HomeMy WebLinkAboutMiscellaneous - 45 BRIDGES LANE 4/30/2018 45 BRIDGES LANE e -
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-O'Town of North Andover ` f NORTH
OFFICE OF
COMMUNITY DEVELOPMENT AND SERVICES 41
27 Charles Street
North Andover,Massachusetts 01845 ''ice•^°' <�''
WU11AM J.SCOTT ss�cMueE
Director
(978)688-9531 Fax(978)688-9542
October 21, 1998
Laura Lesch
45 Bridges Lane
North Andover,MA 01845
RE. Title 5 inspection
Dear Ms.Lesch_
The Health Department has received a copy of your recent Title 5 inspection indicating that your
system conditionally passes the inspection with approval of the Board of Health. Once your leaking septic
tank has been replaced,the system should fully pass the Title 5 inspection. Please contract with a North
Andover Licensed Septic installer to apply for a permit and replace your tank. A fist is enclosed for your
use.
If you have any questions,please feel free to call the office at the number below.
Sincerely,
Sandra Starr,RS.
Health Administrator
BOARD OF"PF.AU b88-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH ""540 PLANNING 699.9535
* +
-\ COMMON«'EALTH OF MASSACHUSETTS
L EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
DEPARTMENT OF ENVIRONMENTAL PROTECTION
ONE WINTER STREET. BOSTON. ?.IA 03108 6117-292-5560
TRUDY COXE
WILLIAM WELD
Govcmo: ,Q Scactan
ARGEO PAUL CELLUCCI DAVID B.STRUHS
Lt.Governor' SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Commissioner
PART A
CERTIFICATION
Property Address• '�rj g/ti 0e C-s /lt, Address of Owner:
Dale of Inspection: y ,3�8 a 10130`QS (If different)
Name of Inspector: BE4JAMIN `C. OSGOOD JR.
I am z DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.0001
Company Name: NEW ENGLAND ENGINEERING SERVICES, INC.
Mailing Address: 33 WALKER ROAD, NORTH ANDOVER, MA 01845
Telephone Number: 508-686-1768
CERTIFICATION STATEMENT
I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true•accurate
and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper funalon and
maintenance of on-site sewage disposal systems. The system:
asses
&ndrUonalk Passes )
Needs Further Evaluation By the Local Approving Authority
Fails
Inspector's Signature: Date: 10ZSA
AV I IF
The System inspector shall submit a copy of this inspection report to the Approving Authority twithin thirty (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 Department of Environmental Protection. The original should be sent to the system owner
and copies sent to the bgyer, if applicable. and the approving authority 1
INSPECTION SUMMARY: Check A, 8, C, or D:
AI SYSTE PASSES:
71 have not found any information which indicates that the syiten:violates any of the failure c::te::a as d=fined in 310 MR 15.303.
Any failure criteria not evaluated are indicated below.
COMMENTS:
81 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.
Indicate yes, no, or not determined (Y. N.or ND). Deserve basis of determination in L(1 instances; If-not determined-, explain why not.
_ The septic tank is metal, unless the owner or operator has provided the system inspcctdr with a copy of a Certificate of
Compliance (attached) indicating that the tank was installed within twenty(201 years prior to the date of the inspection; or
the septic tank, whether or not metal, is cracked, structurally unsound, shows substantial infiltration or c4litr2tion, or tank
failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforrning septic tank
as approved by the Board of Health.
y s e .•. �sy. yr 4 n o r
r 'r a. jy.x
SUBSURFACE SEWAGE DISPOSAC SYSTEM INSPECTION FORM '
PART A :7„t
CERTIFICATION (continued)
Property Address: fa j g r•i CS hunk N. /g. j
V cZ
Owner: t!.4 u/Yx esG f y
Dale of Inspection:
B) SYSTEM CONDITIONALLY PASSES(continued)
Sewage backup or breakout or high static water level observed in the distribution box is due to brokett or obstructed
pipe(s) or due to a broken. settled or uneven distribution box. The system will pass inspection ifIvAth approval of the
Board of Health). Describe observations:
broken pipe(s) are replaced
obstruction is removed
distribution box is levelled or replaced
The system required pumping more than four times a year due to broken or obstructed pipe(sl. The system will pass
inspection if(with approval of the Board of Health):
r broken pipe(s) are replaces
cbstruction is removed
Cl FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH:
Conditions exist which require further evaluation by the Board of Health in order to determine i(the system.0 failing to protect the
public health. safety and the environment:
t) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER
WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONOENT:
Cesspool or privy is within 50 feet of a surface water
Cesspool or prr.,•is within 50 feet of a bordering vegetated wetland or a salt marsh.
2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE) DETERMINES THAT
THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE
ENVIRONMENT: t
The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet to a surface water supply or
tributary to a surface water supply. I '
The system has a septic tank and soil absorption system and the SAS is within a Zone I of a public water supply well•
The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water Supply well.
_ The system has a septic tank and soil.absorption system and the SAS is less than 100 feet but 50 feet or more from a
private water supply well. unless a well water analysis for coliform bacteria and volatile organic compounds indicates that
the well is free irom pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or
less than 5 ppm. method used to determine distance (approximation not valid).
3) OTHER
(c.�i•.d oa/)S/f7I ►.q. 2 or 10
rl
A
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM `{
PART A
CERTIFICATION (continued)
Property Address: '/S f,3/i saes "V. /,vo a✓cit.
Owner. 1a,./)r, )--G 5G
Date of Inspection: t `'
D) SYSTEM FAILS:
You must indicate either `Yes-or'No"as to each of the following:
I have determined that the system violates one or more of the (61lowing failure criteria as defined in 310 CMR 15.303. The basis
for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to con=':`,:,.,
the failure.
Yes No
Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool.
Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or
cesspool
Static liquid levet ,n the distribution boa above outlet invert due to an overloaded or clogged SAS or cesspool.
Liquid depth ,n cesspool is less than 6' below invert or available volume is less than 1/2 day flow.
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 Soil Absorption System, cesspool or privy is below the high groundwater elevation.
Am•portion of a cesspool or privy is within 100 feet of a surface'water supply or tributary to a suriace water supply.
_ Any pomon of a cesspool or privy is within a Zone I of a public well. 1
Any portion of a cesspool or privy is within 50 feet of a private water supply well
Am•portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no
acceptable water quality analysis. If the well has been analyzed to be acceptable, attach copy of well water analysis for
colriorm bactgria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen.
E)LARGE SYSTEM FAILS: I I
You must indicate either-Yes-or-No'as to each of the following:
The iollowing criteria apply to large systems in addition to the criteria above:
The system serves a facility with a design (low of 10,000 go or greater (Large System) and the system is a significant threat to
public health and saiety and the environment because one or more of the following conditions exist:
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)
The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program
requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of ik-Department for further information.
(revised o4/3s/9ii Page 3 or 20
W�Yiy�rj; G
VT
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECffON FORM
PART B
CHECKLIST s
Property Address: IS— y3,•; S -�•nC, N• &JO U C11-
Owner. o��
Date of Inspection: sc k
91a1�a s tol3a ��� -
Check if the following have been done:You must indicate either "Yes"or-No"as to each-of the following:
Yes, No
Pumping information was provided by the owner•occupant, or Board of Health.
_ None of the system components have been pumped for at least two weeks and the system has been receiving normal
flow rates during that period. Large volumes of water have not been introduced into the system recently or
as pan of this inspection,
As built plans have been obtairted and examined. Note .f they are not availab)e with N/A.
J _ The facility or dwelling was inspected (or signs of sewage back-up.
_✓ _ The system does not recFive non-sanitary or industrial waste flow.
The site was inspected for signs of breakout. /
_ All system components. excluding the Sod Absorption System. have been located on the site.
The septic tank manholq were uncovered. opened. and the interior of the septic tank was in{petted for condition of
baitles or tees.material of construction. dimensions. depth of liquid,depth of sludge,depth of scum.
The size and location of the Soil Absorption System on the site has been determined based on:
The facility owner(and occupants. if different irom owner were provided with information on the proper maintenance of
Sub•Sudace Disposal System.
/ Existing information. Ex.rPlan at B.O.H. t
in in field(if any (t failure criteria related to Part C is at issue approximation of distance is
Determined the e . o he ,
unacceptable) (15.302(31(bll I
(r.vi..d O!/71/f71 P.q. ! or 30
• . ,-'�["'Es'`- $-. � ,+y \� f... �orf•' III
at
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION-FORM
PART C
.t
SYSTEM INFORMATION
Property Address:
Owner. 1.st✓.w `.cs c w;
Date of Inspection:
9 f 3 �9 8_ t o�3b '48 •-�'�`�
FLOW CONDITIONS =
RESIDENTIAL:
Design flow g.p,dJbedroom for S.A.S '
Number of bedrooms: ='
Number of current residents:, -
Garbage gnc.der(yes or no!: LA
Laundry connected to system (yes or no): �(
Seasonal use (yes or no): A/
Water meter readings, if available (last two (2) year usage tgpd):
.Sump Pump (yes or no):��
Last date of occupancy:LC✓C
COMM ERCIAUINDUSTRIAL:
Type of establishment:
Design f)ow: pIlons/day
Grease trap present: (yes or no)_
Industrial Waste Holding Tank present: (yes or no]_
Non-sanitary waste discharged to the Title:5 system•(yes or no)_
Water meter readings, if available•
last date of o:cupanq-
) t
OTHER- (Describe)
Lau date of occupancy.
GENERAL INFORMATION
PUMPING RECORDS and source of iniormanon
6me-e. 3 o.^ q , ec"s Ron
System pumped as part of inspection: (y or no)-"
If yes,volume pumped: Ball s I
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)
VA Technology etc. Copy of up to date contract(
Other
APPROXIMATE AGE of all components, date installed (if known) and source of information: /„? i�, 5- ,e C/` Ov✓rle�'L
Sewage odors detected when arriving at the site: (yes or no)
• i .
(r•vi&•d 04/2S/97) t•V• 5 Of 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C zy.
SYSTEM INFORMATION (continued)
Property Address: Bre 1 [ /V, e1 cY 06,1
Owner: /7
Dale of Inspection: /.a✓erx Gsc�
Q1�319r°�
BUILDING SEWER:
(Locate on site plan)
Depth below gr2de:J3L� /'
Material of construction: _cast iron V 40 PVC_other(explain)
Distance from private water supply well or suction lire- IVA —
Diameter
Comments: (condition of joints, venting, evident of leakage, etc.)
ec /r»L� C �
SEPTIC TANK:_
(locate on site plant
4
Depth below grader
Material of construction: concrete _metal _Fiberglass _Polyethylene _othedexplain)
If tank is metal, list age _ Is age confirmed by Cendicate of Compliance _(Yes/Nol ,
Dimensions: /v6-00
Sludge depth: 0
Distance from top of sludge to bottom of outlet tee or baiflle:-3Z t
Scum thickness:,_
Distance from top of scum to top of outlet tee or baffle: JDc/
Distance from bottom of scum to bottom of outlet tee or bafile: /f`r
How dimensions were determined: mccu c/,4 Sr[cK
Comments:
(recommendation for pumping, condition of inlet and outle tees or baffles, depth of liquid level in relation to outlet invert, stru u 1
int riry, evidence of leakage, etc.! O o eQ ✓r' ��
e� Ccs
GREASE TRAP:/
(locate on site plan)
Depth below grade:
Material of construction: _concrete _metal _Fiberglass _Polyethylene —other(explain)
Dimensions:
Scum thickness:
Distance from top of scum to top of outlet tee or baffle:
Distance from bottom of scum to bottom of outlet tee or baffle:
Date of last pumping:
Comments:
(recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural
integrity, evidence of leakage, etc.)
(r-vio.d 04/2S/11) y�9. 9 or 10
x � �
i V
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM "t
PART C
SYSTEM INFORMATION (continued)
Property Address: 1J5- �ri c��cs �-a.t� N'•• r9•.. o ve
Owner:
Date of Inspection: J av c'
77/ 5
TIGHT OR HOLDING TANK:.dLZ7 s7ank must be pumped prior to,or at time,of inspection) '
gocate on site plan)
Depth below grade: <t'
Material o(constructlon: _concrete _metal _Fiberglass _Polyethylene other(explain) `
Dimensions:
Capacity: gallons ,
Design flow gallonJda%
Alarm level Alarm in working order _ Yes. No
Date of previous pumping:
Comments:
(condition of inlet tee, condition of alarm and float switches, etc.)
DISTRIBUTION BOX:_
(locate on site plan)
Depth of liquid level above outlet inven:1
Comments:
(note if level and distribution is equal, evidence of solids carryoLer, evidence of leakage into or out of
box, etc.) W q/cr— le,ell .L
V` ' r/ LL
e✓e/&Zs n
l I i .s of
Q (JC;rrtln�S�cY �Y.r��,t. ?4,-h•[:l �'/J(,9,'rJ•,. l7cs �7cc..,�r�X.
PUMP CHAMBER:". ✓✓•
0ocate on site plan)
Pumps in working order: (Yes or Not
Alarms in working order(Yes or No)
Comments:
(note condition of pump chamber, condition of pumps and appurtenances, etc.)
tr.vi.•d 04/25/971 r.0. 7 or 10
}}
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued) = " q,
PropertyAddress: yN.
Owner.
i--mo rm A4,r. f,
Date of Inspection:
9�aJ49 7%
SOIL ABSORPTION SYSTEM (SAS):_
(locate on site plan, if possible;excavation not required. but may be approximated by non-intrusive methods)
If not determined to be present, explain:
Type:
leaching pits. number:_
leaching chambers. number:_
leaching galleries. number:
leaching trenches. number length:j3 %rC.K S
leaching fields. number. dimensions:_
overflow cesspool. number:
Alternative system:
Name of Technology:
r r r
Comments:
(note condition of soil. signs of hydraulic failure. level of ponding, condition of vegetation. etc.) '
14"cu c F s•rs le e" l oe lis
I
CESSPOOLS:AZ&
(locate on site plan)
Number and configuration
Depth-(op of liquid to inlet invert:
Depth of solids layer: 1 1
Depth of scum layer:
Dimensions of cesspool:
Materials of construction: I I
Indication of groundwater:
inflow(cesspool must be pumped as pan of inspection)
Comments:
(note condition of soil, signs of hydraulic failure• level of ponding, condition of vegetation. etc.)
PRIVY:ALI•
(locate on site plan)
Materials of construction: Dimensions:
Depth of solids:
Comments:
(riote condition of soil. signs of hydraulic failure. level of ponding, condition of vegetation. etc.) _
(r.vi.•d 04/]5/)71 of 10
c 14W8aq 1E 1 f •a <.
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
/1 n �•4f•!L
Property Address: !�S 8rr' f}..cY O.iG/L 'y's °
Owner.
Date of Inspection: ��"
r
' �x r q r•
3 c"t
SKETCH OF SEWAGE DISPOSAL SYSTEM:
F
include ties to at least two permanent references landmarks or benchmarks
locate all wells within 100' (Locate where public water supply comes into house)
Je/
O4P
� f5•S t.
I�•
r
-
1
r �
i
(r—l...d 04/75/971 P.O. 1 of 10
• MR
,_. 4
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C k�
SYSTEM INFORMATION (continued)
Property Address: d n
Owner: «ff<U/////
Date of Inspection:
`✓�` Q /.c SG I.,
� l
Depth to Groundwater Feet :... `
Please indicate all the methods used to determine High Groundwater Elevation:
Obtained from Design Plans on record
Observation of Site (Abuning property obsen•ation hole• basement sump etc.)
Determine it irom local conditions
Check %vith !oca!-Eivard of health
Che6 FEMA Maps
Check pumping records
Check local excavators, installers ,
Use USGS Data
Describe in vour own words how you established the High Groundwater Elevation.!(Mug be completed)
P 5Lt. •o`. 6e,-� Cog
ll
IGS bct/t G✓t-
1 1
(r.vlr.d Ol/]S/!•11 P.p. 10 of 10
O
NEVA/ ENGLAND ENGNIC EERING SERVICES
. 8
September 4, 1998
North Andover Boarc[of Health
Town Hall Annex
384 Osgood Street
North Andover, MA 01845
RE: TITLE V REPORT fA5-Bridges
ane:
Enclosed is a copy of the Title V reportfor45 Bridges Lane,North Andover, MA. The system
Conditionally Passed our inspection.
If there are any questions please call meatmy office, 686-1768.
