIVE L-COM 45 BEECHWOOD DRIVE NORTH ANDOVER, MA 01845 Class 316 Other Storage,warehouse D Property Type 3 Commercial Zoning2 3 Commercial Zoning3 3 Commercial Size Total 5.01 Acres FY 2016 UB Mailing Index Name/Address Type Loan Number Active/inact. From Until L-COM Payor 45 BEECHWOOD DRIVE NORTH ANDOVER,MA 01845 UB Account Maint. Account No Cycle Occupant Name Activelinactive Bldg Id. 15310.0-45 BEECHWOOD DRIVE Last Billing Date 12/15/2015 2120134 02 Cycle 02 Active UB Services Maint. Account No.2120134 Service Code Rate Charge Multiplier/Users FIREPRO FIRE PROTECTION 66 INCH 672.00 1/1 MISCFEE ADMIN FEE 1.51 112 10.55 l/ WTR WATER 01 ALL METER SIZE /1 UB Meter Maintenance Account No.2120134 Serial No Status Location Brand Type Size YTD Cons 16321758 a Active ERT METE METE w Water 1.5 1.5 3887 Date Reading Code Consumption Posted Date Variance 11/6/2015 7284 a Actual 197 12/30/2015 88% 8/12/2015 7087 a Actual 111 9/14/2015 51% 5/13/2015 6976 a Actual 72 6/22/2015 16% 2/13/2015 6904 a Actual 69 3/20/2015 -60%, 11/6/2014 6835 a Actual 147 12/15/2014 -4% 8114/2014 6688 aActual 167 9/11/2014 117% 5/14/2014 6521 a Actual 76 6/12/2014 19% 2/12/2014 6445 a Actual 69 3/17/2014 -45% 11/6/2013 6376 a Actual 109 12/20/2013 -9% 8/13/2013 6267 a Actual 129 9/18/2013 50% 5/1312013 6138 a Actual 83 6/18/2013 18% 2/13/2013 6055 a Actual 79 3/i 312013 -37% 11/5/2012 5976 aActual 103 12/13/2012 -10% 8/15/2012 5873 a Actual 134 9/26/2012 71% 5/11/2012 5739 a Actual 71 6/20/2012 6% 2/14/2012 5668 a Actual 76 3/14/2012 -43% 11/7/2011 5592 aActual 117 12/15/2011 -55% 8/12/2011 5475 a Actual 274 9/14/2011 278% 5/12/2011 5201 a Actual 71 6/13/2011 4% 2111/2011 5130 aActual 72 3/15/2011 -70% 11/8/2010 5058 a Actual 222 12/13/2010 -29% 8/12/2010 4836 a Actual 325 9/13/2010 253% 5/12/2010 4511 a Actual 93 6/9/2010 30% 2/8/2010 4418 a Actual 73 3/11/2010 -61% 11/5/2009 4345 aActual 165 12/11/2009 16% 8/14/2009 4180 a Actual 160 9/11/2009 120% 5/13/2009 4020 a Actual 72 6/16/2009 -3% 2/10/2009 3948 a Actual 77 3/16/2009 -68% s Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 45 BEECHWOOD-DR. NORTH ANDOVER MA. 01845 + Property Address ALBACADO 1755 LTD. PARTNERSHIP C/O BARBARA TOMKINS, P.O. BOX 334 Owner Owner's Name information is NORTH ANDOVER MA. 01845 2/2/16 required for every page City/Town State Zip Code Date of Inspection i 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. RECEIVE ,,",, Important:When A. General Information LL LL C filling out forms r L� u J on the computer, use only the tab 1. Inspector: TOWN OF NORTH ANDOVER key to move your HEALTH DEPARTMENT cursor-do not RON JENKINS use the return Name of Inspector key. R. JENKINS&SONS Company Name 58 PLEASANT ST. + Company Address ROWLEY MA. 01969 + Cityrrown State Zip Code 978-314-0503 S14268 Telephone Number License Number B. Certification f 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 i Title 5(310 CMR 15.000).The system: ❑ Passes ❑ Conditionally Passes ® Fails I ❑ Needs Further Evaluation by the Local Approving Authority i - 2/2/16 In pector's Signature U Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board II 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 i t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 45 BEECHWOOD DR. NORTH ANDOVER MA. 01845 Property Address ALBACADO 1755 LTD. PARTNERSHIP C/O BARBARA TOMKINS, P.O. BOX 334 Owner Owner's Name information is required for every NORTH ANDOVER MA. 01845 2/2/16 page. CState 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: 4 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): jt5ins•3113 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 2 of 17 S Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 45 BEECHWOOD DR. NORTH ANDOVER MA. 01845 Property Address ALBACADO 1755 LTD. PARTNERSHIP C/O BARBARA TOWNS, P.O. BOX 334 Owner Owner's Name information is NORTH ANDOVER MA. 01845 2/2/16 required for every page. Cityrrown 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 Forth: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 �M °r 45 BEECHWOOD DR. NORTH ANDOVER MA. 01845 Property Address ALBACADO 1755 LTD. PARTNERSHIP C/O BARBARA TOMKINS, P.O. BOX 334 Owner Owner's Name information is NORTH ANDOVER MA. 01845 2/2/16 required for 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 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 El ® 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 t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 9 45 BEECHWOOD DR. NORTH ANDOVER MA. 01845 Property Address ALBACADO 1755 LTD. PARTNERSHIP C/O BARBARA TOMKINS, P.O. BOX 334 Owner Owner's Name information is NORTH ANDOVER MA. 01845 2/2/16 required for every page. CityrFown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ 0 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 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. t5ins•3113 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 ;MgO 45 BEECHWOOD DR. NORTH ANDOVER MA. 01845 Property Address ALBACADO 1755 LTD. PARTNERSHIP C/O BARBARA TOMKINS, P.O. BOX 334 Owner Owner's Name information is NORTH ANDOVER