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Home My WebLink AboutMiscellaneous - 534 BOSTON STREET 4/30/2018 (2) _ 534 BOSTON STREET =t 210/107.D-0081-0000.0 - 1� i 1� �i F' C r • i i I I I North Andover Board of Assessors Public Access Page 1 of 1 'Fo of North A VA*0Ver i A Property Return to the Home page click on logo Record Card Parcel ID:210/107.D-0081-0000.0 Community: North Andover New Search SKETCH PHOTO Click on Sketch to Enlarge Sales No Picture i cti�d�re Summary F7 Residence A liable Detached Structure Condo Commercial Comparable Sales Location: 534 BOSTON STREET Owner Name: PETRALIA FAMILY TRUST THOMAS H PETRALIA,TRUSTEE Owner Address: 534 BOSTON STREET City: NORTH ANDOVER State: MA ZIP:01845 Neighborhood:6-6 Land Area: 1.09 acres �v Use Code: 101 -SNGL-FAM-RES Total Finished Area: 1998 sqft ASSESSMENTS CURRENT YEAR PREVIOUS YEAR Total Value: 523,200 481,800 Building Value: 291,600 271,400 Land Value: 231,600 210,400 Market Land Value:231,600 Chapter Land Value: LATEST SALE Sale Price: 100 Sale Date:09/17/2002 Arms Length Sale Code: F-NO-CONVNIENT Grantor:PETRALIA,THOMAS Cert Doc: Book:07094 Page:0045 I http://csc-ma.us/NandoverPubAcc/j sp/Home.j sp?Page=3&Linkld=992091 7/24/2007 t i { ti. NOTICE The property known as 534 Boston Street, North Andover, Essex County, Massachusetts,referred to in a deed recorded with Essex North District Registry of Deeds in Book 10796, Page 71 has been improved with a subsurface sewage disposal system using an approved alternative technology known as a Clean Solution Alternative Treatment System. Said alternative technology is approved by the Massachusetts Department of Environmental Protection and shall be operated under the terms and conditions of said approval dated June 20, 2006, including the provision that the owner maintain an operations and maintenance contract for the system with a qualified person. This Notice is given by the property seller: rali Family T Date: /7 d15 omas H. Petrali , rustee COMMONWEALTH OF MASSACHUSETTS Essex, ss. On this jn`h.day of January, 2008 before me, the undersigned notary public, personally appeared Thomas H. Petralia, Trustee of Petralia Family Trust, and proved to me through satisfactory evidence of identification, which were Photo ID, to be the persons whose names are signed to this preceding document and acknowledged to me that they signed it voluntarily for its stated purpose. �- ItIt111// Ilj� Notary Pu lic ��o�` • L e !"k, , My Commission expires: .�`�� sstaN :9j-°''. Buyer and current owner acknowledgment of the within described Notice regarcing y ative reatm nt System located at 534 Boston Street North Andover MA= 4aniel W.. Gutm n Cathy L. G an ��lull X111°`� unn COMMONWEALTH OF MASSACHUSETTS Essex, ss. On this1 ay of January, 2008 before me, the undersigned notary public, personally appeared Daniel W. Gutman and Cathy L. Gutman, and proved to me through satisfactory evidence of identification, which were Photo ID, to be thep ersons whose names are signed to this preceding document and acknowledged to me that they signed it voluntarily for its stated purpose. Notary My Commission expires: &, DANA S.COHEN Notary Public Commonwealth of Massachusetts Ulf My Commission Expires Jan.31,2014 DEC 20,2007 12:44A Wastewater Alternatives 508-693-2224 page 2 WASTEWATER ALTERNATIVE'S OF NEW ENGLAND,LLC 6 4 S) s 27 KENSINGTON ROAD 90 : HAMPTON FALLS,NH 03844 Tetephone:( 508)508-2221 Fax:(508)693-2224 MAINTENANCE AGREEMENT August 23,2007 BUYER: TOM Patratia SITE: I Riverview Blvd. 534 Boston Street Methuen,MA 01844 North Andover,MA 01845 ENGINEER: New England Engineering Services,INC Osgood Landing 1600 Osgood Street,Suite 2-64 North Andover,MA 01845 SELLER: Wastewater Altematives of New England, LLC. 27 KENSINGTON ROAD HAMPTON FALLS,NH 03844 Wastewater Alternatives of New England,LLC.