Sincerely,
Ben'afnin C.C?d7r. E.1.T-J
President
33 WALKER ROAD-SUITE 23-NORTH ANDOVER, MA 01845-(978)686-1768-(888)359-7645-FAX(978)685-1099
CO\41,40'N%VEALTH OF MASSACHUSETTS
�I
Vy EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
DEPARTMENT OF ENVIRONMENTAL PROTECTION
ONE WINTER STREET. BOSTON. ?,IA 0210E 6117-292-$$60
WALUA%t F VELD TRU MY CORE
Govcrlw:
Seactm
ARGEO PAUL CELLUCCI DAVID B.STRUHS
Lt.Govcmor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Commissioner
PART A
CERTIFICATION
Property Address: '4 �jr;cQ�cs 4 a i e, Al. Address of Owner:
Date of Inspection: 9PV3//98 (I( different))
Name of Inspector: B NJAMIN C. OSGOOD JR.
I _r.1 i DEP approved systep
m inspector ursuant to Section 15.340 of Title 5 (310 CMR 15.000)
NEW ENGINEERING SERVICES INC.
Company Name: N ENGLAND ,
Mailing Address: 33 WALKER ROAD, NORTH ANDOVER, MA 01845
Telephone Number: 508-686-1768
CERTIFICATION STATE94ENT
I cenify 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 inspection. The inspection was performed based on my training and experience in the proper function and
maintenance of on-site sewage disposal systems. The system:
_ Lasses
Condttlonalk Passes )
Needs Further Evaluation By the Local Approving Authority
_ Fails
Inspector's Signature: C/ Date: :S
1(/ 47
The Svstem !nspector sh111 submit a copy of th inspection report to the Approving Authority twithin thirty (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 Department of Environmental Protection. The original should be sent to the system owner
approving and copies sent to the btEyer, if applicable. a and the app o g a uthori
h
I •
INSPECTION SUMMARY: Check A, B, C, or D:
Al SYSTEM PASSES:
::t ::a d_fined in 310 CMR 15.303.
- failure � e zs
I have not found any information which indicates that the system violates any of the a
Any failure criteria not evaluated are indicated below.
COMMENTS:
BI SYSTEM CONDITIONALLY PASSES:
,�One or more
Oencs as described in the 'Conditional Pass" section replaced need to be ep d or repaired. The system, upon
system components
completion of the replacement or repair, as approved by the Board of Health, will pass.
Indicate yes. no. or not determined (Y. N. or ND). Desaibe basis of determination in all instances: If-not determined',explain why not.
Thc�septie-tank-ir tnetal;vrtless-tfie-r>wr+er oroperatonifieste-of
Compliance-tattached)-indic2tinohaMhe-tank-vas-instaHcd-wr'�
ithin-rwenty-(0)-Yea 'Of--(04he-date-okhe4 • or
the septic tank, whether or not metal, Is , shows substantial inG4ra6en or exfiltntiOnor MM
faa"fe-44nvninew. The system will pass inspection i(the existing septic tank is replaced with a conforming septic tank
as approved by the Board of Health.
04/7S/971 p�9• I or 10
1VJ l�If
SUBSURFACE SEWAGE DISPOSAL. SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address:
Owner:
Date of Inspection: 'G�
BJ SYSTEM CONDITIONALLY PASSES (continvedl
Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed
pipe(s) or due to a broken, settled or uneven distribution'box. The system will pass inspection if(with approval of the
Board of Health;. Describe observations:
broken pipe(s) are replaced
obstruction is removed
distribution box is levelled or replaced
The system required pumping more than four times a year due to broken or obstructed pipets). The system will pass
inspection if(with approval of the Board of Health):
broken pipets) are replaces
obstruction is removed
C) FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH:
Conditions exist which reautre iunher evaluation by the Board of Health in order to determine if the system it failing to protect the
public health, safety and the environment:
t) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER
WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT:
Cesspool or pri.v is within SO feet of a surface water
Cesspool or prn.1•is within SO feet of a bordering vegetated wetland or a salt marsh.
2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE) DETERMINES THAT
THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE
ENVIRONMENT:
I
The system has a septic tank and soil absorption system (&AS) and the SAS is within 100 feet to a surface water supply or
tributary to a suriace water supply.
The system has a septic tank and soil absorption system and the SAS is within a Zone I of a public water supply well.
The system has a septic tank and soil absorption system and the SAS is within SO feet of a private water supply well.
The system has a septic tank and soil absorption system and the SAS is less than 100 feet but SO feel or more from a
private water supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that
thewell i f it m and nitrate nitrogen is equal to or
e s free o pollution from that facility and the presence of ammonia nitrogen a g
less than S ppm. Method used to determine distance (approximat;on not valid).
3) OTHER
(r.vi•.d Ol/25/77) P•y• 2 or 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A E
CERTIFICATION (continued)
Property Address: �(� �'3 l i cQ�cs 1 te r•[, AA /Inv O-JtA
Owner. a rc.
Date of Inspection:
D) SYSTEM FAILS: ! 6
You must indicate either "Yes- or -No-as to each of the following:
1 have determined that the system violates one or more of the f6llowing failure criteria as defined in 310 CMR 15.303. The basis
for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct
the failure.
Yes No
Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool.
Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or
cesspool
Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool.
Liquid depth In cesspool is less than 6" below invert or available volume is less than 1/2 day flow.
Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s)-
Number of urines pumped _.
Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation
Anv portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a suriace water supply.
• _ Any portion of a cesspool or privy is within a Zone 1 of a public well. t
Am porton of a cesspool or privy is within 50 feet of a private water supply well
Am•portion of a cesspool or privy is less than 100 feet but greater than SO feet from a private water supply well with no
acceptable water quality analysis. If the well has been analyzed to be acceptable, attach copy of well water analysis for
colriorm bactgria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen.
E)LARGE SYSTEM FAILS:
You must indicate either'Yes- or 'No"as to each of the following:
The iollowing criteria apply to large systems in addition to the criteria above:
The system serves a (a6lity with a design flow of 10,000 go or greater (Large System) and the system is a significant threat to
public health and saiety and the environment because one or more of the following conditions exist:
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)
The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program
requirements of 314 CMR 5.00 and 6.00- Please consult the local regional office of the Department for further information.
(rwf..d 04/75/)7) Pay. 3 of 10
`V w u .
• Q Q .�"��---fir
SUBSURFACE SEWAGE DISPOSAL. SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: M,y /�/ S {.i.nt, r✓• H...Qo v
Owner:
Dale of Inspection:
9C31�a -
Check if the following have been done: You must indicate either `Yes-or-No- as to each-of the following:
Yes, No
�L/ Pumping information was provided by the owner, occupant, or Board of Health.
_ None of the system components have been pumped for at least two weeks and the system has been receiving normal
flow rates during that period. Large volumes of water have not been introduced into the system recently or
as pan of this inspection, _
As built plans have been obtained and examined. Note if they are not available with N/A.
J _ The facility or dwelling was inspected for signs of sewage back-up.
_ The system does not recFive non-sanitary or industrial waste flow.
The site was inspected for signs of breakout.
_ All system components. excluding the Soil Absorption System, have been located on the site.
The septic tank manholers were uncovered, opened. and the interior of the septic tank was inlpected for condition of
baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge,depth of scum.
The size and location of the Soil Absorption System on the site has been determined based on:
The facility owner(and occupants, if different irom owners were provided with information on the proper maintenance of
Sub-Surface Disposal System.
/ Existing information. Ex.iPlan at B.O.H. t
_ Determined in the field (if any of the failure criteria related to Part C is at issue,approximation of distance is
unacceptable) (15.302(3)(b))
•q• 4 or 1
o . a
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION-FORM
PART C
SYSTEM INFORMATION
Property Address: '/S !�!i c1c y cs �G, N. 14K
Q
K
Owner:
l-a✓ria l•cs c�+
Date of Inspection:
9t3 �� a
FLOW CONDITIONS
RESIDENTIAL:
Design flow: 7 g.p.dAedroom for S.A.5
Number of bedrooms:,
Number of current residents:-L
Garbage g,,r.der (yes or no): L
Laundry connected to system (yes or no):
Seasonal use (yes or no): IV
Water meter readings, if available (last two (2) year usage (gpd):
Sump Pump (yes or no): A/,
Last date of occupancy: C�eetjj
COMMERCIAUINDUSTRIAL:
Type of establishment:
Design flow: pIlons/day
Grease trap present: (yes or no!_ ,
Industrial Waste Holding Tank present: Ives or no)
Non-sanitary waste discharged to the Title 5 system (yes or no)_
Water meter readings, if available
Last date of o•cupanc%
t t
OTHER: (Describe!
Last date of occupancy.
GENERAL INFORMATION
PUMPING RECORDS and source of information t t
6me-e- 3 y^ q u�Gi.-S Rin
System pumped as part of inspection:e(yesor no)
��
If yes, volume pumped: allo s
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)
VA Technology etc. Copy of up to date contract?
Other
APPROXIMATE AGE of all
components, date installed (if known) and source of information: 7,e c/- e? ,✓e7ee .
Sewage odors detected when arriving at the site: (yes or no) A/0
(revip*d o4/2s/97)
P.V. 5 of 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: !�j i3N.
Owner. )�4� t/
Dale of Inspection:
9j3�y� -
BUILDING SEWER:
(Locate on site plan)
Depth below grade:___�_�
Material of construction: _cast iron 40 PVC—other(explain)
Distance from private water supply well or suction Irry -.1Vj4--
Diameter ljl••
Comments: (condition of joints, /venting, evidence of leakage, etc.) y
Pi rhe /JO tr s {rAcrS� ien G`rYle. Z
SEPTIC TANK:_
(locate on site plant
Depth below grader
Material of construction: Y—/Concrete _metal _Fiberglass _Polyethylene —other(explain)
If tank is metal. lost age _ Is age confirmed by Centfrcate of Compliance _(Yes/No) ,
Dimensions: /,,57-0 C)
Sludge depth: &.1
Distance from top of sludge to bottom of outlet tee or baif<-: Ale 04 t
Scum thickness: D
Distance from top of scum to top of outlet tee or baiile:�D
Distance from bottom of scum to bonom of outlet tee or baffle:
How dimensions were determined. "ecu.:.c tt)ak,
Comments:
(recommendation for pumping, condition of inlet and outletees or baffles, depth of liquid level in relation to outlet invert,struoural
integrity, evidence of leakage, etc.) Ta..A r./cs&I le,)el / be la-- n -He f Tj2 r"
I I
GREASE TRAP:,&/"
(locate on site plan]
Depth below grade:
Material of construction: _concrete _metal _Fiberglass _Polyethylene _other(explain)
Dimensions:
Scum thickness:
Distance from top of scum to top of outlet tee or baffle:
Distance from bottom of scum to bonom of outlet tee or baffle.
Date of last pumping:
Comments:
(recommendation for pumping, condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert, structural
integrity, evidence of leakage, etc.)
(r—i—d Ot/2S/f71 P.q. C or 10
3q•"
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: x-15- ari cQ�c cS 6-a�te N• rT.J0 J e2
Owner:
Date of Inspection: tlav'-� I-esc i,
TIGHT OR HOLDING TANK:Al tl- .Tank must be pumped prior to,or at time,of inspection)
(locate on site plan)
Depth below grade:
Material of construction: _concrete _metal _Fiberglass _Polyethylene —other(explain)
Dimensions:
Capacm: gallons ,
Design f!ow . gallonJda%
Alarm level Alarm in working order _ Yes. _ No
Date of previous pumping:
Comments:
(condition of inlet tee. condition of alarm and float switches. etc.)
DISTRIBUTION BOX:_
(locate on site plan!
Depth of liquid level above outlet invert:
Comments:
(note ii level and distribution 1s equal, evidence of solids carryover, evidence of leakage into or out of box, etc.) 4>!� level
oilrr exp e c Jn �v� s r c( c es c�
v✓
le,elelzs IV f
Q �,m (/in.&LC0 Ck�Sc.�. a1 �'/Js,S, rJ. �i�J vcc �.ri5�.
PUMP CHAMBER:N . (/✓
(locate on site plan
Pumps in working order: (Yes or Not
Alarms in working order (Yes or No)
Comments:
(note condition of pump chamber, condition of pumps and appurtenances, etc.)
(r—i—d 04/25/971 P.Q. 7 of 10
it
O ._.. ...... ......
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address:
Owner:
Dale of Inspection: 9 131
SOIL ABSORPTION SYSTEM (SAS):_
(locate on site plan, if possible; excavation not required• but may be approximated by non-intrusive methods)
If not determined to be present, explain:
Type:
leaching pits. number:_
leaching chambers. number:_
i leaching galleries, number.
leaching trenches, number length: •;' 7-ee.K s `
leaching fields. "umber, dimensions:_
overflow cesspool. number:
Alternative system:
Name of Technology:
Comments: r
(note condition of soil• signs of hydraulic (ailure, level of ponding, condition of vegetation, etc.)
lona of s tis tje rr► )ot'6s ►�Drm�`
• t
CESSPOOLS•N&
(locate on site plan)
Number and configuration
Depth-top of liquid to inlet invert:
Depth of solids layer:
Depth of scum layer:
Dimensions of cesspool:
Materials of construction:
Indication of groundwater:
inflow(cesspool must be pumped as pan of inspection)
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—d 04/3S/17) P.y• ! of 10 III
:.i..
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address:
Owner: cl '
Date of Inspection:
9�3�5
SKETCH OF SEWAGE DISPOSAL SYSTEM:
include ties to at least two permanent references landmarks or benchmarks
locate all wells within 100' (Locate where public water supply comers into house)
f{� >s`'
ell
�1Z� C3
(r•vi••d 04/25/971 P.V. 9 of 10
-'
a a � .
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address:
�GegCi rl +NJ✓!�_
Owner: /v�✓� �/l
Date of Inspection:
Depth to Groundwater Feet
Please indicate all the methods used to determine High Groundwater Elevation:
Obtained from Design Plans on record
""Observation of Site (Abutting property, observation hole• basement sump etc.)
Determine .t irom local conditions
Check .with !oca!'Board of health
Ch
C eci. FEMA Wraps
Check pumping records
Check local excavators, installers
Use USGS Data
Describe 1n your own .words how you established the High Groundwater Elevation)(Must be completed)
t� g P
?(o.0 Ck
t t
- I
(r11..d 04/75/97) D.9. 10 0[ 10
;,--.OMMONWEALTH OF MASSACHUSETTS
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
DEPARTMENT OF EM7IRONMENTAL PROTECTION
•y
I
a
r.�
TITLE 5
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
CERTIFICATION
Property Address: , !'a oe - RECEIVED
0, A d-P f
Owner's Name: knpnia AUG 2 7 2004
Owner's Address:
Date of Inspection: —)7_n TO N OIjH DEPARTM NTER
Name of Inspector: lease print)
Company Name• U
Mailing Address:
Telephone Number: "4-72—W7
CERTIFICATION
—
CERTIFICATION STATEMENT
I certify that I have personally inspected the sewage disposal system at this address and that the information reported
below is true,accurate and complete as of the time of the inspection.The inspection was performed based on my
training and experience in the proper function and maintenance of on site sewage disposal systems.I am a DEP
approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system:
F
Passes
Conditionally Passes
Needs Further Evaluation by the Local Approving Authority
Fails
Inspector's Signature: aw Date: ?-/7'y y
f
The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or
DEP)within 30 days of completing this inspection.If the system is a shared system or has a design flow of 10,000
gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the
DEP.The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving
authority.
Notes and Comments
****This report only describes conditions at the time of inspection and under the conditions of use at that
time.This inspection does not address how the system will perform in the future under the same or different
conditions of use.
Title 5 Inspection Form 6/15/2000 page l
\ � ' �r`
��, _ 1 1
Page 2 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address• (! _ /ri lipnendlo ,
n: -
Owner• 1C-
Date of Inspectio —
Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D
A. System Passes:
a
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:
M
B. System Conditionally Passes: N1A
One or more system components as described in the"Conditional Pass"section need to be replaced or
repaired:The system,upon completion of the replacement or repair,as approved by the Board of health,will pass.
Answer yes,no or not determined(Y,N,ND)in the for the following statements.If"not determined"please
explain.
The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally
unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the
existing tank is replaced with a complying septic tank as approved by the Board of Health.
*A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance
indicating that the tank is less than 20 years old is available.
ND explain:
Observation of sewage backup or break out or high static water level in the distribution box due to broken or
obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if(with
approval of Board of Health):
broken pipes)are replaced
obstruction is removed
distribution box is leveled or replaced
ND explain:
The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will
pass inspection if(with approval of the Board of Health):
broken pipe(s)are replaced
obstruction is removed
ND explain:
2
f <' �
.�_ ,
��'
f f
Page 3 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CER1TIFICATION(continued)
Property Address: rl�kxo'
/1.0•
Owner:_�Ic/')/'
Date of Inspection) — —�
C. Further Evaluation is Required by the Board of Health: ,0
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
2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the
system is functioning in a manner that protects the public health,safety and environment:
_ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a
surface water supply or tributary to a surface water supply.