MA. 01845 2/2/16 required for everyState Zip Code Date of Inspection page. City/Town 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? stem received normal flows in the previous two week period? ® ❑ Has the system ❑ ® 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. I ® ❑ 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)] i D. System Information Residential Flow Conditions: i Number of bedrooms(design): Number of bedrooms(actual): DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): t5ins•3113 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments w. 45 BEECHWOOD DR. NORTH ANDOVER MA. 01845 Property Address ALBACADO 1755 LTD. PARTNERSHIP C/O BARBARA TOMKINS, P_O. BOX 334 Owner Owner's Name information is NORTH ANDOVER MA. 01845 2/2/16 required for every page. Citylrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: Does residence have a garbage grinder? ❑ Yes ❑ No Is laundry on a separate sewage system?(Include laundry system inspection El Yes ❑ No information in this report.) 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: Date Commercial/Industrial Flow Conditions: Type of Establishment: OFFICE/MANUFACTURING Design flow(based on 310 CMR 15.203): 1350 GALLONS PER DAY Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): 75GAL/1000 S.F. X 10,000 S.F. +40 PERSON X 15 GAUDAY= 1350 G/P/D 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: 679,184 TOTAL= 930.38 GAL.PER.DAY t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 45 BEECHWOOD DR. NORTH ANDOVER MA. 01845 Property Address ALBACADO 1755 LTD. PARTNERSHIP C/O BARBARA TOMKINS, P.O. BOX 334 Owner Owners Name information is required for every NORTH ANDOVER MA. 01845 2/2/16 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: OCCUPIED Date Other(describe below): General Information Pumping Records: Source of information: LAST PUMPED 1/16 INFO. FROM PLANT WORKER 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): 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 45 BEECHWOOD DR. NORTH ANDOVER MA. 01845 Property Address ALBACADO 1755 LTD. PARTNERSHIP C/O BARBARA TOMKINS, P.O. BOX 334 Owner Owner's Name information is required for every NORTH ANDOVER MA. 01845 2/2/16 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: 20 YEARS OLD, INFO. FROM SYSTEM DESIGN PLANS Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 30"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.): CONDITION OF JOINTS GOOD, PROPER VENTING, NO EVIDENCE OF LEAKAGE. SEWER PIPES LOCATED UNDER CONCRETE SLAB Septic Tank(locate on site plan): Depth below grade: 12"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: 15'X8'6"X7'6"DP. 4000 GAL. Sludge depth: 2" t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 45 BEECHWOOD DR. NORTH ANDOVER MA. 01845 Property Address ALBACADO 1755 LTD. PARTNERSHIP C/O BARBARA TOMKINS, P.O. BOX 334 Owner Owner's Name information is required for every NORTH ANDOVER MA. 01845 2/2/16 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 52" Scum thickness 1" Distance from top of scum to top of outlet tee or baffle 4 Distance from bottom of scum to bottom of outlet tee or baffle 29" How were dimensions determined? MEASURING STICK AND RULER Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): COND. OF INLET AND OUTLET TEES WAS GOOD,STRUCTURAL INTEGRITY APPEARED TO BE GOOD, LIQUID WAS 3"OVER BOTTOM OF OUTLET INVERT, NO EVIDENCE OF LEAKAGE LIQUID WAS 3" UP IN OUTLET PIPE 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 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments w 45 BEECHWOOD DR. NORTH ANDOVER MA. 01845 Property Address ALBACADO 1755 LTD. PARTNERSHIP C/O BARBARA TOMKINS, P.O. BOX 334 Owner Owner's Name information is required for every NORTH ANDOVER MA. 01845 2/2/16 page. CityrFown 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 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System.Page 11 of 17 Commonwealth of Massachusetts ,W u Title 5 Official Inspection Form R Subsurface Sewage Disposal System Form-Not for Voluntary Assessments , 45 BEECHWOOD DR. NORTH ANDOVER MA. 01845 Property Address ALBACADO 1755 LTD. PARTNERSHIP C/O BARBARA TOMKINS, P.O. BOX 334 Owner Owner's Name information is required for every NORTH ANDOVER MA. 01845 2/2/16 page. Citylrown 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 BOX IS FULL 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.): D-BOX WAS FULL, SYSTEM SHOW ALL SIGNS OF HYDRAULIC FAILURE 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.): *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: t5ins-3/13 Title 5 Official Inspection Forth: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 45 BEECHWOOD DR. NORTH ANDOVER MA. 01845 Property Address ALBACADO 1755 LTD. PARTNERSHIP C/O BARBARA TOMKINS, P.O. BOX 334 Owner Owner's Name information is required for every NORTH ANDOVER MA. 01845 2/2/16 page. Citylrown 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 @ 73'X25' ❑ 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.): SANDY/ LOAMY SOIL,SIGNS OF HYDRAULIC FAILURE, NO PONDING, SYSTEM LOCATED ON RIGHT SIDE