(WANE)agrees to maintain the system located at the above site for a period of one year. The maintenance will cosist of an inspection in accordance with our operational technology check list. 1. Should the above property be sold,this agreement should be transferred to the new buyer and will become binding on both the seller and the new owner]s]. 2.This agreement contains a maintenance schedule.Failure to reactivate this maintenance contract could result in premature failure of the dispersal field. In this event it will be the owners responsibility to repair the field. MAINTENANCE The following maintenance is required every 2.5 years in addition to our regular inspections: 1. Puma out both the settling and septic tanks 2.COMPRESSOR replacement if neceesary 3. Inspect and take corrective action,if necessary: al media if plugged,backwash with air b]sludge in BioCon pump BleCon tank if excessive cl diffuser replace if pressure drop too great Tank pumping is not included in the price of our regular inspections and will be billed to you at direct cost when nodded.Tank pumping schedule w ill be dctcrmined by our certified septic inspecto,failior to pump system when operator deems it nessesary will void the company warranty, Rased on the inspection findings at the rirsl scheduled maintenance,the maintenance schedule may be modified by mutual consent and any changes will be redocH to wriling.to the absence of A wrinen muddied maintenance schedule,the above THE CLEAN SOLUTIONTM An Allernutive Septic System DEC 20,2007 12:44A Wastewater Alternatives 508-693-2224 page 3 WAS1 EWxTER ALTERNA'T'IVES OF NEW ENGLAND, LLC 27 KENSINGTON ROAD HAMPTON FALLS,NH 03644 for a period of S years,WANE will warrant the system and repair any malfunction,including parts and labor,at no cost to you.Your responsibility during this period is to contunue the required maintenance and to notify WANE of any failure.Failure to perform either of these items will void this warranty and result in you being billed for repair costs.This warranty also does not cover damage caused by unreasonable use or acts of God. THIS LIMITED WARRANTY IS IN LIEU OF ALL OTHER EXPRESS WARRANTIES.ANY IMPLIED WARRANTY OF FITNESS FOR A PARTICULAR PURPOSE,MERCHANTABILITY OR OTHERWISE, APPLICABLE TO THE SEWAGE TREATMENT SYSTEM SHALL BE LIMITED IN DURATION TO ONE YEAR. WASTEWATER ALTERNATIVES SHALL NOT BE LIABLE FOR ANY DIRECT OR IN DIRFCT,SPECIAL, INCIDENTAL,OR CONSEQUENTIAL DAMAGES.NOR,SMALL WASTL'WATER ALTERNATIVE'S LIABILITY UNDER THIS WARRANTY EXCEED THE PRICE PAID BY THE BUYER. PERFORMANCE SPECIFICATIONS: The system is warranted to discharge clean,odor free water to the dispersal field, equivalent or better than that obtained from a municipal system with secondary treatment(30ppm BODS;30ppmTSS). PAYMENT The agreed upon price for the WAN F,equipment and services detailed in this agreement is $175.00 per visit every six months Ownership will transfer to the buyer upon final payment_ THIS PRICE IS VAL D FOR 60 DAYS FROM THE DATE OF THIS DOCUMFNT. RIGHTS TO DATA AND ACCESS TO THE SYSTEM WANE reserves the right ofreasonable access to collect data,modify,maintain and repair THE CLEAN SOLUTION and its subsystems.WANE will retain all data collected and the rights to it. TRADE SECRETS THE CLEAN SOLUTION is the resu It of the expenditure of much effort and money.The design of the components and operational cycle are the intellectual property of WANE and may not be revealed without written permission. r\ �u `.aC�..