The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply.
The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well.
_ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a
private water supply well".Method used to determine distance
"This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform
bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and
the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other
failure criteria are triggered.A copy of the analysis must be attached to this form.
3. Other:
3
Page 4 of 11 0 ID
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS `
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address�� ho
Owner:
Date of I spectionrd
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''/z day flow
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 coliform bacteria and volatile organic compomads
indicates that the well is free from pollution from that facility and the presence of ammonia
nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria
are triggered.A copy of the analysis must be attached to this form.]
S (Yes/No)The system fails.I have determined that one or more of the above failure criteria exist as
described in 310 CMR 15.303.therefore the system fails.The system owner should contact the Board of
Health to determine what will be necessary to correct the failure.
E. Large Systems:
To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000
gpd.
You must indicate either"yes"or"no"to4ach of the following:
(The following criteria apply to large systems in addition to the criteria above)
yes no
_ the system is within 400 feet of a surface drinking water supply
_ 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.
4
Page 5 of I 1
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address:: .
Owner•
Date of Inspectied`c -/'7-
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?
/
c� Have large volumes of water been introduced to the system recently or as part of this inspection?
of _ 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:
Yes no
✓ _ 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(3)(b))
5
Page 8 of l 1 0
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: o
Owner. P / _
Date of I spectiow./ —
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/day
Alarm present(yes or no):
Alarm level: Alarm in working order(yes or no):
Date of last pumping:
Comments(condition of alarm and float switches,etc.):
DISTRIBUTION BOX: r S (if present must be opened)(locate on site plan)
Depth of liquid level above outlet invert:J&o t O d T� ->S
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 or no):
Alarms in working order(yes or no):
Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.):
8
Page 9 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C .
SYSTEM INFORMATION(continued)
Property Address: 15 A-1 I
Owner•
Date of I specti� — —
SOIL ABSORPTION SYSTEM(SAS): (locate on site plan,excavation not required)
If SAS not located explain why:
Type a
V leaching pits,number:
leaching chambers,number:
leaching galleries,number:
leaching trenches,number,length:
leaching fields,number,dimensions:
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.):
9i T.5 Lr !jG,D z—E'wa / /GN 46�6en,.f LG/TAl /�iyerrS
S'A4
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 or no):
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.):
9
Page 10 of l l "
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM'INFORMATION(continued)
Property Address: jL�
Owner:
Date of n`spection•
SKETCH OF SEWAGE DISPOSAL SYSTEM
Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or
benchmarks.Locate all wells within 100 feet.Locate where public water supply enters the building.
4 4
6A-) b
6 0
-6/
Ww ell�s !
10
1
Page 11 of 11 J
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address:
Owner:
Date of In pecti — '
SITE EXAM
Slope
Surface water
Check cellar
Shallow wells
Estimated depth to ground water /7 feet "
Please indicate(check)all methods used to determine the high ground water elevation:
41_Obtained from system design plans on record-If checked,date of design plan reviewed: 98 5
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:
fin 7-r/)" e Sy STrtiv �j'a „ �/1a�.,� e-y2,4O z
11
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9
BOARD:,OF HEAL1
NORTH ANDOVER, MASS. 01 5 RECEIVED
978-688-9540
APPLICATION FOR SOIL TES S
AUG 2 4 2004
O DEPATME TH TER
DATE: 4 d MAP&PARCEL:
LOCATION OF SOIL TESTS: �h cICa�2 J- rl 1 h�10 V e C
OWNER t?1 I 1 ()en, 1(a TEL.NO.:
ADDRESS: 'LI `J Bkdr QA k". IUC�
ENGINEER:A)�'U_) i 1 a Idur)( -1 G4( ;-oP7 �EL.NO.: C I pS- L(` (Q - i 7 ud;
CERTIFIED SOIL EVALUATOR:IEnc7Aig C, D&W�, /9KMA-)
Intended use of land: Residential Subdivision Single Family Home Commercial`
Is This:
Repair testing x — Undeveloped lot testing Upgrade for addition
In the Lake Cochichewick Watershed? Yes No
THE FOLLOWING MUST BE INCLUDED WPTH THIS FORM:
1. Proof of land ownership(Tax bill,deed,or letter from owner permitting tests)
2. Plot plan
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$360.00 per lot for repairs or up ades.
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 i
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:
Date Received: Check Amount: Check Date:
RECEIVED
SEp — 3 �Ma
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Page 1 of 1
Dellechiaie, Pamela
From: Dan Ottenheimer[info@millriverconsulting.com]
Sent: Friday, August 27, 2004 11:45 AM
To: Susan Sawyer; amcbrearty@millriverconsulting.com; 'Pamela Dellechiaie'
Subject: soil tests
Sue and Pam,
We are scheduled with NEES for soil testingges Lane nd 121 Raleigh Tavern Lane on Monday
9/13.
Enjoy the nice weather.
Dan
! ll ever
consulting
Daniel Ottenheimer,President
Mill River Consulting
Septic System Management Services
2 Blackburn Center
Gloucester, MA 01930-2259
978-282-0014 or 1-800-377-3044
fax: 978-282-0012
www.millriverconsulting.com
info millriverconsulting.com
8/27/2004
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U PAGE 01
U (tel
FORM it SOIL. EVALUATOR kORN-1
Pale X of 3
/ Date:
No.
Commonwealth of Massachusetts
Massachusetts
oil Suit
abil>' Assessment >Or (fin--site Sewa .Diss 0sczl
pate
B
Performed y.
witnessed By:
Lewconstnuction
AddMI,ona`f`JTelephm/O Repair
Ofriice� ]E____e_view
Published Soil Survey Available'. No Yes Q C
Year Published � �
....... Publication Scale j Soil Map Unit
Drainage Class '�
, � G Soil Limitationsr/ .. .�" 2 '�
Surf`ic'tal Geglogic Itsport Available: No
Yes
Year Published Publication Scale
Geoiogic Material (Map Unit) ...
Landfarrn ..................... ........ ..
Flood Insurance Rate Malt"-
Above 500 year flood boundary No L.1 Yes r&
Within 500 year flood boundary No Oyes ❑
Within 100 year flood boundary No Yes t� 1
Weiland Area:
National Wetland Inventory h'MaP(map unit)
Wetlands Conservancy Prcgf= N%p(map unit)
�,urren
t Water Resource Conditions(USGS): Month�416(/�
Range :Above Normal ONorrnal Normal LJ
Other References Reviewcd: __�_�----------_—
DEp APFRGVED FM)t j•121071S
I
tei:eSrz�Ha: �1.3t ii8:3J:1ei!b r~racar,�r arae; <.�z
FORM 11 - SOIL EVALUATOR FC RIM
Yaffe 2 of 3
Location address or Lot 140.
Ofd-Site ?eyiew
Deepufe NumCer / dare; "�` Time: Weather
Location (identify on site plan) ` T �
Land Use7�411— Slope J%) ( SllrfSCe Stones -�-....,.
vegetation
Landform
Position on landscape
Distances from:
Open Water Sody/ feet Drainage way 's feet
Possible Wet Area /0,1 fecit Property Line feet
Drinkirg Water Well . f feet other
DEEP OBSERVATION MOLE LOG --�'
Death from Soli Horizon -Solt Texture Soil Calor Soil ether
5u'face tlnchE&i ( lUSQAt iMun e0! Mottling !Structure,Stones.Boulders, Consistency, 'p
GravaU it
E
fj mel
�iur i
Parent Material lgtolopie) C�+� rL� Pecthto9adrock:���
Standing "- .....,,�-„� _......_.._____...
Depth to.Groundwater: g Water in the.Nola: Weeping from Pit Face:.
Estimated Seasonal High Groond
DEF APPROVED FORM. IVV I5
FORM 11 SOIL EVALUATOR FORM
Page 2 of 3
Loca!ian Address or ?..ot ,Jo.
On-siteReview
Deep Hnie Number DMc-,. Time: Weather
Location (iai n tify an site plan) f7-= � ''�
Land Used e-.. Slope (°r6? -- surface Stones
vegetativn
Landform ,'", y �.r(r?
Position on landscape
Distances from:
Open Water Body ^`' feet Drainage way ®�' feet
Possible Wet Area feet Property L-ine feet
Drinking Water Well feet Other .
DEEP OBSERVATION HOLE LOG �
Dspih from Soil Horizon Soo Texture Sbll Cobr Soil Other
Surta:e onehes) (US-0Ai (Munsell; Mor!ling (Strucrure.Stones, Boulder;,Consistencv, %
uravell _
l
., /V }
I �/•I�NCI
Parent Material(geologie)
Depth to Groundwater: Standing water in the Hoe; Weeping Eror,~Pit!ace;
r
Estimated Seasonal High Ground Woo:_
VEP APpaatzn FORM 1:107/95
�i512��A;Ki:2I'31 T J �R
178? 3a 115
LxR
. s ,
FORM ll - SOIL LVALVATOR FORM
Page 3 of 3
Location Address or Lot No. �i �� =s ,�xf 4'
Determination or seasonal Hi Water Table
Method Used:
Depth observed standing in observation hole ..... . inches
Depth weeping from side of observation hole-- inches
Depth to soil mottles ...." . inches
[1 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 MI a eas
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 "/, '?�f (date) I have passed the soil evaluator examination
approved by the 17ep r ment of Environmental Protection and that the above analysis
was performed by me consistent with the required training, expertise and experience
described in 310 CMR 1�5..0-17.
Signature,/ Date
a /
DEP APPROVED FORM•12!07/95
I
i
Commonwealth of Massachusetts
City/Town of
u,p Percolation Test
Form 12
Percolation test results must be submitted with the Soil Suitability Assessment for On-site Sewage
Disposal. DEP has provided this form for use by local Boards of Health. Other forms may be used, but
the information must be substantially the same as that provided here. Before using this form, check with
the local Board of Health to determine the form they use.
Important:
WilliA. Site Information
When filling out
forms on the
computer, use Elizabeth Koenig
only the tab key Owner Name
to move your 45 Bridges Lane
cursor-do not Street Address or Lot#
use the return
key. North Andover MA 01845
Cityrrown State Zip Code
tab
Contact Person(if different from Owner) Telephone Number
B. Test Results
9/21/04 9 a.m. 9/22/04 9 a.m.
Date Time Date Time
Observation Hole# PT 1 PT 1
Depth of Perc 36 /20" 36'720"
Start Pre-Soak 9:01 9:08
End Pre-Soak 9:16 9:23
Time at 12" 9:16 9:23
Time at 9" 9:46-9.75" 10:08
Time at 6" 4 hr. Soak Required 11:10
Time (9"-6") 62 min.
Rate (Min./Inch) 25
Test Passed: ❑ Test Passed:
Test Failed: ❑ Test Failed: ❑
Benjamin C. Osgood, Jr., P.E.
Test Performed By:
Andrew McBrearty, Mill River Consulting
Witnessed By:
Comments:
t5form12.doc•06/03 Perc Test•Page 1 of 1
NEW ENGLAND ENGINEERING SERVICES
INC
- RECE
February 14, 2005
F9 ���
Susan Sawyer
North Andover Board of Health
400 Osgood Street
North Andover, MA 01845
Re: 45 Bridges Lane,North Andover
Local Upgrade Approval Form 9A, 9B
Dear Susan:
The following forms are being submitted as requested by your office. Enclosed are the following
documents:
1. (2) Copies of the Form 9A-Application for Local Upgrade Approval.
Z. (2) Copies of the Form 9B-Local Upgrade Approval.
Please contact this office with any questions or concerns.
Sincerel
J
Thomas Hector
Project Engineer
60 BEECHWOOD DRIVE-NORTH ANDOVER,MA 01845-(978)686-1768-(888)359-7645-FAX(978)685-1099 �
i'
Commonwealth of Masspcusetts
1
City/Town of /�/pr.�h over
o Local Upgrade Approval
Form 913
DEP has provided this form for use by local Boards of Health if they choose to do so.
The Local Upgrade Approval is to be completed by the local Board of Health and a signed copy provided
to the system owner. The system owner shall provide a copy of the Local Upgrade Approval to the
appropriate Regional Office of the Department of Environmental Protection, Bureau of Resource
Protection, Title 5 Permitting Program, upon issuance by the local approving authority and before
commencement of construction.
A. Facility Information
Important:
When filling out 1. Facility Name and Address
forms on the
computer, use Beth Koenig
only the tab key Name
to move your 45 Bridges Lane
cursor-do not Street Address
use the return
key. North Andover MA 01845
City/Town State Zip Code
' tab
2. Owner Name and Address (if different from above):
Beth Koenig 29 Berry Patch Lane
Name Street Address
Boxford MA
City/Town State
01921 (978) 561-5007
Zip Code Telephone Number
3. Type of Facility (check all that apply):
® Residential ❑ Institutional ❑ Commercial ❑ School
4. Design flow per 310 CMR 15.203: 440
gpd
New England Engineering
5. System Designer: Name ® PE ElRS
60 Beechwood Drive North Andover 01845
Address City/Town State,ZIP
B. Approval
1. Local Upgrade Approval is granted for:
Reduction in setback(s) —specify:
1. Reduction in offset distance between the leach bed and a foundation wall from 20 feet required by
Title 5, Section 15.211(1) to 9 feet.
2. Reduction in offset distance between the leach bed and a property line from 10 feet required by
Title 5, Section 15.211(1) to 6 feet.
Reduction in SAS area of u to 25%:
❑ p o
SAS size,sq.ft. /o reduction
926 Local Upgrade Approval 45 Bridges Lane, North Andover•rev. Local Upgrade Approval* Page 1 of 2
5/02
0 _J
Commonwealth of Massachusetts
City/Town of
Local Upgrade Approval
Form 913
B. Approval (continued)
❑ Reduction in separation between the SAS and high groundwater:
Separation reduction ft
Percolation rate min./inch
Depth to groundwater ft
❑ Relocation of water supply well (explain):
List local variances granted not requiring DEP approval per 310 CMR 15.412(4):
List variances granted requiring DEP approval:
Approving Authority
Print or Type Name and Title Signature Date
926 Local Upgrade Approval 45 Bridges Lane, North Andover•rev. Local Upgrade Approval, Page 2 of 2
5/02
I
V
Commonwealth oassachusetts
City/Town of
Form 9A - Application for Local Upgrade Approval
1M
DEP has provided this form for use by local Boards of Health. Other forms may be used, but the
information must be substantially the same as that provided here. Before using this form, check with your
local Board of Health to determine the form they use.
Form 9A is to be submitted to the Local Board of Health for the upgrade of a failed or nonconforming
septic system with a design flow of less than 10,000 gpd, where full compliance, as defined in 310 CMR
5.404(1), is not feasible.
310 CMR 15.403(4) requires the system owner to provide a copy of the local upgrade approval to the
appropriate Regional Office of the Department of Environmental Protection, Bureau of Resource
Protection, Title 5 Permitting Program, upon issuance by the local approving authority and before
commencement of construction.
System upgrades that cannot be performed in accordance with 310 CMR 15.404 and 15.405, or in full
compliance with the requirements of 310 CMR 15.000, require a variance pursuant to 310 CMR 15.410
through 15.417.
NOTE: Local upgrade approval shall not be granted for an upgrade proposal that includes the addition of
a new design flow to a cesspool or privy, or the addition of a new design flow above the existing approved
capacity of an on-site system constructed in accordance with either the 1978 Code or 310 CMR 15.000.
A. Facility Information
Important:
When filling out 1. Facility Name and Address:
forms on the
computer,use Beth Koenig
only the tab key Name
to move your 45 Bridges Lane
cursor-do not
use the return Street Address
key. North Andover MA 01845
City/Town State Zip Code
tab
2. Owner Name and Address (if different from above):
Beth Koenig 29 Berry Patch Lane
fe"tl Name Street Address
Boxford MA
City/Town State
01921 (978) 561-5007
Zip Code Telephone Number
3. Type of Facility (check all that apply):
® Residential ❑ Institutional ❑ Commercial ❑ School
4. Describe Facility:
Installation of replacement subsurface swage disposal system.
5. Type of Existing System:
❑ Privy ❑ Cesspool(s) ® Conventional ❑ Other(describe below):
Current residential Y sewage disposal system is in failure.