OF BUILDING UNDER MOWED LAWN 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 Title 5 Official Inspection Form IRV Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 45 BEECHWOOD DR_ NORTH ANDOVER MA. 01845 Property Address ALBACADO 1755 LTD. PARTNERSHIP C/O BARBARA TOMKINS, P.O. BOX 334 Owner Owners Name information is required for every NORTH ANDOVER MA. 01845 2/2/16 page. City(rown 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.): i t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form, Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 45 BEECHWOOD DR. NORTH ANDOVER MA. 01845 Property Address ALBACADO 1755 LTD. PARTNERSHIP C/O BARBARA TOMKINS, P.O. BOX 334 Owner Owner's Name information is required for every NORTH ANDOVER MA. 01845 2/2/16 page. Cityrrown 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 43oe A t5ins.3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 45 BEECHWOOD DR. NORTH ANDOVER MA. 01845 Property Address ALBACADO 1755 LTD. PARTNERSHIP C/O BARBARA TOMKINS, P.O. BOX 334 Owner Owner's Name information is required for every NORTH ANDOVER MA. 01845 2/2/16 page. Cityfrown 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: APPROX. 9' DP. 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: 9/10/96Date ❑ 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: EL.88.5 NO GROUND WATER, BOTTOM OF LEACH BED EL. = 93.50 INFO. FROM SYSTEM PROFILE DATED 9/10/96 BY CHRICTIANSEN & SERGI Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 45 BEECHWOOD DR. NORTH ANDOVER MA. 01845 Property Address ALBACADO 1755 LTD. PARTNERSHIP C/O BARBARA TOMKINS, P.O. BOX 334 Owner Owner's Name information is required for every NORTH ANDOVER MA_ 01845 2/2/16 page. Citylrown 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 t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENERGY & ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION NORTHEAST REGIONAL OFFICE 205B Lowell Street, Wilmington, MA 01887 • (978) 694-3200 DEVAL L. PATRICK IAN A. BOWLES Governor Secretary TIMOTHY P. MURRAY ARLEEN O'DONNELL Lieutenant Governor Commissioner APR 20 2007 Mr. James Roberts RE: Final Approval of LPA for L-com Connectivity Products Non-Fuel Emissions 45 Beechwood Drive L-com Connectivity Products North Andover, Massachusett-s-8 -84 1755 Osgood Street RECEIVED North Andover, MA 01845 Transmittal No. W125509 APR 2 6 2007 Application No. MBR-07-IND-003 TOWN OF NORTH ANDOVER HEALTH DEPARTMENT Dear Mr. Roberts: The Metropolitan Boston/Northeast Regional Office of the Department of Environmental Protection (MassDEP), Bureau of Waste Prevention has determined that the referenced Limited Plan Application ("LPA") is administratively complete and in conformance with current air pollution control engineering practices. MassDEP approves the referenced LPA authorizing the installation and operation of a Vertical Injection Molding Machine at the subject facility. Included as part of the LPA Approval are the following: Stamped.approved BWP AQ 01-B Application form, General Conditions for Non-Fuel Emission LPAs, Special Conditions,and Appeal Rights. Please review the entire LPA Approval carefully as it stipulates the particular conditions to which the facility owner/operator must adhere for the facility to be constructed/reconstructed/altered and operated in compliance with the Regulations. MassDEP has determined that the filing of an Environmental Notification Form ("ENF") with the Secretary of Environmental Affairs, for air quality purposes, was not required prior to this action by MassDEP. Notwithstanding this determination, the Massachusetts Environmental Policy Act and Regulation 301 CMR 11.00, section 11.04, provide certain "Fail-Safe Provisions" which This information is available in alternate format.Call Donald M.Gomes,ADA Coordinator at 617-556-1057.TDD Service-1-800-298-2207. http://www.mass.gov/dep.Fax(978)694-3499 �� Printed on Recycled Paper L-com Connectivity Products MBR-07-IND-003 Transmittal No.W125509 Page 2 of 5 allow the Secretary to require the filing of an ENF and/or Environmental Impact Report at a later time. Should you have any questions concerning this Approval,please contact Mr. Dhiraj Desai at (978) 694-3282. Very truly yours, i Dhiraj B. De6i es E. Belsky Environmental Engineer renrmit Chief Bureau of Waste Prevention eau of Waste evention I I i cc: Board of Health,Town Building,North Andover, MA 01845 Fire Headquarters, 124 Main Street,North Andover,MA 01845 DEPBWP,E-Copy,Attn: Yi Tian DEP/NERO, T. Parks, M. Persky, D. Desai Attachment: BWP AQ 01-B LPA This information is available in alternate format by calling our ADA Coordinator at(617)574-6872. DEP on the World Wide Web: http://www.magnet.state.ma.us/dep 10 Printed on Recycled Paper L-com Connectivity Products MBR-07-IND-003 Transmittal No. W125509 Page 3 of 5. GENERAL CONDITIONS FOR NON-FUEL EMISSION LPAs 1. Operation - No person shall operate a facility constructed, substantially reconstructed, or altered pursuant to 310 CMR 7.02 except in conformance with the requirements established therein and in conformance with the specific written plan approval requirements. 