�tS�`' �1-�.. M�--i►'t�-G+n,C,w�C.�. -�t':r`t'r�S, G� �'h� THE CLEAN SOLUTI TM An Alt rpIgtr ve Septic System �-�t'4�M [.i. to C—k .r t'�Ci�- v��C�iu DEC 20,2007 12:44A Wastewater Alternatives 508-693-2224 page 4 WASTEWATER ALTERNATIVES OF NEW ENGLAND,LLC 27 KENSINGTON ROAD y.� HAMPTON FALLS,NH 03844 ACCEP _ BUYER: 7v Sfl..I,Bjesley ter Alteesident ngland,LLC righton i Date: �'�` .Z,L-t -� Date: August 23,2007 Included: Sample of our technology checklist THE CLEAN SOLUTIONI'm An Alternative.Septic.Vstem WASTEWATER ALTERNATIVES OF NEW ENGLAND, LLC 27 Kensington Road Hampton Falls, NH 03844 Telephone: ( 508) 508-2221 Fax: (508) 693-2224 MAINTENANCE AGREEMENT AUGUST 1, 2007 BUYER: Thomas Patralia 1 River View blvd. SITE: Methuen, MA 534 Boston St. 01 844 N. Andover, MA ENGINEER: NE Engineering services 01856 SELLER: Wastewater Alternatives of New England,LLC. 27 KENSINGTON ROAD HAMPTON FALLS, NH 03844 Wastewater Alternatives of New England, LLC. (WANE) agrees to maintain the system located at the above site for a period of one year. The maintenance will cosist of an inspection in accordance with our operational technology check list. 1. Should the above property be sold, this agreement should be transferred to the new buyer and will become binding on both the seller and the new owner[s]. 2. This agreement contains a maintenance schedule. Failure to reactivate this maintenance contract could result in premature failure of the dispersal field. In this event it will be the owners responsibility to repair the field. I MAINTENANCE THE CLEAN SOLUTION TM An Alternative Septic System r � WASTEWATER ALTERNATIVES OF NEW ENGLAND, LLC 27 Kensington Road Hampton Falls, NH 03844 The following maintenance is required every 2.5 years in addition to our regular inspections: 1. Pump out both the settling and septic tanks 2. COMPRESSOR replacement if neccesary 3. Inspect and take corrective action, if necessary: a] media if plugged,backwash with air b] sludge in BioCon pump BioCon tank if excessive c] diffuser replace if pressure drop too great Tank pumping is not included in the price of our regular inspections and will be billed to you at direct cost when needed. Tank pumping schedule will be determined by our certified septic inspecto, failior to pump system when operator deems it nessesary will void the company warranty. Based on the inspection findings at the first scheduled maintenance, the maintenance schedule may be modified by mutual consent and any changes will be reduced to writing. In the absence of a written modified maintenance schedule, the above schedule must continue to be performed. For a period of 5 years, WANE will warrant the system and repair any malfunction, including parts and labor, at no cost to you. Your responsibility during this period is to contunue the required maintenance and to notify WANE of any failure. Failure to perform either of these items will void this warranty and result in you being billed for repair costs. This warranty also does not cover damage caused by unreasonable use or acts of God. THIS LIMITED WARRANTY IS IN LIEU OF ALL OTHER EXPRESS WARRANTIES. ANY IMPLIED WARRANTY OF FITNESS FOR A PARTICULAR PURPOSE, MERCHANTABILITY OR OTHERWISE, APPLICABLE TO THE SEWAGE TREATMENT SYSTEM SHALL BE LIMITED IN DURATION TO ONE YEAR. WASTEWATER ALTERNATIVES SHALL NOT BE LIABLE FOR ANY DIRECT OR INDIRECT, SPECIAL, INCIDENTAL, OR CONSEQUENTIAL DAMAGES. NOR, SHALL WASTEWATER ALTERNATIVE'S LIABILITY UNDER THIS WARRANTY EXCEED THE PRICE PAID BY THE BUYER. PERFORMANCE SPECIFICATIONS: The system is warranted to discharge