P
926 Application for Local Upgrade Approval 45 Bridges Lane,North Application for Local Upgrade Approval• Page 1 of 4
Andover•rev.5/02
I
Commonwealth of Massachusetts O
City/Town of
Form 9A - Application for Local Upgrade Approval
' M
DEP has provided this form for use by local Boards of Health. Other forms may be used, but the
information must be substantially the same as that provided here. Before using this form, check with your
local Board of Health to determine the form they use.
A. Facility Information (continued)
6. Type of soil absorption system (trenches, chambers, leach field, pits, etc):
Leach pits.
7. Design Flow per 310 CMR 15.203:
Design flow of existing system: Unknown
gpd
Design flow of proposed upgraded system 440
gpd
Design flow of facility: n/a
gpd
B. Proposed Upgrade of System
1. Proposed upgrade is (check one):
❑ Voluntary ❑ Required by order, letter, etc. (attach copy)
® Required following inspection pursuant to 310 CMR 15.301: 8/17/04
date of inspection
2. Describe the proposed upgrade to the system:
3. Local Upgrade Approval is requested for(check all that apply):
® Reduction in setback(s)—describe reductions:
1. Reduction in offset distance between the leach bed and a foundation wall from 20 feet required by
Title 5, Section 15.211(1)to 9 feet.
2. Reduction in offset distance between the leach bed and a property line from 10 feet required by
Title 5, Section 15.211(1)to 6 feet.
❑ Reduction in SAS area of up to 25%: SAS size,sq.ft. %reduction
❑ Reduction in separation between the SAS and high groundwater:
Separation reduction ft
Percolation rate min./inch
Depth to groundwater ft
926 Application for Local Upgrade Approval 45 Bridges Lane, North Application for Local Upgrade Approval* Page 2 of 4
Andover•rev. 5/02
I
Commonwealthofof Massachusetts O
City/Town of
Form 9A - Application for Local Upgrade Approval
DEP has provided this form for use by local Boards of Health. Other forms may be used, but the
information must be substantially the same as that provided here. Before using this form, check with your
local Board of Health to determine the form they use.
B. Proposed Upgrade of System (continued)
❑ Relocation of water supply well (explain):
❑ Other requirements of 310 CMR 15.000 that cannot be met—describe and specify sections of the
Code:
If the proposed upgrade involves a reduction in the required separation between the bottom of the soil
absorption system and the high groundwater elevation, an Approved Soil Evaluator must determine the
high groundwater elevation pursuant to 310 CMR 15.405(1)(i)(1). The soil evaluator must be a member
or agent of the local approving authority.
High groundwater evaluation determined by:
Andrew McBrearty 9/21/04
Evaluator's Name(type or print) Signature Date of evaluation
C. Explanation
Explain why full compliance, as defined in 310 CMR 15.404(1), is not feasible. (Each section must be
completed)
1. An upgraded system in full compliance with 310 CMR 15.000 is not feasible:
No other location available on the the lot for the system size required
2. An alternative system approved pursuant to 310 CMR 15.283 to 15.288 is not feasible:
A 1500 gallon Micro Fast septic tank is included in the design.
926 Application for Local Upgrade Approval 45 Bridges Lane,North Application for Local Upgrade Approval* Page 3 of 4
Andover•rev. 5/02
CommonwealthQoMassachusetts O
City/Town of
a
Form 9A — Application for Local Upgrade Approval
ly,M
DEP has provided this form for use by local Boards of Health. Other forms may be used, but the
information must be substantially the same as that provided here. Before using this form, check with your
local Board of Health to determine the form they use.
C. Explanation (continued)
3. A shared system is not feasible:
An appropriate area does not exist adjacent to this property.
4. Connection to a public sewer is not feasible:
No sewer available in the area.
5. The Application for Local Upgrade Approval must be accompanied by all of the following (check the
appropriate boxes):
❑ Application for Disposal System Construction Permit
❑ Complete plans and specifications
❑ Site evaluation forms
❑ A list of abutters affected by reduced setbacks to private water supply wells or property lines.
Provide proof that affected abutters have been notified pursuant to 310 CMR 15.405(2).
❑ Other(List):
D. Certification
"I, the facility owner, certify under penalty of law that this document and all attachments, to the best of my
knowledge and belief, are true accurate and complete.9 p te. I am aware that there may be significant
consequences es for submitting false Information including, but not limited to, penalties or fine and/or
imprisonment for deliberate violations."
2/14/05
Fac Owner's SignatufV Date
Benjamin C. Osgood, Jr., PE (agent for owner)
Print Name
New England Engineering Services Inc. 2/14/05
Name of Preparer Date
60 Beechwood Drive North Andover
Preparer's address City/Town
MA 01845 (978)686-1768
State/ZIP Code Telephone
926 Application for Local Upgrade Approval 45 Bridges Lane, North Application for Local Upgrade Approval* Page 4 of 4
Andover-rev.5102
P9 PP g
0
NEW ENGLAND ENGINEERING SERVICES
INC
January 26, 2005
Susan Sawyer
North Andover Board of Health RVC%*�1VED
400 Osgood Street
North Andover, MA 01845 JAN 2 7 2005
TOWN Or NCARTH ANDOVER
Re: 45 Bridges Lane Lane, North Andover HEALTH DEPARTMENT
Septic System Plan Re-Submittal
Dear Susan:
The following plans for the above referenced property are being re-submitted for review and
approval. The new septic design plans have been revised to reflect the comments in your letter
dated January 18, 2005. The following changes have been addressed:
1. The minimum dose volume should be 5-10 times the lateral void volume. The plans
reflect a minimum dose volume of 125 gallons.
2. Total dose volume does not include proper drain back volume. The plans reflect a
drain back volume of 27 gallons.
3. Perforation positions. Perforations have been specified to be alternately positioned at 5
o'clock and 7 o'clock.
4. All perforations should be considered when doing calculations. Calculations and
details accurately show 15 perforations in each lateral. Pump calculations were not
affected, thus calculations dated 12/20/04 are still valid.
Enclosed are (3) copies of the revised septic design plans. Please contact this office with any
questions or concerns.
Sincerely,
Thomas Hector
Project Engineer
i
60 BEECHWOOD DRIVE-NORTH ANDOVER,MA 01845-(978)686-1768-(888)359-7645-FAX(978)685-1099
a o
,> TOWN OF NORTH ANDOVER t NCRTq
Office of COMMUNITY DEVELOPMENT AND SERVICES
HEALTH DEPARTMENT
400 OSGOOD STREET
NORTH ANDOVER, MASSACHUSETTS 01845 'Ss,cNust`
Susan Y.Sawyer,REHS/RS 978.688.9540—Phone
Public Health Director 978.688.9542—FAX
January 18,2005
Benjamin C. Osgood, Jr,P.E.
New England Engineering Services, Inc.
60 Beechwood Drive
North Andover,MA 01845
RE: 45 Bridges Lane,North Andover,MA
Dear Mr. Osgood,
The proposed septic system design plans for the above site dated October 15,2004, revised 12/03/04 and
12/20/04 and received on December 30, 2004 have been reviewed. Unfortunately, it cannot be approved
until the following items are corrected. Each item is followed by the specific section in Title 5: 310
CMR 15.000, or North Andover regulation which is not met by this design.
1. The pressure distribution system shall be designed in accordance with the procedures set forth in
Department guidance. (3 10 CMR 15.254(2)(c)). The following items in the design plan do not
conform to the Title 5 Pressure Distribution Design Guidance:
a. The minimum dose volume should be 5-1 Ox the lateral void volume. This should be 121
— 143 gallons per dose.
b. The total dose volume does not include the proper drainback volume,which should be on
the order of +/-28 gallons.
c. A shield is required for any perforations located at the 6:00 o'clock position to reduce
scouring of the aggregate below the lateral. Alternatively, perforations may be placed
alternately at 5 o'clock and 7 o'clock positions without a shield.
d. All perforations should be considered when doing calculations. It appears that the
optional perforation vent hole at the distal end of the elbow of the lateral sweep is not
accounted for in the volume discharge computations.
Please feel free to contact the office with any questions you may have. We look forward to working with
you to obtain a septic system which will be in compliance with all regulations and assure protection of
public health and the environment of North Andover.
Sincer
S an Y. Sawyer,REHS/RS
Public Health Director
cc: Owner
File
Q Page 1 of 1
Dellechiaie, Pamela
From: Dan Ottenheimer[info@millriverconsulting.com]
Sent: Tuesday, January 18, 2005 1:10 PM
To: amcbrearty@millriverconsulting.com; Lisa Kozel LeVasseur; 'Pamela Dellechiaie'; Susan Sawyer
Subject: 45 Bridges Lane
Sue and company,
Here is the review letter for 45 Bridges Lane. Hope this is in enough time for all parties to deal with this on
Thursday evening. The changes needed are not significant ones which would scuttle the project. They involve
correcting some engineering items in the soil absorption system design. The result might be a larger pump or
some different piping but should not result in a different field configuration.
Dan
0
I
Daniel Ottenheimer,President
Mill River Consulting
Septic System Management Services
2 Blackburn Center
Gloucester, MA 0193.0-2259
978-282-0014 or 1-800-377-3044
fax: 978-282-0012
www.millriv_erconsulting.com
dano millriverconsulting-Orn
1/18/2005
TOWN OF NORTH ANDOVERf NORTH,
Office of COMMUNITY DEVELOPMENT AND SERVICES
HEALTH DEPARTMENT
27 CHARLES STREET "
NORTH ANDOVER, MASSACHUSETTS 01845 'SSACHUSEt
Susan Y. Sawyer 978.688.9540—Phone
Public Health Director 978.688.9542—FAX
December 6,2004
Elizabeth Koenig
45 Bridges Lane
North Andover,MA 01845
Re:45 Bridges Lane,Map 104D,Parcel 120
Dear Homeowners,
The North Andover Board of Health has completed the review of the septic system design plans,for the above
referenced property,submitted on your behalf by New England Engineering Services,Inc.dated October 15,2004
(Last Rev.December 3,2004).
The 44xx1room(9-room maximum)design has been approved for use in the construction of a replacement onsite
septic system.At a regularly scheduled Board of Health meeting held on October 23,2004 the following upgrade
and variance was approved regarding the proposed septic system.
1) A reduction in offset distance between the leach bed and a wetland from 100 feet to 88 feet.
2) A reduction in offset distance between the leach bed and a foundation wall from 20 feet required by Title
V to 11 feet
This approval generally is valid for three years from the date of this letter and during this time a licensed septic
system installer must obtain a permit and complete this work,and a Certificate of Compliance must be endorsed by
the installer,designer and the Town of North Andover. The time period for which this plan is valid is reduced to
two years from the date of a septic system inspection that did not meet the acceptable criteria in the state
regulations.
This approval is subject to the following conditions:
1. The attached DEP Form 9b must be submitted by the homeowner to the appropriate Regional Office
of the Department of Environmental Protection at One Winter Street,Boston MA by the property
owner.
2. A signed maintenance agreement for quarterly inspections,due to the use of the FAST treatment
system,must be submitted prior to the issuance of a Certificate of Compliance will be issued by the
Health Department.
3. If site conditions are found in the field to be different from those indicated on the design plan and/or
soil evaluation,the originally issued Disposal System Construction Permit is void,installation shall
stop,and the applicant shall reapply for a new Disposal Systems Construction Permit(3 10 CMR
15.020(1)).
4. It is the responsibility of the applicant and/or the applicant's septic system designer,septic system
installer or other representative to ensure that all other state and municipal requirements are met.
These may include review by the Conservation Commission,Zoning Board,Planning Board,
Building Inspector,Plumbing Inspector and/or Electrical Inspector. The issuance of a Disposal
System Construction Permit shall not construe and/or imply compliance with any of the
aforementioned requirements.
o 0
Your effort to provide a properly functioning septic system for your dwelling is greatly appreciated The Health
Department may be reached at 978-688-9540 with any questions you might have.
Sincerely,
S Y. Sawyer,RE /RS
Public Health Director
cc: New England Engineering Services Inc.
attachments:. form 9b
sample maintenance agreement
0
Commonwealth of Massachusetts
City/Town of
Local Upgrade Approval
Form 9B
DEP has provided this form for use by local Boards of Health if they choose to do so.
The Local Upgrade Approval is to be completed by the local Board of Health and a signed copy provided
to the system owner. The system owner shall provide a copy of the Local Upgrade Approval to the
appropriate Regional Office of the Department of Environmental Protection, Bureau of Resource
Protection, Title 5 Permitting Program, upon issuance by the local approving authority and before
commencement of construction.
A. Facility Information
wdN out 1. Facility Name and Address
fortes on the
coffqx*er,use Elizabeth Koenig
only the tab key Name
to move your 45 Bridges Lane
cursor-do not sheet Address
use the return
key. North Andover MA 01845
City/Town state zip Code
VQ
2. Owner Name and Address(if different from above):
Name Street Address
city/Town state
Zip Code Telephone Number
3. Type of Facility(check all that apply):
X Residential ❑ Institutional ❑ Commercial [I School
4. Design flow per 310 CMR 15.203: 440
gpd
5. System Designer. BeneOsgoodJr. X PE E] RS
Nwn
60 Beechwood Drive North Andover MA
Address c4yfrown State,ZIP
B. Approval
1. Local Upgrade Approval is granted for
X Reduction in setback(s)—specify:
Reduction in setback distance between SAS and cellar wall from 20 feet to 11 feet
❑ Reduction in SAS area of up to 2596: sas see,sq.It. reduction
45 Bridges Lane 9b 11.6.04.doc•rev.5/02 local Upgrade Approvals Page 1 of 2
Commonwealth of Massachusetts
City/Town of
Local Upgrade Approval
Fonn 9B
B. Approval (continued)
❑ Reduction in separation between the SAS and high groundwater:
Separation reduction
Percolation rate minJhvh
Depth to groundwater
❑ Relocation of water supply well (explain):
List local variances granted not requiring DEP approval per 310 CMR 15.412(4):
Local bylaw variance to allow reduction in offset distance between the leach bed and wetlands from
100 feet to 88 feet
List variances granted requiring DEP approval:
Susan Sawyer
Approving Autlwfity
Public Health Director October 25,2004
Print or Type Name and Title Date
45 Bridges Lane 9b 11.6.04.doc•rev.5102
Local Upgrade Approval Page 2 of 2
i
NEW ENGLAND ENGINEERING SERVICES
INC
December 3, 2004
Susan Sawyer - a��
North Andover Board of Health Recr`�
27 Charles Street p 3 2004
North Andover, MA 01845 DEC
,ANDOVER
TO�ni�s Gt_I''�;r s. . T
HEALI H
DEP
Re: 45 Bridges lane, North Andover
Septic System Design
Dear Susan:
The following plans and enclosures for the above referenced property are being submitted
for approval.
1. (3) Copies of the revised Septic System Design Plans.
These plans incorporate the following revisions to address the items in your letter dated
November 12, 2004.
1. The grades over the system slope toward the house at 2%. They slope towards the
house and towards the slope because it was considered not desirable to create a
low area between the slope and the top of the system. The slope is not large so the
water volume that will travel over the system will not have an adverse effect on
the system. In order to route this water as it gets near the house, a swale has been
specified running along the house to divert water away from the front of the house
and out to the side.
2. The plan has been revised to include a conventional stone leach field that meets
the design size requirements specified in title 5.
3. The drain back volume has been included in the dosing calculations.
4. The pressure distribution calculation worksheet is enclosed.
5. The blower unit and vent location have been specified.
6. A copy of the DEP approval letter for the fast system is enclosed.
7. Note 12 has been revised to say ALL
8. A draft operation and maintenance agreement is enclosed.
9. The date and name of the wetland delineator are included on the plan.
60 BEECHWOOD DRIVE-NORTH ANDOVER, MA 01845-(978)686-1768-(888)359-7645-FAX(978)685-1099
As you know, the owner is ready to sell the home as soon as the septic system design can
be approved. Any assistance you could give to help complete the review and approval of
this revised plan would be appreciated.
If you have any comments or questions please do not hesitate to contact this office.
Sincerely,
1-2 C (9
Benjamin C. Osgoo , Jr. P.E.