2. Record keeping - The facility owner/operator shall establish and continue an on-site recording system. All records shall be maintained up-to-date such that year-to-date information is readily available for MassDEP examination. Record keeping shall, at a minimum, include: a) -The initiation and completion dates for the proposed construction /reconstruction/ alteration. b) Malfunctions. A record of all malfunctions including, at a minimum: the date and time the malfunction occurred; a description of the malfunction and the corrective action taken; the date and time corrective actions were initiated; and the date and time corrective actions were completed and the facility returned to compliance. C) Records shall be maintained documenting the air contaminant emission analysis supporting the response to B WP AQ 01-B Section-E items 1 a, 1 b and 2. d) All records shall be kept on site for five (5) years from date of record and shall be made available to the MassDEP upon request. 3. The Regional Bureau of Waste Prevention office must be notified by telephone or fax as soon as possible after the occurrence of any upsets or malfunctions to the facility equipment, air pollution control equipment, or monitoring equipment which result in an excess emission to the air and a condition of air pollution. 4. The MassDEP must be notified in writing within 30 days of commencement of construction and completion of the approved installation. 5. The MassDEP may revoke, in accordance with 310 CMR 7.02(3)(k), any plan approval if the actual construction has not begun within two years from the date of issuance or if, during the construction,the construction is suspended for the period of one year or more. 6. Reporting - Any construction, substantial reconstruction or alteration, as described in 310 CMR 7.02, at a facility subject to the reporting requirements of 310 CMR 7.12, shall be reported to the MassDEP on the next required source registration. 7. This approval may be suspended,modified, or revoked by the MassDEP if, at any time, the MassDEP determines that the facility is violating,any condition or part of this LPA Approval. The MassDEP shall be notified in writing prior to any modification of the This information is available in alternate format by calling our ADA Coordinator at(617)574-6872. DEP on the World,�Wide Web: http://www.magnet.state.ma.us/dep . C� Printed on Recycled Paper v v L-com Connectivity Products MBR-07-IND-003 Transmittal No.W125509 Page 4 of 5 facility such as a change in raw materials or an increase in production capacity, which may increase emissions. 8. Noise from the facility during construction, initial start-up and routine operation, including start-ups and shutdowns, shall not exceed the MassDEP noise guidelines and shall not cause a condition of air pollution as defined in 310 CMR 7.01 and 7.10. 9. The facility shall be constructed and operated in a manner to prevent the occurrence of dust or odor conditions, which may cause or contribute to a condition of air pollution as defined in 310 CMR 7.01 and 7.09. 10. This Final Approval does not negate the responsibility of owner/operator of-the referenced facility to comply with this or any other applicable federal, state, or local regulations now or in the future. Nor does this approval imply compliance with any other applicable federal, state or local regulation now or in the future. 11. Should asbestos removal and/or demolition be required, then said removal or demolition shall be done in full compliance with 310 CMR 7.15 and 310 CMR 7.09. The facility shall notify MassDEP, in writing, at least ten (10) working days in. advance of removing any asbestos or performing any demolition." SPECIAL CONDITIONS L That L-com Connectivity Products shall take immediate steps to abate any nuisance condition(s), including but not limited to visible emissions, noise, and odor, that may be generated by the operation of the subject facility. 2. That L-com Connectivity Products shall limit its facility-wide volatile organic compounds (VOC) emissions, hazardous air pollutants (HAP), and particulate matter (PM) emissions each to a total of no more than 1.0 ton per month and 4.5 tons per rolling 12 month period from the subject processes and shall maintain records on-site to demonstrate compliance with these emissions/limitations. 3. That L-com Connectivity Products shall record the amount of solvent used to clean the machine parts, and the VOC/HAP content of each solvent used each month to calculate the resulting monthly and rolling 12-month facility-wide emissions of VOC/HAP. These records shall be maintained on-site for a minimum of five years and shall be made available for review by MassDEP personnel upon request. 