clean, odor free water to the dispersal field, equivalent or better than that obtained from a municipal system with secondary treatment (30ppm BODS, 30ppmTSS). PAYMENT THE CLEAN SOLUTIONTM An Alternative Septic System WASTEWATER ALTERNATIVES OF NEW ENGLAND, LLC 27 Kensington Road Hampton Falls, NH 03844 The agreed upon price for the WANE equipment and services detailed in this agreement is $175.00 per visit every six months Ownership will transfer to the buyer upon final payment. THIS PRICE IS VALID FOR 60 DAYS FROM THE DATE OF THIS DOCUMENT. RIGHTS TO DATA AND ACCESS TO THE SYSTEM WANE reserves the right of reasonable access to collect data, modify, maintain and repair THE CLEAN SOLUTION and its subsystems. WANE will retain all data collected and the rights to it. TRADESECRETS THE CLEAN SOLUTION is the result of the expenditure of much effort and money. The design of the components and operational cycle are the intellectual property of WANE and may not be revealed without written permission. ACCEPTED: BUYER: SELLER: Wastewater Alternatives of New England, LLC Wesley Brighton, President Date: Date: August,1 2007 Included: Sample of our technology checklist THE CLEAN SOLUTIONTM An Alternative Septic System Bac 11037 � Ps X4-8 - ..a j' 1,34r3 01-18-2008 I� COVER SHEET THIS IS THE FIRST PAGE OF THIS DOCUMENT DO NOT REMOVE GRANTOR GRANTEE r 01��S ADDRESS OF PROPERTY CITY/TOWN TYPE OF DOCUMENT MLC ASSIGNMENT TYPE DEED 6D MORTGAGE NOTICE TYPE DISCHARGE SUBORDINATION AFFIDAVIT CERT TYPE DEC OF HOMESTEAD UCC TYPE DEC OF TRUST OTHER_ _ D_0 Ci�' DESCRIBE Essex North Registry of Deeds Robert F. Kelley, Register 354 Merrimack St. Suite 304 Lawrence, MA 01843 (978) 683-2745 PS'' www.lawrencedeeds.com 'S ��' JAN- 17 2008 0111J) 09 : 55 CHMS0 AND CARUSO (FAK) 9784751001 P. 001/002 • Caruso&Caruso,LLP One Elm Square • Andover MA 01810 978475-2200 Fax 978475-1001 Email:dlemay(u`lcarusoandcaruso.com facse �ra�r�srr� ttal To: Susan Sawyer—Town North Andover Fax: 978-688-8476 Health Dept From: Debbie Date: 1/17/08 Re: 534 Boston Rd Pages: Request for Title V Certificate CC: N/A ❑ Urgent ❑For Review Cl Please Comment ❑ Please Reply ❑ Please Recycle Susan This office prepared the Notice of Alternative Septic System to comply with your requirements for this property. Before recording,we would like the approval from you roffice that this is the document that will satisfy the requirement to issue a Title Von 534 Boston Road. Mr.Petralia is coming in at Noon today to sign,then we would like to record at the Registry of Deeds immediately after. Can you please peek at this asap and fax back an OK"? appreciate your assistance. Debbie NOTICE OF CONFIDENTIALITY This message is a PRIVATE communication which may contain attomey/client privileged material. If you are not the intended recipient,please do not read,copy,use,or disclose to others. If you have received this message in error,please reply to sender and delete this message from your system. Thank You. To ensure compliance with requirements imposed by the IRS,we inform you that any U.S.tax advise contained in this communication is not intended or written to be used by any taxpayerfor the purpose of avoiding U.S.tax penalties. i y RECEIPT Printed:01-09-2008 @ 10:47:54 Essex North Registry Robert F. Kelley Register Trans#: 3376 Oper:KEVINA CARUSO ----------------------- Book: 11027 Page: 37 Inst#: 530 Ctl#: 63 Rec:1-09-2008 @ 10:47:46a DOC DESCRIPTION TRANS AMT --- ----------- --------- NOTICE Surcharge CPA $20.00 20.00 50.00 recording fee 50.00 5.00 TECH FEE 5.00 Total fees: 75.00 *** Total charges: 75.00 CHECK PM 3487 75.00 1.9 co as—2 9 C0'Q 4-7 4 