President
NEW ENGLAND ENGINEERING SERVICES
INC
PRESSURE,-biSTRIBUT1ION DESIGN SPREADSHEET" -
Property Location: 46 Bridges,Lane,North Andover,NIA_'
°bak(december"1.2.-2004
DESIGN FLOW(in gallons/day)? 440 Calculated by TH
Elevation of the PUMP OFF SWITCH,in feet? 93.2 Date: 12/2/04
Elevation of the upper LATERAL,in feet? 99.84
DELIVERY PIPE distance,from pump to manifold,in feet? 7
DELIVERY PIPE diameter,in inches(if not 2"--use 2"min)? 3
Design DISTAL PRESSURE,in feet(if not 2.5)?(hd) 3 y
IS MANIFOLD CENTER-FED&SYMETRICAL(yes or no)? yes YES
How many orifices in the MANIFOLD? 0 RECE
MANIFOLD ORIFICE diameter,in inches(if not 5/16") 0.3125 0.3125
MANIFOLD DIAMETER(if not 2"--use 2"min)? 4 4
TOTAL LENGTH OF Does MANIFOLD drain tNIFOLD 12 DEC 0 3 2004
o FIELD after dose(yes or no)? no
How many LATERALS? 4
Pumping chamber weep hole size(usually.25") L 0.1875 USE 0 IF FORCE MAIN DOES NOT DRAINr�W OF pSOk�T H,aNDOVER
PROGRAM WILL CALCULATE UP TO 26 LATERALS AND UP TO 50 ORIFICES PER LATERAL HEALTH JFi'NRTNiENT
Your HIGHEST elevation lateral MUST be LATERAL 1:
(first orifice from lateral 1/2 of orifice spacing) Lateral 1: Lateral 2: Lateral 3: Lateral 4:
Length of each LATERAL,in feet? 69 _ 69 69 69
Diameter of each LATERAL,in inches(1.5"min)? 1.5 1.5 1.5 1.5
Elevation of each LATERAL,in feet? 99.84 99.84 99.84 99.84
Number of ORIFICES per lateral 17 17 17 17
Distance from Manifold to closest Orifice,in feet 2.5 2.5 2.5 2.5
ORIFICE SPACING,in feet 4 4 4 4
Diameter of ORIFICES,in inches?(D) 0.25 0.25 0.25 0.25
Square feet of leachfield per laterals(can ignore) 147 147 147 147.
Maximum number of orifices in any one lateral 17
Minimum lateral diameter 1.5
t
FRICTION CALCULATIONS(using Hazen Williams friction ft=Ld((3.55Qm/Ch(Dd^2.63)))^1.85)
PRESSURE CALCULATIONS(using orifice dischage equation Q=11.79 D^2 hd1.5
Lateral 1: Lateral 2: Lateral 3: Lateral 4:
LATERAL DISCHAGE(first approximation) 21.70 21.70 21.70 21.70
MANIFOLD ORIFICE DISCHARGE 0.00
TOTAL SYSTEM DISCHAGE(first approximation) 86.79
TOTAL DISCHARGE PER LATERAL 21.89 21.89 21.89 21.89
DISCHARGE PER SQUARE FOOT OF LEACHFIELD 0.14888551 0.14888551 0.1488855 0.1488855
ORIFICE MAXIMUM DISCHARGE BY LATERAL 1.31 1.31 1.31 1.31
ORIFICE MINIMUM DISCHARGE BY LATERAL 1.28 1.28 1.28 1.28
ORIFICE%DIFFERENCE DISCHARGE within LATERAL 2.4% 2.4% 2.4% 2.4% 0.0%
MAXIMUM DISCHARGE LATERAL 21.89
MINIMUM DISCHARGE LATERAL 21.89
MAXIMUM DISCHARGE PER SQUARE FOOT 0.15
MINIMUM DISCHARGE PER SQUARE FOOT 0.15
•DIFFERENCE DISCHARGE for SYSTEM by orifice #REFI as percent of maximum orifice in system
•DIFFERENCE DISCHARGE for SYSTEM by laterals 0.0%as percent of maximum lateral in system
•DIFFERENCE DISCHARGE for SYSTEM by square feet O.0%as percent of maximum square foot in system
WEEP HOLE DISCHARGE(usually a 1/4"weep hole) 1.20 weep hole= 0.1875 inch
VOID VOLUME IN DELIVERY PIPE 2.57
VOID VOLUME IN MANIFOLD 7.83
VOID VOLUME IN EACH LATERAL 6.33 6.33 6.33 6.33 0.00
TOTAL LATERAL VOID VOLUME 25.33
MINIMUM DOSE VOLUME(based on void volume) 126.67 to 253.35 MIN
ACTUAL MINIMUM IS BASED ON DAILY DESIGN FLOW
(weep hole,usually 1/4",not counted for dose,effluent is repumped during process and not counted for friction,except as fitting headloss)
TOTAL HEAD LOSS IN EACH LATERAL 1.16 1.16 1.16 1.16
MAXIMUM TOTAL LATERAL HEADLOSS IN SYSTEM 1.16
MANIFOLD HEADLOSS(center-fed unless manifold design) 0.05
DELIVERY PIPE HEADLOSS 0.13 w/delivery 3 inch diameter
FITTING LOSS(headloss'.15) 0.45 add extra head if fittings are more than absolute minimum
DISTAL PRESSURE HEAD 3.00
STATIC HEAD(OFF-SWITCH TO HIGH LATERAL/MANIFOLD) 6.64
HEADLOSS PUMP TO WEEPHOLE(assume 3'run) 0.06
PUMP MUST BE ABLE TO PASS SOLIDS AT 88.75 G.P.M 11.49 FEET OF HEAD
or
After OTIS(network losses=1.3'distal head) 88.75 G.P.M. 13.75 FEET OF HEAD
60 BEECHWOOD DRIVE-NORTH ANDOVER,MA 01845-(978)686-1768-(888)359-7645-FAX(978)685-1099
TOWN OF NORTH ANDOVER Ot eORTN 7
Office of COMMUNITY DEVELOPMENT AND SERVICES F' `'•�°°p
HEALTH DEPARTMENT
400 OSGOOD STREET ►", . .''#
NORTH ANDOVER, MASSACHUSETTS 01845 'ss��►n,stt
Susan Y. Sawyer,REHS/RS 978.688.9540—Phone
Public Health Director 978.688.9542—FAX
November 12, 2004
Benjamin C. Osgood, Jr, P.E.
New England Engineering Services, Inc.
60 Beechwood Drive
North Andover,MA 01845
RE: 100 Raleigh Tavern Lane,North Andover, MA
Dear Mr. Osgood,
The proposed septic system design plans for the above site dated October 15, 2004 and received
on October 20, 2004 has been reviewed. Unfortunately, it cannot be approved until the following
items are corrected. Each item is followed by the specific section in Title 5: 310 CMR 15.000, or
North Andover regulation which is not met by this design.
Please show grading so that it slopes away from the building and leaching field(3 10 CMR
15.240(11)&245(5)).
2. The plan includes the use of a DEP-approved wastewater pretreatment ent unit and gravel-
less
P �
less chambers(Infiltrator brand). The Design Plan shows a reduction of 2' from the
bottom of the leaching field to the ESHGW as well as a reduction in area calculated for
Infiltrator Chambers. This is a"double credit" and is not allowed under Title 5. Infiltrator
Chambers may be used, but are not allowed to reduce leaching field size when using pre-
treatment.
-,3. The dose volume for the pump chamber does not include the drain-back volume from the
manifold and the force main. (3 10 CMR 15.231(2)).
✓4. Please include calculations used to determine pump sizing for the pressure distribution
system.
1-5. Please specify the location of blower unit and vent for the treatment device.
�-6. Please include a copy of the Massachusetts DEP approval letter for use of the treatment
unit.
7. Construction note 12 should indicate that ALL piping(not just gravity piping)must be
glued watertight.
c� Please provide a draft operations and maintenance agreement for the treatment unit and
pressure distribution system.
L-9. Please indicate the date of wetland delineation, name of delineator, and whether this has
been accepted by the Conservation Commission.
a � , .
NEW ENGLAND ENGINEERING SERVICES
INC
PRESSURE.DISTROUTION DESIGN SPREADSHEET
-_Property Location: 45:Bridge5;Lane,North Andover,MA
.. 9filPb/2004; .
DESIGN FLOW(in gallons/day)? 440
Elevation of the PUMP OFF SWITCH,in feet? 93.2
Elevation of the upper LATERAL,in feet? 99.71
DELIVERY PIPE distance,from pump to manifold,in feet? 42
DELIVERY PIPE diameter,in inches(if not 2"--use 2"min)? 3
Design DISTAL PRESSURE,in feet(if not 2.5)?(hd) 3
IS MANIFOLD CENTER-FED&SYMETRICAL(yes or no)? yes YES
How many orifices in the MANIFOLD? 0
MANIFOLD ORIFICE diameter,in inches(if not 5/16") 0.3125 0.3125
MANIFOLD DIAMETER(if not 2"--use 2 min)? 4 4
TOTAL LENGTH OF MANIFOLD 18
Does MANIFOLD drain to FIELD after dose(yes or no)? no
How many LATERALS? 5
Pumping chamber weep hole size(usually.25") 0.25 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 lateral MUST be LATERAL 1:
(first orifice from lateral 1/2 of orifice spacing) Lateral 1: Lateral 2: Lateral 3: Lateral 4: Lateral 5:
Length of each LATERAL,in feet? 37.24 46.62 53.62 60.62 66.5
Diameter of each LATERAL,in inches(1.5 min)? 1.5 1.5 1.5 1.5 1.5
Elevation of each LATERAL,in feet? 99.71 99.71 99.71 99.71 99.71'
Number of ORIFICES per lateral 15 15 15 15 15,
Distance from Manifold to closest Orifice,in feet 0 0 0 0 0
ORIFICE SPACING,in feet 2.66 3.33 3.83 4.33 4.75
Diameter of ORIFICES,in inches?(D) 0.25 0.25 0.25 0.25 0.25
Square feet of leachfield per laterals(can ignore) 220 220 220 220 220,
Maximum number of orifices in any one lateral 15
Minimum lateral diameter 1.5
i26SULTS}
"` >
FRICTION CALCULATIONS(using HWilliams friction ft=Ld((3.SSQm/Ch(Dd^2.63)))^1.85)
Z", azen
PRESSURE CALCULATIONS(using orifice dischage equation Q=11.79 D12 hd^.5
Lateral 1: Lateral 2: Lateral 3: Lateral 4: Lateral 5:
LATERAL DISCHAGE(first approximation) 19.14 19.14 19.14 19.14 1914
MANIFOLD ORIFICE DISCHARGE 0.00
TOTAL SYSTEM DISCHAGE(first approximation) 95.72
TOTAL DISCHARGE PER LATERAL 19.23 19.25 19.27 19.29 19.30
DISCHARGE PER SQUARE FOOT OF LEACHFIELD 0.08741571 0.08751525 0.0875896 0.0876639 0.0877263
ORIFICE MAXIMUM DISCHARGE BY LATERAL 1.29 1.30 1.30 1.30 1.30
ORIFICE MINIMUM DISCHARGE BY LATERAL 1.28 1.28 1.28 1.28 1.28
ORIFICE%DIFFERENCE DISCHARGE within LATERAL 1.2% 1.5% 1.8% 2.0% 2,2%
MAXIMUM DISCHARGE LATERAL 19.30
MINIMUM DISCHARGE LATERAL 19.23
MAXIMUM DISCHARGE PER SQUARE FOOT 0.09
MINIMUM DISCHARGE PER SQUARE FOOT 0.09
•DIFFERENCE DISCHARGE for SYSTEM by orifice #REF! as percent of maximum orifice in system
•DIFFERENCE DISCHARGE for SYSTEM by laterals 0.4% as percent of maximum lateral in system
•DIFFERENCE DISCHARGE for SYSTEM by square feet 0.4% as percent of maximum square foot in system
WEEP HOLE DISCHARGE(usually a 1/4"weep hole) 2.19 weep hole= 0.25 Inch
VOID VOLUME IN DELIVERY PIPE 15.42
VOID VOLUME IN MANIFOLD 11.75
VOID VOLUME IN EACH LATERAL 3.42 4.28 4.92 5.56 6.10
TOTAL LATERAL VOID VOLUME 24.29
MINIMUM DOSE VOLUME(based on void volume) 121.44 to 242.89 MIN
ACTUAL MINIMUM IS BASED ON DAILY DESIGN FLOW
(weep hole,usually 1/4",not counted for dose,effluent is repumped during process and not counted for friction,except as fitting headloss)
TOTAL HEAD LOSS IN EACH LATERAL 0.50 0.62 0.72 0.81 0.89
MAXIMUM TOTAL LATERAL HEADLOSS IN SYSTEM 0.89
MANIFOLD HEADLOSS(center-fed unless manifold design) 0.04
DELIVERY PIPE HEADLOSS 0.92 w/delivery 3 inch diameter
FITTING LOSS(headloss'.15) 0.45 add extra head if fittings are more than absolute minimum
DISTAL PRESSURE HEAD 3.00
STATIC HEAD(OFF-SWITCH TO HIGH LATERAL/MANIFOLD) 6.51
HEADLOSS PUMP TO WEEPHOLE(assume T run) 0.07
PUMP MUST BE ABLE TO PASS SOLIDS AT 98.53 G.P.M 11.88 FEET OF HEAD
or
After OTIS(network losses=1.3'distal head) 98.53 G.P.M. 14.43 FEET OF HEAD
60 BEECHWOOD DRIVE-NORTH ANDOVER,MA 01845-(978)686-1768-(888)359-7645-FAX(978)685-1099
To*n of NoAW-Andover
HEALTH DEPARTMENT
27 Charles Street
North Andover,MA 01845
978.688.9540
healthdepina townofnorthandover.com
1
SEPTIC PLAN SUBMITTAL FORM
DATE OF SUBMISSION: 10 1A9
SITE LOCATION:-
ENGINEER:_ ./Ve L,) Enu.n�er�►v� r v.ces ISL
NEW PLANS: YES__X $225.00/Plan Check#: c--,2-,G
(Includes]"OE and one Re-Review Only)
REVISED PLANS: YES $75.00/Plan Check#: 1
SITE EVALUATION FORMS INCLUDED: YES' NO
LOCAL UPGRADE FORM INCLUDED: YES NO-
Telephone
O-
Tele hone#• - o
p C� -1 6$ Fag#: 7S - C� s - IIj
• �7� �� 7 8 q
E-mail:
HOMEOWNER NAME:
p _
OFFICE USE ONLY
RECEIVED
When the submission
is.complete(Including check):
I. / D st plans and letter OCT 2 0 2004
4t;� t�
/�
2. Cetnplete'and attach Receipt
TDHEALWN TH DEPARTMENT
F NORTH ER
3. y File; Forward to Consultant
4. Enter on
Log Sheet and Database
! 0 0
NEW ENGLAND ENGINEERING SERVICES
INC
October 15, 2004
Susan Sawyer OCT 2 0 2004
North Andover Board of Health
27 Charles Street TOWN OF NORTH ANDOVER
North Andover, MA 01845 HEALTH DEPARTMENT
Re: 45 Bridges Lane,North Andover,MA
Local Bylaw Waiver Request
Dear Susan,
The purpose of this letter is to request that the above referenced property be included in
the upcoming Board of Health meeting agenda to discuss the following variances:
Local Bylaw Waivers Required
1. Allow reduction in offset distance between leach bed and wetlands from 100 feet
required to 88 feet.
If you have any comments or questions please do not hesitate to contact this office.
Sincerely,
Steven E. Poulio�
Project Manager
60 BEECHWOOD DRIVE-NORTH ANDOVER,MA 01845-(978)686-1768-(888)359-7645-FAX(9 78)685-1099
0 Q
8 '
Commonwealth of Massachusetts
Cityffown of
Form 9A - Application for Local Upgrade Approval
M
DEP has provided this form for use by local Boards of Health. Other forms may be used, but the
information must be substantially the same as that provided here. Before using this form, check with your
local Board of Health to determine the form they use.
Form 9A is to be submitted to the Local Board of Health for the upgrade of a failed or nonconforming
septic system with a design flow of less than 10,000 gpd, where full compliance, as defined in 310 CMR
5.404(1), is not feasible.
310 CMR 15.403(4) requires the system owner to provide a copy of the local upgrade approval to the
appropriate Regional Office of the Department of Environmental Protection, Bureau of Resource
Protection, Title 5 Permitting Program, upon issuance by the local approving authority and before
commencement of construction.
System upgrades that cannot be performed in accordance with 310 CMR 15.404 and 15.405, or in full
compliance with the requirements of 310 CMR 15.000, require a variance pursuant to 310 CMR 15.410
through 15.417.
NOTE: Local upgrade approval shall not be granted for an upgrade proposal that includes the addition of
a new design flow to a cesspool or privy, or the addition of a new design flow above the existing approved
capacity of an on-site system constructed in accordance with either the 1978 Code or 310 CMR 15.000.