4. That L-com Connectivity Products shall maintain an Environmental Logbook, or equivalent record keeping system, which shall record actions associated with environmental issues and overall emission changes at the facility. The facility shall. record information such as the results of federal, state, or local environmental This information is available inalternate format by calling our ADA Coordinator at(617)574-6872. DEP on the World Wide Web: http://www.magnet.state.ma.us/dep CIO Printed on Recycled Paper L-com Connectivity.Products MBR-07-IND-003 Transmittal No. W125509 Page 5 of 5 inspections; and measures taken to lower overall emissions to the environment (air, solvent waste, etc.). This logbook, or equivalent, shall be made available to MassDEP personnel upon request. 5. That a copy of this Approval letter shall be affixed adjacent to the subject equipment. APPEAL OF APPROVAL This Approval is an action of MassDEP. If you are aggrieved by this action, you may request an adjudicatory hearing. A request for a hearing must be made in writing and postmarked within twenty-one (21) days of the date of issuance of this Approval. Under 310 CMR 1.01(6)(b), the request must state clearly and concisely the facts which are the grounds for the request, and the relief sought. Additionally, the request must state why the Approval is not consistent with applicable laws and regulations. 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 Boston, MA 02211 The request will be dismissed if the filing fee is not paid, unless the appellant is exempt or granted a waiver as described below. The filing fee is not required if the appellant is a city or town (or municipal agency) county, or district of the Commonwealth of Massachusetts, or a municipal housing authority. MassDEP may waive the adjudicatory hearing filing fee for a person who shows that paying the fee will create an undue financial hardship. A person seeking a waiver must file, together with the hearing request as provided above, an affidavit setting forth the facts believed to support the claim of undue financial hardship. This information is available in alternate format by calling our ADA Coordinator at(617)574-6872. DEP on the World Wide Web: http://www.magnet.state.ma.us/dep Printed on Recycled Paper R Massachusetts Department of Environmental Protection Bureau of Waste Prevention —Air Quality W125509 Transmittal Number BWP AQ 01 -B Limited Plan Approval •Application for Non-Fuel Emissions Date Received INSTRUCTIONS A. Description of Project This form is for approval of 1. L-com Connectivity Products 1755 Osgood Street North Andover, MA. construction, substantial Facility Name Location reconstruction or alteration of any 2 General of construction, substantial reconstruction facility which would l description p � , or alteration and exact location within result in an the facility. increase in potential emissions greater than or Installation of a vertical injection molding machine. equal to one ton and less than five tons per 12 month time period of: a. any single criteria contaminant Yuh-Dak (Sox,NO,lead, Manufacturer of affected process equipment* Estimated Maximum Operating Schedule CO,Ozone, Particulates or Y350C 8 VOCs); Model number* Hour/Day or b.any single non- April 6, 2007 5 criteria air Estimated Instillation Date Days/Week contaminant. 96 molding cycles/hour assuming 80%efficiency 48 This form is not to Normal Hourly Production Rate(as%Maximum Hourly Production Rate) Weeks/Year be used for combustion .sources(see form 3. Is the proposed project modifying previously approved equipment? ❑ Yes ® No BWP AQ 01-A). If"Yes", list the previously issued air quality approval(s)for this equipment. Application Number Approval Date For DEP use only Application No I Date Received I Date Assigned B. Air Pollution Control Equipment None j Date 1n Deficiency Type of Air Pollution Control Equipment Date I"Response. Make* Model Number* Reviewer Brief Description Permit: Approved Terminated Decision Date CPA Required: * If undetermined at time of application, indicate probable unit"or equliviant". Specific make and Yes No model must be provided prior to final approval. ag0103a•rev.7/03 AQ 01-B•Page 1 of 4 A• - Massachusetts Department of Environmental Protection Bureau of Waste Prevention —Air Quality W125509 BWP AQ 01 -B Transmittal Number Limited Plan Approval•Application for Non-Fuel Emissions Date Received C. Potential Annual Emissions POTENTIAL EMISSIONS are calculated from the maximum capacity of the equipment to emit pollutant under its physical and operational design. Any physical or operational limitation on the capacity of the equipment to emit a pollutant, including air pollution control equipment, restriction on hours of operation, or on the type or amount of material combusted, stored or processed, shall be treated as part of its design only if the limitation is specifically stated in (a) plan approval(s)or if the facility proposed to incorporate such a restriction into this current Plan Approval. Fugitive emissions, to the extent quantifiable, are included in determining the potential emissions. Unless otherwise documented,potential emissions shall be based on 8,760 hours per year of source operation. Provide the potential emissions for each pollutant in this section and show calculations, assumptions and restrictions used in section D. I Pounds Description of Control er year Pounds per Pounds per Description of air control pEfficiency (after year(after year(after contamination source (percent control) control) equipment control) by weight) sox NOx Particulate 1. V..O.C.s NONE 9,000. 