A. Facility Information
Important:
When filling out 1. Facility Name and Address:
forms on the
computer, use Elizabeth Koenig
only the tab key Name
to move your 45 Bridges Lane
cursor-do not Street Address
use the return
key. North Andover MA 01845
City/Town State Zip Code
2. Owner Name and Address (if different from above):
same
Name Street Address
City/Town State
Zip Code Telephone Number
3. Type of Facility (check all that apply):
® Residential ❑ Institutional ❑ Commercial ❑ School
4. Describe Facility:
Installation of new residential subsurface sewage disposal system.
5. Type of Existing System:
❑ Privy ❑ Cesspool(s) ® Conventional ❑ Other(describe below):
Current residential sewage disposal system is in failure.
45 BRIDGES LN-FORM 9a•rev.5/02 Application for Local Upgrade Approval, Page 1 of 4
Q Q
Commonwealth of Massachusetts
City/Town of
o Form 9A — Application for Local Upgrade Approval
DEP has provided this form for use by local Boards of Health. Other forms may be used, but the
information must be substantially the same as that provided here. Before using this form, check with your
local Board of Health to determine the form they use.
A. Facility Information (continued)
6. Type of soil absorption system (trenches, chambers, leach field, pits, etc):
Leach field
7. Design Flow per 310 CMR 15.203:
Design flow of existing system: Unknown
gpd
Design flow of proposed upgraded system 440
gpd
Design flow of facility: n/a
gpd
B. Proposed Upgrade of System
1. Proposed upgrade is(check one):
® Voluntary ❑ Required by order, letter, etc. (attach copy)
❑ Required following inspection pursuant to 310 CMR 15.301: date of inspection
2. Describe the proposed upgrade to the system:
3. Local Upgrade Approval is requested for(check all that apply):
® Reduction in setback(s)—describe reductions:
Request reduction in setback distance between SAS and cellar wall (foundation)from 20 feet
required by Title V Section 15.211 to 11 feet.
❑ Reduction in SAS area of up to 25%: SAS size,sq.ft. %reduction
❑ Reduction in separation between the SAS and high groundwater:
Separation reduction ft
Percolation rate
min./inch
Depth to groundwater ft
45 BRIDGES LN-FORM 9a•rev.5/02 Application for Local Upgrade Approval• Page 2 of 4
Commonwealth o Wlassachusetts
City/Town of
a
a Form 9A — Application for Local Upgrade Approval
DEP has provided this form for use by local Boards of Health. Other forms may be used, but the
information must be substantially the same as that provided here. Before using this form, check with your
local Board of Health to determine the form they use.
B. Proposed Upgrade of System (continued)
❑ Relocation of water supply well (explain):
❑
Other requirements of 310 CMR 15.000 that cannot be met—describe be and specify sections of the
Code:
If the proposed upgrade involves a reduction in the required separation between the bottom of the soil
absorption system and the high groundwater elevation, an Approved Soil Evaluator must determine the
high groundwater elevation pursuant to 310 CMR 15.405(1)(i)(1). The soil evaluatormust be a member
or agent of the local approving authority.
High groundwater evaluation determined by:
Andrew McBrearty 8/3/04
Evaluator's Name(type or print) Signature Date of evaluation
C. Explanation
Explain why full compliance, as defined in 310 CMR 15.404 1 is not feasible. Each section
p y p ( ), ( must be
completed)
1. An upgraded system in full compliance with 310 CMR 15.000 is not feasible:
No other location available on the lot for the system size required.
2. An alternative system approved pursuant to 310 CMR 15.283 to 15.288 is not feasible:
A 1500n.allon Micro Fast Septic tank is included in the design.
9 p 9
45 BRIDGES LN-FORM 9a•rev.5/02 Application for Local Upgrade Approval* Page 3 of 4
0 0
Commonwealth of Massachusetts
City/Town of
Form 9A - Application for Local Upgrade Approval
M
DEP has provided this form for use by local Boards of Health. Other forms may be used, but the
information must be substantially the same as that provided here. Before using this form, check with your
local Board of Health to determine the form they use.
C. Explanation (continued)
3. A shared system is not feasible:
4. Connection to a public sewer is not feasible:
Town sewer is not in the area of the property.
5. The Application for Local Upgrade Approval must be accompanied by all of the following (check the
appropriate boxes):
I
❑ Application for Disposal System Construction Permit
❑ Complete plans and specifications
❑ Site evaluation forms
❑ A list of abutters affected by reduced setbacks to private water supply wells or property lines.
Provide proof that affected abutters have been notified pursuant to 310 CMR 15.405(2).
❑ Other(List):
D. Certification
"I, the facility owner, certify under penalty of law that this document and all attachments, to the best of my
knowledge and belief, are true, accurate, and complete. I am aware that there may be significant
consequences for submitting false information, including, but not limited to, penalties or fine and/or
imprisonment for deliberate violations."
6? 9/9/04
c i y wner's Signature Date
Benjamin C. Osgood, Jr., P.E.
(Agent for owner)
New England Engineering 9/9/04
9 9 g
Name of Preparer Date
60 Beechwood Drive North Andover
Preparer's address City/Town
MA 978-686-1768
State/ZIP Code Telephone
45 BRIDGES LN-FORM 9a•rev.5/02 Application for Local Upgrade Approval, Page 4 of 4
0 0
NEW ENGLAND ENGINEERING SERVICES
INC
November 23, 2004
By Fax and Mail
Attention Clair Golden
EHIAM
Department of Environmental Protection
Division of Water Pollution Control 004
1 Winter Street
Boston, MA 02108 T-to�T
RE: 45 Bridges Lane,North Andover
Dear Clair:
Thank you for your call today regarding the above referenced property. The specific issue
which needs clarification is the"doubling" of different reductions allowed by different
alternative leaching and treatment systems in one subsurface sewage system repair
design.
The specific question regarding the above referenced property is the use of a Fast
pretreatment system to lower the required offset between the bottom of the leaching
system and the water table from 4 feet to 2 feet combined with the use of the Infiltrator
chamber system to reduce the required area for the leach system. It is the opinion of the
review engineer for the Town of North Andover that the systems can not be combined to
take multiple reductions without first applying to DEP for a variance. I am specifically
asking for your interpretation of the matter and it is my belief that a variance should not
be required. My reasoning is as follows.
The Fast pretreatment system is being used to pre-treat the effluent prior to distribution in
the leach field. The fact that the effluent is cleaner and therefore needs less treatment
prior to coming in contact with the water table is the basis for DEP having granted the
approval of the Fast system for this type of reduction. The science behind the granting of
the approval of this system is separate from the science behind the granting of the
Infiltrator system approval. The infiltrator system approval for a reduced leach field size
is based upon the fact that there is more surface area to treat the effluent at the bottom of
the trench than that of a stone trench. By combining these two approvals there is no loss
of the ability of each system to work as designed. The infiltrator field will work as
designed to treat the effluent in the same manner as a system without the Fast
pretreatment unit.
60 BEECHWOOD DRIVE-NORTH ANDOVER,MA 01845-(978)686-1768—(888)359-7645—FAX(978)685-1099
i
O
This same question has been raised before by the same review engineer but the
combination of reductions was different. In those instances I asked for reductions in leach
area size for the use of pretreatment, pressure dosing, and the equivalent size of the leach
chambers. In that instance I agreed that the proposal coupled reductions in a manner that
was not allowed. This present request however does not couple the same type of
reduction and in my p separately opinion should be viewed se aratel and therefore allowed.
Thank you for your expedient review of my question. If you need any additional
information please do not hesitate to contact me at the office number or at my cell phone
number which is 508-328-4633..
Sincerely,
Benjamin C. Osgood, r.,PE
President
CC Susan Sawyer, RS
North Andover board of Health Agent.
w v. _w
E h-
' C
COMMONWEALTH OF MASSACHUSETTS
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
DEPARTMENT OF ENVIRONMENTAL"PROTECTION
ONE WINTER STREET, BOSTON, MA 02108 617-292-5500
MITT ROMNEY
Governor ELLEN ROY HERZFELDER
Secretary
KERRY HEALEY
Lieutenant Governor ROBERT W. GOLLEDGE,Jr.
Commissioner
December 1, 2004
Benjamin C. Osgood, Jr., P.E. -
President
New England Engineering Services, Inc. DEC
O
60 Beechwood Drive 6 ?004
North Andover, MA 01845
Dear Mr. Osgood: - -1
Your letter of November 23, 2004 to Claire Golden was forwarded to this office to
respond to your question concerning clarification of sizing reductions for soil adsorption systems
using chambers when installed following an alternative treatment system in a remedial situation.
The MODIFIED CERTIFICATION FOR GENERAL USE for Infiltrator Systems,
dated February 21, 2003 addresses sizing of a chamber system in a remedial use situation.
Section II, Design Standards, in item 7 states "Systems installed on remedial sites shall be
allowed to utilize the effective leaching areas presented in item 5 above or additional reductions
in soil absorption leaching area approved by the approving authority in accordance with 310
CMR 15.284. In no instance shall the reduction in the soil absorption system required in
310 CMR 15.242 exceed the maximum reduction allowed for alternative systems approved
in accordance with 310 CMR 15.284. The effective leaching areas presented in item 6 above
shall be used for remedial sites located in Department designated Zone II or IWPA when the
facility is to be brought into full compliance in accordance with 310 CMR 15.404."
The APPROVAL FOR REMEDIAL USE for MicroFAST,NitriFAST, and High
Strength FAST Systems issued to Bio-Microbics, Inc., August 13, 2001 also addresses the sizing
reduction for a soil adsorption system allowed when using this alternative treatment system.
Section III, Allowable Soil Absorption System Design item 1 states "Reduction of the Required
Soil Absorption System Size -An Applicant is eligible for up to a 50 percent reduction in the
area of the soil absorption system required by 310 CMR 15.242, where all the following is
met. Accordingly, in approving design and installation of the System by a particular Applicant,
the local approving authority may allow up to a 50 percent reduction in the area of the soil
absorption system required by 310 CMR 15.242,provided that all of the following conditions are
met:"
This information is available in alternate format.Call Donald M.Gomes,ADA Coordinator at 617-556-1057.TDD Service-1-800-298-2207.
DEP on the World Wide Web: http://www.mass-gov/dep
Za Printed on Recycled Paper
o a
Benjamin C. Osgood, Jr., P.E.
Page 2
The BOLD type in the above paragraphs is shown for clarity. I
Should you need any further information or wish to discuss other potential technologies, j
please contact Steven H. Corr,P.E. at 617-292-5920.
cerely,
i'
David Ferris, Acting Director
Watershed Permitting Program
Cc: DEP/NERO C. Golden
North Andover BOH, Susan Sawyer, RS
DEP/SERO B. Dudley
DEP/WERO P. Neitupski
DEP/CERO D. Boyer
i
f
�-\ COMMONWEALTH OF MASSACHUSETTS
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
DEPARTMENT OF ENVIRONMENTAL PROTECTION
ONE WINTER STREET, BOSTON, MA 0216 617 292-5500.
DEC 0 3 2004
JANE SWIFT BOB DURAND
Governor
TOWN OF NOK I r:„r.uu Secretary
HEALTH DEPAKTMEN f
LAUREN A.LISS
Commissioner
APPROVAL FOR REMEDIAL USE
Pursuant to Title, 310 CMR 15.00
Name and Address of Applicant:
Bio-Microbics, Inc,
8450 Cole Parkway
Shawnee, KS 66227
Trade name of technology and model: MicroFAST Treatment System Models MicroFAST 0.5,
0.9, 1.5, 3.0, 4.5 and 9.0;HighStrengthFAST Treatment System Models HighStrengthFAST 1.0,
1.5, 3.0, 4.5 and 9.0 and NitriFAST Treatment System Models NitriFAST 0.5, 1.0, 1.5, 3.0, 4.5
and 9.0(hereinafter called the"System"). Schematic drawings of each model are attached and are
a part of this Approval.
Date of Application: March 16, 2001
Transmittal Number: W 019013
Date of Issuance: August 13, 2001
Expiration date: August 13, 2006
Authority for Issuance
Pursuant to Title 5 of the State Environmental Code, 310 CMR 15.000, the Department of
Environmental Protection hereby issues this Approval for Remedial Use to: Bio-Microbics, Inc.,
8450 Cole Parkway, Shawnee, KS 66227 (hereinafter "the Company"), approving the System
described herein. for Remedial Use in the Commonwealth of Massachusetts. Sale and use of the
System are conditioned on compliance by the Company and the System owner with the terms and
conditions set forth below. Any noncompliance with the terms or conditions of this Approval
constitutes a violation of 310 CMR 15.000.
Glenn Haas, Acting Assistant Commissioner Date
Bureau of Resource Protection
Department of Environmental of Protection
This information is available in alternate format by calling our ADA Coordinator at(617)574-6872.
DEP on the World Wide Web: http:/Mmm.state.ma.us/dep
A Printed on Recvcled Pener
rte_
Bio-Microbics Remedial Use Approval MicroFAST,HighStrengthFAST and NitriFAST
f
I. Purpose
i
1• The purpose of this
approval is to allow use of the System in Massachusetts, on a Remedial `
Use basis. �
2. With the necessary permits and approvals required by 310 CMR 15.000, this Approval for
Remedial Use authorizes the use and installation of the System in Massachusetts.
3• The System may only be installed on facilities that meet the criteria of 310 CMR 15.284(2).
4. This Remedial Use Approval authorizes the use of the System where the local approving I
authority finds that the System is for upgrade of a failed, ``
the design flow for the facility is less than failing or nonconforming system and
10,000 gallons Per
increase in.design flow to be served by the system, g p day ( GPD) and there is no
i
I1• Design Standards
i
1• The FAST treatmentstem
sy (Fixed Activated Sludge Treatment),Models MicroFAST
0.5, 0.75, 0.9,and 1.5, lEghStrengthFAST 1.0 and 1.5, NitriFAST 0.5, 0.75, 0.9 and 1.5
all consist of a single tank having a primary settling zone and an aerobic biological zone.
Solids are trapped in the primary zone where they settle. In the aerobic zone, the bacteria
colony attaches itself to the surface of a submerged media bed and feeds on the sewage as
it circulates. Models MicroFAST, lEghStrengthFAST and NitriFAST 3.0, 4.5 and 9.0
consist of a standard Title 5 septic tank for settling solids and a second tank with the
submerged media for aerobic treatment.
i
2. Models MicroFAST 0.5, 0.75 and 0.9.
0HighStrengthFAST 1.0, NitriFAST 0.5
9 shall be installed in the second compartment of a two compartment septic tank with d
total liquid capacity of at least 1,500 gallons. Models MicroFAST, a
' and NitriFAST 1.5 shall be installed in the HighStrengthFAST
second compartment of a 3000 gallon tank. The h
two compartment septic tank shall be installed between the building sewer and the pump
' chamber of a standard Title 5 system constructed in accordance with 310 CMR 15.100- F
15.279, subject to the provisions of this Approval. MicroFAST, HighStrengthFAST and
NtriFAST Models 3.0, 4.5 and 9.0 shall be installed between a septic tank desi
accordance with 310 CMR 15.223 and the pump chamber of a SAS. gned in
JJ� 3• The System is approved for use at facilities with a maximum design flow u to 10,000
�I GPD. p
4. The System may be used in soils with a percolation rate of up to 90 min./inch. For o s
with a percolation rate of 60 to 90 min./inch,
sq. the effiuent loading rate shall be 0.15 GPD/
ft.
5• Pressure distribution designed in accordance with Departmentideline
installations of the System. s is required for all
� t
I
Now 2ofR
' � � _ - � _ -- --- — a_ �.
�, � I
:�� ,^.�4
I
� �.
i
Bio-Microbics Remedial Use Approval MicroFAST,HighStrengthFAST and NitriFAST
1. The Department may suspend, modify or revoke this Approval for cause, including, but
not limited to, non-compliance with the terms of this Approval, nonpayment of the annual
compliance assurance fee, for obtaining the Approval by misrepresentation or failure to
disclose fully all relevant facts or any change in or discovery of conditions that would
constitute grounds for discontinuance of the Approval, or as necessary for the protection
of public health, safety, welfare or the environment, and as authorized by applicable law.
The Department reserves its rights to take any enforcement action authorized by law with
respect to this Approval and/or the System against the owner, or operator of the System
and/or the Company.
IX. Expiration Date
1. Notwithstanding the expiration date of this Approval, any System sold and installed prior to the
expiration date of this Approval, and approved, installed and maintained in compliance with
this Approval (as it may be modified) and 310 CMR 15.000, may remain in use unless the
Department, the local approving authority, or a court requires the System to be modified or
removed,or requires discharges to the System to cease.