2. Total HAP NONE 9,000 3. Total Particulate Matter NONE 9,000 . 4. i Total potential annual emissions after control Pounds per Stack or Pounds Pounds year(after vent Pounds per per year per year control)other year(after (after (after pollutants Number control)VOC control) . control) (give Circle new HOC Lead chemical (N)or name) Modified(M) 1. (continued) ❑ N ❑ M. 2. (continued) [-I N E] M 3. (continued) ❑ N ❑_M I . 4. (continued) [:1 N M Total potential annual emissions after control ag0103a•rev.7/03 AQ 01-B•Page 2 of 4 FROM 41-COM INC FAX NO. :9786856467 Apr. 18 2007 04:22PM P3 �7 Massachusetts Department of Environmental Protection Bureau of Waste prevention —Air Quality W125509 Transmittal Number i r BWP. AQ01 -B Limited PlaApproval•Application for Non-Fuel Emissions Date Received D.- Detailed Emission Calculations Use the space' -provided below to show the assumptions and the arithmetic used to calculate the Potential Annual Emissions you have estimated for this facility,and.how the increase of less then five ton*ear was calculated. (Attach separate sheets if necessary.) Assumptions regarding volume of emissions was determined through conversation with Mung Wong. It is believed that emissions will be much lower than stated on this form as the total weight of resin that will be processed in this facility would be less then 9,000 pounds.The company's plan is to build odd length cable assemblies and customs.The primary location for this type of production activity is in China. E. Miscellaneous 1. is this project subject to: Yes No a. Appendix A—Nonattainment review 310 CMR 7.00? ❑ b. Prevention of significant Deterioration Permit(PSD), 40 CFR 52.21? Note:PSD applications are filed with the U.S.Environmental Protection Agency(EPA). c. New Source Performance Standards,40 CFR 60? ❑ If yes,which part d. National Emissions Standards for Hazardous Air Pollutants(NESHAPS), • 40 CFR 61? If yes,which.subpart e. Maximum Achievable Control Technology(MACT),40 CFR 63? ❑ If yes,which subpart .2. Was netting used to avoid review under 310 CMR 7.00 Appendix A or CFR El Note:PSD questions should be directed to EPA. 3. Does the proposed project meet the requirements of Best Available Control Technology(BACT), as required? Brief description AQ 01-B•Page 3of4 ag0103a•i ev.7/03 a Massachusetts Department of Environmental Protection Bureau of Waste Prevention _Air Quality W125509 LI Transmittal Number BWP AQ 01 -B Limited Plan Approval•Application for Non-Fuel Emissions Date Received F. Certification The signature below provides the affirmative demonstration pursuant to 310 CMR 7.02(3)that any facility(ies)in Massachusetts, owned or operated by the proponent for this project(or by an entity controlling, controlled by or under common control with such proponent)that is subject to 310 CMR 7.00, et seq., is in compliance with, or on a Department approved compliance schedule to meet, all provisions of 310 CMR 7.00, et seq., and any plan approval, order, notice of noncompliance or permit issued thereunder. This form must be signed by a.responsible official working at the location of the proposed new or modified facility. Even if an agent has been designated to fill out this form, the responsible official must sign it. (Refer to the definition given in 310 CMR 7.00.) certify that have examined the responses provided herein and that to the best of my knowledge they are true and complete. James T. Roberts The space below is reserved for the placement Print name of the Department Approval Stamp Au orized signature (Ygineering Manager Position title L-com Connectivity Products Representing < March 21, 2007 Date VVV a i ag0103a•rev.7/03 AQ 01-B•Page 4o f 4 WGI r.,� �;�e.�ir�k'^ 1Y{ �ar^ aiyt�;yy �.'�i�•_ .ts i7Gtiv{p� ,v wiJ:-�'"l &� 4� r"g( n O AGI cz� Nl iq FORM 11 SOIL EVALUATOR FORM Page I of 3 Date: 0 61 No Commonwealth of Massachusetts Massachusetts Soil SuiOn-site jewa e Disposal Date: ............. Performed By: -TA ff,--t ..H.Coqti-m......................................... 1. Witnessed By: ......5 ....6-WO-A-A V oww's Nam. C140-4ji 1:171 rLacLtMn Address Of (,OT Address.and Loth Telephone!13VC;C1fQ009 01 C-L 41 It "n'."no4t N(jp,(,7p 4"V00")f iii 6'bZ, - 6?3(- Office_Review Repair El --------�1 - Published Soil Survey Available: No ❑ Yes 6.40 Soil Map Unit Ut, .............. ....... Publication Scale Year Published . .... EV cW(V4,4,1 ....................................................................... Drainage Class 0 1 X*vvow......... Soil Limitat ons ..................................... Surficial Geologic Report Available: No 7Yes Year Published Publication Scale ....................................... Geologic Material (Map Unit) .................................................................................... ............................. ................r, -....................... 0 Landform ............................................................................................................... 80 F Ivon 140boF�,,A Flood Insurance Rate Map: 0 t� STH Above 500 year flood boundary No ❑[]Yes SEP Within 500 year flood boundary No [I Yes ❑ 1996 Within 100 year flood boundary No El Yes ❑ WetlandArea: unit) ............................................................................ ............................. National Wetland Inventory Map (map ........................... Wetlands Conservancy Program Map (map unit) Current Water Resource Conditions (USGS): Month ........ Range :Above Normal E]Normal E]Belcm.v Normal ❑ Other References Reviewed: DEP APPROVED FORM-12/07/95 FORM 11 - SOIL EVALUATOR FORM Page 2 of 3 Location Address.or Lot No. [�OT 2 ME CH 00 fll LL ` On-site Review i me: Weather Deep Hole Number / IN. Location (identify on site plan) E Land Use ::::W..O b.bs Slope. (%) 3"..© Surface Stones Vegetationa?IN 011-9-C _ ::..... Landform .... .:.. Position on landscape(sketch on the back) - - Distances from: Open Water Body - feet Drainage way, :.::.. feet Possible Wet-Area. ....:. ........ feet' Property Line . . ..:...... feet Drinking Water;Well ...... .::. feet Other __.:... .............. ::. DEEP OBSERVATION HOLE LOO: Depthtfrom Soil Horizon Soil Texture- Soil Color Soil Other Surface(Inches) (USDA) (Munsell) Mottling (Structure,Stones; Bridle rs, Consistency,'% GveD— 4 i0Yre3/Z FSS- mR,vIf RvQ1S*. 2,o-3(o g W z- ,.36.— FS L �M UIV rO O I f�r1,�GN[.�rt. �aa�✓�n-may. • 2�5H6/4 5y��3 36.— l&0 C,, 5T",17Fi �,t�k ,�►frssiv� S,NC.c i C.wa A49DI 104 (Pots 15LC iQa(.06>a e. 60lbA4 y Parent Material,(geologic) be t ,/tq-S1•f DepthtoSedrock: Depth to Groundwater. Standing Water in the Hole: A1CAJAE Weeping from Pit Face: NG VIL Estimated,Seasonal: High Ground Water: �R DEP APPROVED FORM-12107/95 FORM 11 - SOIL EVALUATOR FORM Page 2of3 Location Address or Lot No. WT Z 6jaJ4 ljo0o 814,4, On-site Review Deep Hole Number 96." .Z Date - ./46 Time:. Weather Location (identify on site plan) _ Land: Use Slope M) 3-b Surface Stones n/0. Vegetation ..I. ....t.;r .�.12z Landform .:.:.:. . ::.. . . . ........:::. . ... ..... Position on landscape (sketch on the back) .::... :.:. Distances from: Open Water Body feet Drainage way. ..:... feet'. Possible Wet Area ..:..........: feet' Property Line .._....:... .. feet Drinking,Water Well ..::..:::::_. :.. feet Other DEER OBSERVATION, HOLELOW Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface,(inches) (USDA) (Munsell) Mottling: (Structure;Stones% Boulders, Consistency, % t7- 4 Aro FSS i 1 .41 - 54- CZ WS Z,sf61¢ 5y-7)3 G3 si'FfAT1Re 5Y6(3 7.Stilf'L5�`d sc,��u waw , �s� MMWh. G Z ice. P10013 iu CoI4414N; S Mbs. w C_�Is S 1.d S jParent Material(geologic) ( /,"T"( ,'SN DepthtoBedrock: > /o Depth to Groundwater:, Standing Water in the Hole: NONE Weeping from Pit Face: /IlUA/°L N Estimated:Seasonal:High Ground Water.: DEP-APPROVED FORM-12107/95: FORM 11 - SOIL EVALUATOR FORINT Pip 2of3 . Location Address or Lot No. LOT Z-,,q rliccyLJ wo On-site Review C .� 2 7 -� Deep Hole Number ! ' ..J Date:.: .� .�5�o Time:.:. . .%. U Weather S�P�m/y .5�:.. Location (identify.on.site plan) _:: .... .:::..::....:::.::.. ..... Land-Use .i.•?.4:v.lqS, ... Slope. (°h) Surface Stones Nv. Vegetation ..:014.0.,. ,.: Landform Position on landscape (sketch on the back) - i , Distances from: Open Water Body feet Drainage way. 5U. feet Possible Wet Area . .. feet' Property Line feet Drinking:.Water Well .... .: . feet Other DEEP OBSERVATION, HOLE BOG. Dept)t.from Soil Horizon: Soil Texture Soil Color Soil Other Surfam(Inches) (USDA) (Munsell) MottQng (Structure,Stones.Go lle)rs, Consistency, °r6 I OW-3t Z- W - G 11A ni l(,kW1 — WoS/L" Aq6ti7 12-00(1 G1=S� 2,S'1S� wa` C FS Z•sm`1¢ W r- M tf-ss(UZI , F(2i,413(4- , t i.anMtcw n.�o l3 � 36 • 5 i lZr�7l1� Z.S''�G J¢ ��N� °F 36— 13 S �Jf4rvhs ��- �(Z G�w�"►- s't ti G � �+�v w4.7 3 /VI�vJ M kREA �uv�C G11AW6i, is Parent Material,(geologic) 0 a(—L-�i+44 DepthtoSedrock: 7 OeattrtQGroundwater, Standing Water in the Hole: /I/f7 Weeping from Pit Face: 11/U Estimated-Seasonal, High-*Ground Water. 4 (SA-14M(xX9 i_ DEP APPROVED FORM- 12/07/95 f FORM 11 - SOIL EVALUATOR FORM Page 2of3 Location Address or Lot 1�(0. LOT- On-site Review Weather STjN✓vIf uJ... Deep Hole-Number `�4--4' Date:..:..u.. ::�..�16 Mme:.: ..:...... .. Location (identifyon.site plan) :.:..::.......... Land Use .:::a�JOc.iQ :.. Slope (%) 3 '� Surface Stones Vegetation �1..�4Kr, .:..:..... . �7 � Landform ..:...::::054,1 . :.::fX.:. ... . . .. .:::.:... . ..... .::..... Position on landscape(sketch on the back) ..::,:..: :: : Distances from: Open Water Body feet Drainage way.. :. .....:. - feet Possible Wet Area . .. __. feet' Property Line :............... feet Drinking.Water Well feet- Other DEEP OBSERVATION= HOLE —! QG` Depth from Soil Horizon Soil Texture-- Soil Color Soil. Other Surtacen(inches) (USDA) (Munsefl) Mottling: (Structure.Stones.Go lleders, Consistency, 0/a, FSC (044,31 Z :.�cw�L, irrrv7,l1N Yfao C3. 