W019013 Remedial Bio-Microbics 8-13 Combined
Pave.9of8
i
Town of North Andover
Office of the Health Department F: •'>° �''`<�
Community Development and Services Division t -
400 OSGOOD STREET �+► ,��A�o ,.°"
North Andover,Massachusetts 01845 �Ss�:H
Susan Y. Sawyer,REHS/RS 978.688.9540-Phone
Public Health Director 978.688.8476-Fax
C� ',;VFI"2�E Off' CO9VI<1'.GIA�1�CE
As of:
June 23, 2005
This is to cert that
the individual su6surface disposafsystem
Constructed(---� or
Repaired— (f)
by
James A-ellett
at
45 Oridges Gane
North Andover, X4 01845
has been instaffed in accordance with the provisions of Titfe V of the State Sanitary Code and
with the North Andover Board of Yfeafth regulations.
The Issuance of this certificate shall not 6e construed as a guarantee that the system wiff
function satisfactorify.
r'Sus `Y. Sawyer
1Pu6CcWealth Director
BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535
O
TOWN OF NORTH ANDOVER SEWAGE DISPOSAL SYSTEM
INSTALLATION CERTIFICATION
The undersigned hereby certify that the Sewage Disposal System ( )'constructed;
(K)repaired;
by e l e++ aF Ke l le 4 E'xcay-:&�Aej
located at 57 8t`+d a es aVn e
was installed in conformance with the North AiRdover Board of Health approved plan,
System Design Permit.# ,plan dated 1016 a-( Rev—. 1 a6 oS, with a design flow
of ft gallons per day. The materials used were in conformance with those specified
on the approved plan; the system was installed in accordance with the provisions of 310
CMR 15.000,Title 5 and local regulations, and the final grading agrees substantially with
the approved plan. All work is accurately represented on the As-built which has been
submitted to the Board of Health.
Bed inspection date: 3' 17 O,'r SP TH-
Engineer Representative
Final inspection date: o S
Engineer Representative
Installer:
I.ic.#: Date: �
�,A OF SSS
Engineer: Date:
OD,JR.
CIVIL C
NO.45891
�FSSIONAL��G
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, .
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O
._ �_
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r �) �rrr.� \ •Kitt
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Q Q
NEW ENGLAND ENGINEERING SERVICES
INC
June 14, 2005
Susan Sawyer
North Andover Board of Health
400 Osgood Street
North Andover, MA 01845
Re: 45 Bridges Lane, North Andover, MA
Septic System As-Built Plan Submittal
Dear Ms. Sawyer,
The following Septic As-Built plans for the above referenced property are being submitted for
approval.
Enclosed are the following:
1. (3) Copies of the Septic System As-Built Plan.
2. Copy of Designer's/Installer's Certification Form.
This as built plan is being submitted and certified as being built per the plans with the exception
of the location of the leach field. The leach field was shifted by the contractor to a location
which places the edge of the leach field at the property line in lieu of the six foot offset(which
was approved by the Town). It is the opinion of this office that an additional approval may be
warranted.
Please contact this office with any questions or concerns.
Sincerely,
Benjamin C. Osgood, Jr., P.E.
President
cc: Homeowner
60 BEECHwoob DRIVE-NORTH ANDOVER,MA 01845-(978)686-1768-(888)359-7645-FAX(978)685-1099
0 0
TOWN OF NORTH ANDOVER E N°RTM
.
Office of COMMUNITY DEVELOPMENT AND SERVICES
HEALTH DEPARTMENT
I
400 OSGOOD STREET "►�, ;
NORTH ANDOVER, MASSACHUSETTS 01845 �''ss�CHU
Susan Y. Sawyer,REHS/RS 978.688.9540—Phone
Public Health Director 978.688.9542—FAX
ADDRESS: 45 Bridges Lane MAP:104 LOT: 120
INSTALLER: James Kellett
DESIGNER: Benjamin Osgood
PLAN DATE: 1/26/2005
BOH APPROVAL DATE ON PLAN: 2/14/2005
DATE OF BED BOTTOM INSPECTION:5/4/2005
DATE OF FINAL CONSTRUCTION INSPECTION-
DATE OF FINAL GRADE INSPECTION:
SITE CONDITIONS
®Existing septic tank properly abandoned
❑Internal plumbing all to one building sewer
❑Topography not appreciably altered
Comments:
SEPTIC TANK
❑ Bottom of tank hole has 6" stone base
❑ Weep hole plugged
❑ 1500 gallon tank has been installed
H-10 loading Monolithic construction
❑ Water tightness of tank has been achieved
(Visual or Vacuum Test or Water held for 24hrs)
❑ Inlet tee installed, centered under access port
❑ Outlet tee (gas baffle or effluent filter) installed,
centered under access port
❑ 24" inch cover to within 6" of final grade installed over
one access port, must be over outlet of tank if effluent
filter is present
❑ Hydraulic cement around inlet & outlet
Comments:
Page 1 of 5
0 0
TOWN OF NORTH ANDOVER t NORTIj
Office of COMMUNITY DEVELOPMENT AND SERVICES �?e',,,to '•�°oA
HEALTH DEPARTMENT
400 OSGOOD STREET
NORTH ANDOVER, MASSACHUSETTS 01845 �'�Ss;;CHU
Susan Y. Sawyer,REHS/RS 978.688.9540—Phone
Public Health Director 978.688.9542—FAX
PUMP CHAMBER
❑ Bottom of tank hole has 6" stone base
❑ Weep hole plugged
❑ 1000 gallon Pump Chamber installed
H-10 loading
Monolithic construction)
❑ Inlet tee installed, centered under access port
❑ Pump(s) installed on stable base
❑ Alarm float working
❑ Pump On/Off float working
❑ Drain hole in pressure line
❑ 24" inch cover to within 6" of final grade installed over
pump access port
❑ Watertightness of tank has been achieved
Visual testing
❑ Hydraulic cement around inlet & outlet
Comments:
ADVANCED TREATMENT TECHNOLOGY
❑ Type of treatment
❑ Installed per manufacturers requirements
❑ All components working in accordance with
manufacturer's requirements
Comments:
Fast-brand treatment unit
D-BOX
❑ Installed on stable stone base
❑ Inlet tee (if pumped or >0.08'/foot)
❑ Hydraulic cement around inlet & outlets
❑ Observed even distribution
❑ Speed levelers provided (not required)
Comments:
Page 2 of 5
a o
TOWN OF NORTH ANDOVER t NoarH
Office of COMMUNITY DEVELOPMENT AND SERVICES ar "Ooc
F p
HEALTH DEPARTMENT
400 OSGOOD STREET
NORTH ANDOVER, MASSACHUSETTS 01845
Susan Y. Sawyer, REHS/RS 978.688.9540—Phone
Public Health Director 978.688.9542—FAX
SOIL ABSORPTION SYSTEM
® Bottom of SAS excavated down to C soil layer, as
provided on plan
® Size of SAS excavated as per plan
❑ Title 5 sand installed, if specified on plan
❑ 3/4-1 Y2" double washed stone installed
❑ 1/8-1/2" (peastone) double washed stone installed
❑ laterals installed and ends connected to header (and
vented if impervious material above)
❑ Orifices @ 5 & 7 o'clock positions
❑ Gravelless disposal systems: type, number and
location as per plan
❑ Elevations of laterals installed as on approved plan
❑ 40 Mil HDPE barrier installed
❑ Retaining wall (boulder/ concrete /timber/ block)
❑ Final cover as per plan
Comments:
Second bed-bottom inspection required on May 5, 2005 as correct dimensions and
depth not provided on first inspection on May 4, 2005.
PRESSURE DISTRIBUTION
❑ -- inch manifold
❑ laterals installed with end sweeps
size:
material:
❑ Squirt test ft in height
❑ Equal distribution to all laterals
❑ orifice size inch as per plan
Comments:
Page 3 of 5
TOWN OF NORTH ANDOVER E NORTH
Office of COMMUNITY DEVELOPMENT AND SERVICES
HEALTH DEPARTMENT s p
400 OSGOOD STREET `►^, ,�4 :
NORTH ANDOVER,MASSACHUSETTS 01845 'ss rull <`y
Susan Y. Sawyer,REHS/RS 978.688.9540—Phone
Public Health Director 978.688.9542—FAX
CONTROL PANEL
❑ Alarm & Pump are on separate circuits
❑ Alarm sounds when float is tripped
❑ Location of control panel:
❑ Rated for exterior if placed outside
Comments:
Page 4 of 5
I
�OWN OF NORTH ANDOVER a pOR7N
Office of COMMUNITY DEVELOPMENT AND SERVICES °
HEALTH DEPARTMENT
400 OSGOOD STREET
NORTH ANDOVER, MASSACHUSETTS 01845
�cMuse
Susan Y. Sawyer,REHS/RS 978.688.9540—Phone
Public Health Director 978.688.9542—FAX
SYSTEM ELEVATIONS
Benchmark:
Rod at Benchmark:
Height of Instrument:
INVERT ON DESIGN PLAN INVERT ELEVATION
Building Sewer OUT
Septic Tank IN
Septic Tank OUT
Pump Chamber IN
Pump Chamber OUT
Distribution Box IN
Distribution Box OUT
Manifold
Lateral 1 HIGH
Lateral 1 LOW
Lateral 2 HIGH
Lateral 2 LOW
Lateral 3 HIGH
Lateral 3 LOW
Lateral 4 HIGH
Lateral 4 LOW
Lateral 5 HIGH
Lateral 5 LOW
I
I
i
i
Page 5 of 5
Page 1 of 1
0
Dellechiaie, Pamela
From: Dan Ottenheimer[info@millriverconsulting.com]
Sent: Thursday, May 12, 2005 11:30 AM
To: amcbrearty@millriverconsulting.com; Lisa Kozel LeVasseur; 'Pamela Dellechiaie'; Susan Sawyer
Subject: 45 Bridges Lane
Bed bottom inspection for 45 Bridges Lane attached. Kellett did not have the correct size of the leach area
excavated, nor did he properly clean up the bottom of the former tank holes, so we had to go back out the next
day. We were not scheduled already to be in Town that day so I am unfortunately going to have to invoice the
Town for the second inspection. You may wish to pass that cost along to Kellett as his lack of proper excavation
is what caused us to have to go back out.
Dan
I I
Daniel Ottenheimer,President
Mill River Consulting, Inc.
Septic System Management Services
2 Blackburn Center
Gloucester, MA 01930-2259
978-282-0014 or 1-800-377-3044
fax: 978-282-0012
www.millriverconsultinp-.com
dano@millriverconsulting.com
5/12/2005
Commonwealth of Massachusetts Map-Block-Lot
Qgk«cc 'A�a4104.D-0120-
Board of Health ---r------
Permit No
n N
BHP-2005-0082
orth Andover
P.I.
FEE
F.I. $250.00
-----------------------
Disposal Works Construction Permit
Permission is hereby granted JAMES-KELLETT
-------------------------------------------- ------- -------------------------------------------
441
to(Repair)an Individual Sewage Disposal System.
at No 45 BRIDGES LANE
-
--------------------------------------------------------------- -----------------------------------------
i
as shown on the application for Disposal Works Construction Permit No. BHP-2005-008 Dated __April 12,-2005
-----------------------------------------------------------------
Issued On:Apr-12-2005 Board of Health
� o
TOWN OF NORTH ANDOVER f NORT11 4
,r h Office of COMMUNITY DEVELOPMENT AND SERVICES 3:;t'.,`e`"
HEALTH DEPARTMENT A
400 OSGOOD STREET ��,� . , :
NORTH ANDOVER, MASSACHUSETTS 01 845 SgCMY
978.688.9540—Phone
Susan Y. Sawyer,REHS/RS 978.688.9542—FAX
Public Health Director healthdept(a townofnorthandover.com-e-mail
www.townofnorthandover.com-website
APPLICATION FOR DISPOSAL WORKS CONSTRUCTION PERMIT
DATE:
LOCATION: 415 7A-,4
LICENSED INSTALLER NAME: 01,4)-7-rd
PLEASE PRINT
SIGNATURE: -"� ��� TELEPHONE#7f- IJ— % �l
4 CHECK ONE:
FULL SYSTEM REPAIR: ($250)
COMPONENT REPAIR(indicate what parts): ($125)
* NEW CONSTRUCTION:
* If NEW CONSTRUCTION, please attach the Foundation As-Built Plan.
$250.00 or$125 Fee Attached? Yes No
Project Manager Obligation From Attached? Yes No
Foundation As-Built? Yes No
Floor Plans? Yes No
Date:
Approval of Health Agent
0
INSTALLER PROJECT MANAGEMENT OBLIGATIONS
As the North`,Andover licensed installer for the construction of the septic system for the
property at 4S xg YPrelative to the application
ofJAr^--1 kWle4 dated for plans by X/c E-5 and
dated with revisions dated
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
manger,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 nec@ssary work completed prior to the applicable
inspections as indicated below. I understand that requesting an inspection, without
completion of the items in accordance with Tile 5 and the Board of Health Regulations may
result in a$50.00 fine being levied against my company.
a) Bottom of Bed - generally first inspection unless there is a retaining wall which should be done
first. Installer must request the inspection but does not have to be present.
b) Final inspection — Engineer must first do their inspection for elevations, ties, etc. As-built or
verbal OK from engineer must be submitted to Board of Health, after which installer calls for
inspection time. Installer must be present for this inspection. With 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. Does not have to be
on site.
4. As the installer I understand that only I may perform the work (other than simple excavation)
required to complete the installation of the system identified in the attached application for
installation. I further understand that work by others unlicensed to install septic systems in
North Andover can constitute reasons for denial of the system, and/or revocation or
suspension of my license to operate in the Town of North Andover; significant fines to all
persons involved are also possible.
5. As the Installer I understand that I must be on site during the performance of the following
construction.steps:
a) Determination that the proper elevation of the excavation has been reached.
b) Inspection of the sand and stone to be used.
c) Final inspection by Board of Health staff or consultant.
d) Installation of tank, D-box, pipes, stone, vent, pump chamber, retaining wall and other
components.
6. As the installer I understand that I am solely responsible for the installation of the system as
per the approved plans. No instructions by the homeowner, general contractor, or any other
persons shall absolve me of this obligation.
Undersigned Licensed Septic Installer
Date:
sposal Works Construction Permit#
_ 07/21/1999 04:39 303-75675 KOENIGQ PAGE 01/01
Beth and Mike Koenig
29 Berry Patch Lane
Boxford, MA 01921
(Property owners of
45 Bridges Lane, NA)
Board of Health
Town of North Andover
400 Osgood Street
North Andover MA 01845
Phone: 888-9540
Fax: 888-9542
To Whom it May Concern,
Ben Osgood,Jr. has the authority to sign, submit and/or perform other
septic related duties on our behalf re: our property at 45 Bridges Lane,
North Andover, MA 01845.
Kind regards,
0��4
Beth Koenig
s
DEC 2'126110
44 Commercial Stregl0WN OF NORTH ANDOVER
Raynham,MA T1 IjEALTHDEPARWENT
02767
Tel: (508)880-0233
Fax: (508)880-7232
November 9, 2016
North Andover Board of Health
1600 Osgood Street
North Andover, MA 01845
Attention: Health Agent
Reference: FAST' Wastewater Treatment System- Serial Number: 24751
Attached please find the Field Inspection& Service Report with field test results for
services performed on 10/13/16 at the property of Michael Fox located at 45 Bridges
Lane,North Andover, MA.
Please call if you have any questions or require additional information.
Sincerely,
Wastewater Treatment Services, Inc.
Service Department
Enclosures
Copy to: Michael Fox
Massachusetts DEP
i�
I
f 11 C O R P O R A T E U
8450 Cole Parkway, Shawnee, KS 66227, Phone 913-422-0707, Fax 913-422-0808
e-mail:onsite(aDbiomicrobics.com, www.biomicrobics.com, 800-753-FAST(3278)
FIELD INSPECTION & SERVICE REPORT
For Bio-Microbics Single Home FAST°System
26747
INSTALLATION AUTHORIZED SERVICE PROVIDER
Installation Address: 45 Bridges Lane Name:Wastewater Treatment Services,Inc.
North Andover,MA 01845
Owner Name:Michael Fox
Mail Address: 45 Bridges Lane Mail Address: 44 Commercial Street
North Andover,MA 01845 Raynham,MA 02767
Phone: Fax: e-mail: Phone:(508)880-0233 Fax:(508)880-7232 a-mail:
INSTALLATION INFORMATION
Model No. Serial No. Date of Installation Date of last pump out
MicroFAST.5 24751 5/17/2005 3-I1-13
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
Pumpout Required x
Primary Settling Zone 36"
Aerobic Treatment Zone 26"
EFFLUENT(optional), LIMIT RESULT
Estimated Daily Flow 440 gpd
pH(Standard Units) 5
Color Turbid
Temperature 59
Odor Turbid
Comments:System needs to be pumped.
TECHNICIAN SERVICE DATE
John Medeiros 10/13/16
I
Massachusetts Department of Environmental Protection
Bureau of Resource Protection -Title 5
DEP Approved Inspection and O&M Form for Title 5 I/A
Treatment and Disposal Systems
26747
A. Installation
Michael Fox
Owner
45 Bridges Lane
Facility Street Address
North Andover 01845
City Zip
Mailing address of owner, if different:
45 Bridges Lane
Street Address/PO Box:
North Andover MA 01845
City State Zip
Telephone Number
B. Authorized Service Provider
Wastewater Treatment Services Inc.
O&M Firm
44 Commercial Street
Street Address
Raynham MA 02767
City State Zip
508-880-0233
Telephone Number
John Medeiros 17549
Certified Operator Name Certification Number
C. Facility/System Information
24751 Bio-Microbics, Inc. MicroFAST .5
DEP ID Manufacturer ID Model Number
5/17/2005 5/17/2005
Installation Date Start of Operation
Approval Type: [] General [] Provisional [] Piloting [x] Remedial [] General Denite
Seasonal Residence—used less than 6 mo./year: []Yes [x] No
D. Operating Information
10/13/16
Inspection Date Previous Inspection Date
36" Pumping Recommended [x]Yes [] No
Sludge Depth(to be checked yearly)
1
Massachusetts Department of Environmental Protection
Bureau of Resource Protection -Title 5
Ll�
DEP Approved Inspection and O&M Form for Title 5 I/A
Treatment and Disposal Systems
26747
E. Field Testing
Field Inspection:
Color: [] gray [] brown []clear [x]turbid
[] Other(specify):
Odor: [] musty [] earthy [] moldy []offensive [x]turbid
Effluent Solids: [] no [x] some
pH 5 SU DO 6.88 mq/L Turbidity 8.66 NTU
6 to 9 2 or greater 40 or less
Should a Remedial or General Use system fail the Field Testing, effluent samples shall be
collected per Standard Methods and analyzed for BOD and TSS.
F. Sampling Information
Samples Taken: [] Influent [] Effluent
Commercial systems or systems with a design flow of 2000 gpd and greater, and General Use
nitrogen reducing systems:
440
gpd
Parameters sampled:
Influent: [] pH [] BOD []CBOD []TSS []TKN [] Nitrate [] Nitrite [] Phosphorus [ ] Spec.
Cond. []Ammonia []Alkalinity [] Oil Grease []VOC [] Fecal Coliform
Effluent: [] pH [] BOD [] CBOD []TSS []TKN [] Nitrate [] Nitrite [] Phosphorus [] Spec.
Cond. []Ammonia []Alkalinity [] Oil Grease [ ]VOC [] Fecal Coliform
G. Inspection and Maintenance
Description of any maintenance performed since previous inspection &during this inspection:
Cleaned Filter, Checked Splash Recycle, Checked Distal Pressure, Pump(s) Inspected, Float(s)
Inspected
Notes and Comments:
System needs to be pumped.
2
Massachusetts Department of Environmental Protection
Bureau of Resource Protection -Title 5
DEP Approved Inspection and O&M Form for Title 5 I/A
Treatment and Disposal Systems
26747
H. Certification
I certify: I have inspected the sewage treatment and disposal system at the address above, have
conducted the required Field Testing and/or sample collection in accordance with Standard
Methods, have completed this report and the attached technology operation and maintenance
checklist, and the information reported is true, accurate, and complete as of the time of the
inspection. I am a Massachusetts certified operator in accordance with 257 CMR 2.00.
tf
10/13/16
Operator Signature Date
System owner must submit this report, technology O&M checklist, and any required sampling
results to the local board of health and DEP as follows for each inspection performed:
Remedial Use—by January 31 st of each year for the previous calendar year
Piloting Use-within 45 days of inspection date
Provisional Use—by March 31th of each year for the previous 12 months
General Use— by September 30th of each year for the previous 12 months
Send to:
Department of Environmental Protection
Attention: Title 5 Program
One Winter Street, 6th Floor
Boston, MA 02108
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Bio-Microbics Remedial Use Approval MicroFAST,HighStrengthFAST and NitriFAST
III. Allowable Soil Absorption System Design
1. Reduction of the Required Soil Absorption System Size - An Applicant is eligible for up to a
50 percent reduction in the area of the soil absorption system required by 310 CMR 15.242,
where all the following is met. Accordingly,in approving design and installation of the System
by a particular Applicant, the local approving authority may allow up to a 50 percent reduction
in the area of the soil absorption system required by 310 CMR 15.242,provided that all of the
following conditions are met:
A. No reduction in the required separation(four feet in soils with a recordedP ercolation rate
of more than two minutes per inch or five feet in soils with a recorded percolation rate of
two minutes or less per inch)between the bottom of the stone underlying the SAS and the
high groundwater elevation is allowed unless such a reduction is first approved by the local
approving authority and then approved by the Department pursuant to 310 CMR 15.284.
B. No reduction in the required four feet of naturally occurring pervious material is allowed
unless the Applicant has demonstrated that the four foot requirement cannot be met
anywhere on the site,that easements to adjacent property on which a system in compliance
with the four foot requirement could be installed have been requested but cannot be
obtained, and that a shared system is not feasible. Any such reduction must first be
roved the local approving authority and then roved b the Department pursuant
approved by aPP g t3' approved Y
eP
to 310 CMR 15.284.
C. Where full compliance with all of the minimum set back distances in 310 CMR 15.211 is
not feasible, the local approving authority may allow a reduction under a local upgrade
approval in accordance with 310 CMR 15.405 (1)(a),(b),(fl, (g), and(h).
D. Where full compliance with all of the minimum set back distances in 310 CMR 15.211 is
not feasible, even taking into account provisions for local upgrade approval as described
above, then pursuant to 310 CMR 15.410,the applicant first must obtain variance(s) from
the local approving authority and then approval of the Department.
2. Reduction of the Required Separation Distance to High Groundwater Elevation- An applicant
is eligible for a reduction in separation (four feet in soils with a recorded percolation rate of
more than two minutes per inch or five feet in soils with a recorded percolation rate of two
minutes or less per inch) between the bottom of the stone underlying the SAS and the high
groundwater elevation, where all of the following conditions are met. Accordingly, in
approving design and installation of the System by a particular Applicant, the local approving
authority may allow a redaction in the required separation (four feet in soils with a recorded
percolation rate of more than two minutes per inch or five feet in soils with a recorded
percolation rate of two minutes or less per inch)between the bottom of the stone underlying the
SAS and the high groundwater elevation,provided that all of the following conditions are met:
A. A minimum two foot separation(in soils with a recorded percolation rate of more than two
minutes per inch) or a minimum three foot separation(in soils with a recorded percolation
rate of two minutes or less per inch) between the bottom of the stone underlying the SAS
and the high groundwater elevation is maintained.
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Bio-Microbics Remedial Use Approval MicroFAST,13ighSirengthFAST and NitriFAST
B. No reduction in the required SAS size is allowed unless such a reduction is first approved
by the local approving authority and then approved by the Department pursuant to 310
CMR 15.284.
C. No reduction in the required four feet of naturally occurring pervious material is allowed
unless the Applicant has demonstrated that the four foot requirement cannot be met
anywhere on the site,that easements to adjacent property on which a system in compliance
with the four foot requirement could be installed have been requested but cannot be
obtained, and that a shared system is not feasible. Any such reduction must first be
approved by the local approving authority and then approved by the Department pursuant
to 310 CMR 15.284.
D. Where full compliance with all of the minimum set back distances in 310 CMR 15.211 is
not feasible, the local approving authority may allow a reduction under a local upgrade
approval in accordance with 310 CMR 15.405 (1)(a), (b),(f), (g),and(h).
E. Where full compliance with all of the minimum set back distances in 310 CMR 15.211 is
not feasible, even taking into account provisions for local upgrade approval as described
above, then pursuant to 310 CMR 15.410, the applicant first must obtain variance(s) from
the local approving authority and then approval of the Department.
3. Reduction of the Requirement for Four Feet of Naturally OccurrinPervious Material — An
Applicant is eligible for a reduction in the required four feet of naturally occurring pervious
material in an area of no less thano f f
tw feet o naturally occurring pervious material,where all of
the following conditions are met. Accordingly, in approving design and installation of the
aPP g �
System by a particular Applicant, the local approving authority may allow a reduction in the
required four feet of naturally occurring pervious material in an area with no less than two feet
of naturally occurring pervious material,provided that all of the following conditions are met:
A. The Applicant has demonstrated that the four foot requirement cannot be met anywhere on
the site, and that easements to adjacent roe on which a stem' compliance l property rtY system in comp ance with the
four foot requirement q ent could be installed have been requested but cannot be obtained, and
that a shared system is not feasible.
B. No reduction in the required SAS size is allowed unless such a reduction is first approved
by the local approving authority and then approved by the Department pursuant to 310
CMR 15.284.
C. No reduction in the required separation (four feet in soils with a recorded percolation rate
of more than two minutesr '
per arch or five feet in soils with a recorded percolation rate of
two minutes or less per inch)between the bottom of the stone underlying the SAS and the
high groundwater elevation is allowed unless such a reduction is first approved by the local
approving authority and then approved by the Department pursuant to 310 CMR 15.284.
D. Where full compliance with all of the minimum set back distances in 310 CMR 15.211 is
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Bio-Microbics Remedial Use Approval MicroFAST,HighStrengthFAST and NitriFAST
not feasible, the local approving authority may allow a reduction under a local upgrade
approval in accordance with 310 CMR 15.405 (1)(a),(b),(f),(g), and(h).
E. Where M compliance with all of the minimum set back distances in 310 CMR 15.211 is
not feasible, even taking into account provisions for local upgrade approval as described
above, then pursuant to 310 CMR 15.410,the applicant first must obtain variance(s)from
the local approving authority and then approval of the Department.
IV. General Conditions
1. All provisions of 310 CMR 15.000 are applicable to the use of this System,the owner and the
Company, except those that specifically have been varied by the terms of this Approval.
2. Any required sample analysis shall be conducted by an independent U.S. EPA or DEP
approved testing laboratory,or a DEP approved independent university laboratory. It shall be a
violation of this Approval to falsify any data collected pursuant to an approved testing plan, to
omit any required data or to fail to submit any report required by such plan.
3. The facility served by the System and the System itself shall be open to inspection and
sampling by the Department and the local approving authority at all reasonable times.
4. In accordance with applicable law, the Department and the local approving authority may
require the owner of the System to cease operation of the System and/or to take any other
action as it deems necessary to protect public health, safety,welfare and the environment.
5. The Department has not determined that the performance of the System will provide a level of
protection to public health and safety and the environment that is at least equivalent to that of a
sewer system. Accordingly,no System shall be installed, upgraded or expanded,if it is feasible
to connect the facility to a sanitary sewer,unless as allowed by 310 CMR 15.004.
6. Design and installation shall be in strict conformance with the Company's DEP approved plans
and specifications,310 CMR 15.000 and this Approval.
V. Conditions Applicable to the System Owner
1. The System is approved for the treatment and disposal of sanitary sewage only. Any wastes
that are non-sanitary sewage generated or used at the facility served by the System shall not be
introduced into the System and shall be lawfully disposed.
2. Effluent discharge concentrations shall meet or exceed secondary treatment standards of 30
mg/L biochemical oxygen demand (BODS) and 30 mg/L total suspended solids (TSS). The
effluent pH shall not vary more than 0.5 standard units from the influent water supply.
3. Operation and Maintenance Agreement:
A. Throughout its life, the Owner of the System shall have the System properly operated
and maintained in accordance with Company's and designer's operation and
maintenance requirements and this Approval and be under an operation and
PP p
maintenance agreement(O&M). No O&M agreement shall be for less than one year.
B. No System shall be used until an O&M agreement is submitted to the approving
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Bio-Microbics Remedial Use Approval MicroFAST,HighStrengthFAST and NitriFAST
authority which:
a. provides for the contracting of a person or firm competent in providing services
consistent with the System's specifications and the operation and maintenance
requirements specified by the designer and those specified by the Department;
b. contains procedures for notification to the local approving authority and the
Department within five days of a System failure, malfunction or alarm event and
for corrective measures to be taken immediately; and
c. Provides the name of the operator, which must be a Massachusetts certified
operator as required by 257 CMR 2.00 that will operate and monitor the System.
The owner of the System shall at all times have the System properly operated and
maintained, at a minimum every three months and every time there is an alarm
event. The local approving authority and the Department shall be notified, in
writing,within seven days every time the operator or operators are changed
4. The owner shall furnish the Department any information, which the Department may request
regarding the System,within 21 days of the date of receipt of that request.
5. Within 30 days of the approving authority's issuance of the Certificate of Compliance for the
system,the owner shall submit a copy of the Certificate of Compliance to the Department.
6. By January 31*` of each year for the previous year, the System owner shall submit to the
Department and the local approving authority an O&M checklist and a technology checklist,
completed by the System operator for each inspection performed during the previous calendar
year. Copies of the checklists are attached to this approval.
7. The owner of the System shall record in the appropriate registry of deeds a notice that discloses
the existence of this Remedial Use approved alternative system. A copy of the book and page
number of the recording must be provided to the local approving authority and the Department
prior to the issuance of the Certificate of Compliance.
8. The owner of the System shall provide a copy of this Approval, prior to the signing of a
purchase and sale agreement for the facility served by the System or any portion thereof,to the
proposed new owner.
9. Effluent from a system serving a facility with a design flow of less than 2000 GPD shall be
monitored quarterly. Both influent and effluent from a system serving a facility with a design
flow 2000 GPD to 10,000 GPD shall be monitored monthly. At a minimum, the following
parameters shall be monitored: pH, BODS, and TSS. All monitoring and operation and
maintenance data shall be submitted to the local approving authority and the Department by
January 31't of each year for the previous calendar year. After one year of monitoring and
reporting and at the written request of the owner, the Department may reduce the monitoring
and reporting requirements.
10. When sanitary sewer connection becomes feasible,within 60 days of such feasibility,the owner
of the System shall obtain necessary permits and connect the facility served by the System to
the sewer, shall abandon the System in compliance with 310 CMR 15.354, unless a later time
is allowed, in writing, by the local approving authority, and shall in writing notify the
Department of the abandonment.
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Bio-Microbics Remedial Use Approval MicroFAST,HighStrengthFAST and NitriFAST
VI. Conditions Applicable to the Company
1. By January 3 V4 of each year, the Company shall submit to the Department,a report,signed by
a corporate officer, general partner or Company owner that contains information on the System,
for the previous calendar year. The report shall state:the number of units of the System sold for
use in Massachusetts including the installation date and date of start-up during the previous
year, the address of each installed System, the owner's name and address, the type of use(e.g.
residential, commercial, school, institutional) and the design flow, and for all Systems installed
since the date of issuance of this Approval, all known failures, malfunctions, and corrective
actions taken and the address of each such event.
2. The Company shall notify the Director of the Watershed Permitting Program at least 30 days in
advance of the proposed transfer of ownership of the technology for which this Approval is
issued. Said notification shall include the name and address of the proposed new owner and a
written agreement between the existing and proposed new owner containing a specific date for
transfer of ownership, responsibility, coverage and liability between them. All provisions of this
Approval applicable to the Company shall be applicable to successors and assigns of the
Company,unless the Department determines otherwise.
3. The Company shall furnish the Department any information that the Department requests
regarding the System,within 21 days of the date of receipt of that request.
4 Prior to its sale of the System, the Company shall provide the purchaser with a copy of this
Approval. In any contract for distribution or sale of the System, the Company shall require the
distributor or seller to provide the purchaser of the System, prior to any sale of the System,
with a copy of this Approval.
5. If the Company wishes to continue this Approval after its expiration date, the Company shall
apply for and obtain a renewal of this Approval. The Company shall submit a renewal
application at least 180
days before the expiration date of
this Approval, unless written
permission for a later date has been granted in writing by the Department.
VII. Reporting
1. All notices and documents required to be submitted to the Department by this Approval shall
be submitted to:
Director
Watershed Permitting Program
Department of Environmental Protection
One Winter Street-61h floor
Boston,Massachusetts 02108
VIII. Rights of the Department
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