3 Ct M1 ib 33 s mos a�.J �,Stit 6 J4- I,�vv7S "N �oYIG5�6 fel MINIMUM Ut-2-HOLES RECIUIRED AT-EVERY PROPOSED DISP05AL AREA Parenr Material-(geologic) 0"Pills" DepthtoBedrock: DepttrtoGroundwater, Standing Water in the Hole: /I/�. Weeping from Pit- Estimated- Seasonat High Ground: Water: l: k DEP'APPROVED FORM-12/07/95 • I F NORM 11 - SOIL L:VALUATOR FORM Page 3 of 3 Location Address or Lot No. W, f 4A 13EAF-CA WOu!2 /-11L-6 Determination ,dor Seasonal High Water Table I Method Used: ❑ Depth observed standing in observation hole.................. inches ❑ Depth weeping from side of observation hole ............ ... inches Depth to soil mottles ;.5¢ inches F. ❑ Ground water adjustment ................... feet Index Well Number .................. Reading Date ................... Index well level ................... Adjustment factor ................... Adjusted ground water level ............................................:....... .. Depth of Naturally Occurrin4 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? Y>✓.S If not, what is the depth of naturally occurring pervious material? Certification I certify that on tQ&& (date) I have passed the soil evaluator examination approved by the Deptirtment 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 til DEP APPROVED FORM-12/07/95 n FORM 12 - PERCOLATION TEST Location Address or Lot No. (,pT Z!9 3CK(,.lOuvJ (-{ICAC. COMMONWEALTH OF MASSACHUSETTS Massachusetts Percolation Test* Date: . .: g 1-7Time..... Observation Hole #. �. 3 Depth of Perc 1( Start Pre-soak End Pre-soak f ; 2 ;4A Time at 12" 13 Time at 9" ( ZZ- ! Z l Z; !3 ;¢y' Time at 6" / Time (9"-6") 4 SSC 2-4 5'6C Rate Min./Inch G Z M� ,v�!^/ Z ���✓ j�✓ * Minimum of 1 percolation test must be performed in both the primary area AND reserve area. Site Passed a Site Failed ❑ ....................................................................................................................................._.._......_........ Performed By: )pn/15 C. �`c�oiyi✓r�C.L I Witnessed By: iYhqkA_ Comments: _ .:::.. DEP APPROVED FORM-12/07/95 ,1 -- _ Form No.4 I -- Town of North Andover, Massachusetts BOARD OF HEALTH 19 97 . CERTIFICATE OF COMPLIANCE This is to certify that the Individual Soil Absorption Sewage Disposal System constructed (x ) or repaired ( ) by Peter Breen INSTALLER at 1755 Osgood Street SITE LOCATION has been installed in accordance with Board of Health Regulations as described in the Design Approval Site System Permit No. 863' dated Sept- _ 1 2 , 19 96 The issuance of this certificate shall not be construed as a guarantee that the system will function satisfactorily. BOARD OF HEALTH t F N°RThI Town of dover No. e- CONrr CONSTRUCTION � ioce_ LAKE' i �• b_ m� dover, Mass., 7 19 AIC11 HEWICK 0 A'0 PFoodBOARD OF HEALTH /Kitchen N, ER, MIT T Septic SysteM THIS CERTIFIES THAT .�.�..� ��}.T..�..r.�.,;�..r.-........... c..�..��C.('®. ...............:...........:.:................................ BUILDING INSPECTOR Foundation has permission to erect..........:...�11/..........:............. buildings on......................:.............................:............. .........:.......:........... g � Rough p (j),47/ig� t0 be OCCUpled aS.:... ................:.:.:....:... : : ..:.....: : : ...... : : ........................... Chimney ` provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUM ING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. � PERMEXPIRES IN 6 MONTHS Final IT UNLESS CONSTRUCTION STARTS ELECTRICAL INSPECTORi (/ .........:....................................................................................................... Service BUILDING INSPECTOR r�t Q►—) Occupancy Permit Required to OCCLt Building GAS INSPECTOR �-(, U ' s Place on the Premises — Do Not Remove Rough Display-m a Conspicuou Final No; Lathing or Dry,,*'I[To Be Done FIRE DEPARTMENT � ove ',r y` he Building Inspector. Until Inspected; a'"d Apprt , I i` a w Burner Street No. Smoke Det. N1ORT Toof - ' _ 9 over No. ®� P LANE dower, Mass., oZ -1914 ° - A C O CMICMEW IC K L`�",�• �y �G BOARD OF HEALTH PERM. IT -, T Food/Kitchen Septic System //�7 �� Clew 18h��0 U 11�� + A r 1�(! �u� BUILDING INSPECTOR 1 l �1 THISCERTIFIES THAT .1, .:. ........................................ ..................,t. .............................�......,T.............}�.�.......... Foundation n"t r P..l'�.... b ........ buildings on �(iT o�A.� .1.. .�!.c.h.w ..... 1.V'�. Rough w to� 1.°O O.p.... 'f. . �f I = .N� ly� �o , � ..{ a . 0���� Chimney provided that the person accepting this permrt shall in every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough cd &J*Vfto ` PERMIT EXPIRES IN 6 MONTHS Final • ELECTRICAL INSPECTOR Com jbA p�`,+j;AJNLESS CONSTRUCTION TARTS Rough g 4t ^ N ....................................................... Service v P L `,4 i--e 6 BUILDING INSPECTOR Final Occupancy Permit Required t0 Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove Rough Final No Lathing or Dry Wall To BeDone FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Cr 0 I CQ S+ r V 4 11 O Street No. Smoke Det. ®