0. ESSEX NORTH REGISTRYOF DEEDS COVER SHEET This is the first paLye of this document - Do not remove ESSEX NORTH REGISTRY OF DEEDS ROBERT F. KELLEY, REGISTER 354 MERRIMACK STREET SUITE 304 LAWRENCE, MA 01844 (978) 683-2745 www.lawrencedeeds.com t%ORTFr Q��SLly /6�tiO O O COCwItM WKw 1' 0,0 TED ��SSAC HUS�t�y PUBLIC HEALTH DEPARTMENT Community Development Division C FRTjFICArrCF O F CO�VI<1'GIAjrVCE As of: january 18, 2008 This is to cert that the individua(su6surface d4osafsystem received a SA`I7SFAC`7ORTI.AVSPECTIOW of the: Complete Septic System Repair/Replacement Oy. James Kellett At: 534 (Boston Street Map 107. 10; Parce[81 JVorthAndover, 914A 01845 The Issuance of this certificate shaft not 6e construed as a guarantee that the system wiff -function satin actorif. � f y Susan 7 Sawyer (Pu6fic 9feaCth Director 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 Fax 918.688.8476 Web www.townofnorthandover.com TOWN OF NORTH ANDOVER Ot NORTry^� Office of COMMUNITY DEVELOPMENT AND SERVICES or HEALTH DEPARTMENT i 400 OSGOOD STREET "` ----- NORTH ANDOVER, MASSACHUSETTS 01845 'Ss^cNuSe� 978.688.9540—Phone Susan Y.Sawyer,REHS/RS 978.688.8476—FAX Public Health Director E-MAIL: healthde t a townofnorthandover.com WEBSITE:http://wwkv.townofiiorthandover.com TOWN OF NORTH ANDOVER SEPTIC DISPOSAL SYSTEM - INSTALLATION CERTIFICATION The undersigned hereby certify that the Sewage Disposal System ( ) constructed; ( repaired; by _ A Mes Ke//-e 44- (Print 4(Print Name) located at 53 q &-too (��" etL &/(I. Adotyv, (Installation Address)- was installe in conformance with the North Andover Board of Health approved plan, originally dated UktS f and last Revised on iAllAP , with a design flow of gallons per day. The materials used were in conformance with those specified on the approved plan;the system was installed in accordance with the provisions of 310 CMR 15.000, Title 5 and local regulations, and the final grading agrees substantially with the approved plan. All work is accurately represented on the As-built which has been submitted to the Board of Health. Bed inspection date: f EnlVeer Re resentative(Signature) �vL 13Q�gssyEYZ And-Print Name Final inspection date: _ E weer Representative( ature)nM, _ And-Pmt Name Installer: ` (Signature) Date: /�G o7 7 And-Print Name Engineer: (Signature) Date: eft 2 And- Print Nam RECEIVED DEC Y 1 2007 TOWN OF NORTH HEALTH DEPARTMENTER Daniel Gutman 534 Boston St. j North Andover, MA 01845 To Whom It May Concern: As the current owner of the property at 534 Boston St., I can affirm that Jim Kellett of Kellett excavation spread loam across the disturbed areas of the yard upon completion of the installation of the septic system. After speaking with Jim Kellett about the remainder of the work, we have decided to defer the installation of the hydro mulch until-next spring to give it a better chance to grow. Money will be set aside from the escrow established by the previous owner of the property to cover the expense of installing the hydro mulch/ seeding which will be completed at the earliest prudent time in 2008. Sincerely, Dan Gutman I RECEIVED DEC 1 1 2007 , AS-BUILT CHECKLIST TOWN OF NORTH ANDOVER HEALTH DEPARTMENT LOT NUMBER, STREET NAME ASSESSORS MAP & PARCEL NUMBER,. ✓"� LOT LINES & LOCATION OF DWELLINGS LOCATIONS &DIMENSIONS OF SYSTEM, INCLUDING RESERVE TIES TO LOT LINES &DWELLING, WELLS a. FROM SEPTIC TANK b. FROM LEACH AREA LOCATIONS OF DEEP HOLES &PERC TESTS '` ELEVATIONS OF DISPOSAL SYSTEM TOP OF FDN ELEVATION LOCATIONS OF WELLS, DRAINS, WATERCOURSES ,s WITHIN 150' OF SYSTEM ✓ LOCATION OF WATER, GAS, ELECTRIC LINES, CABLE DISTANCES FROM CORNERS OF HOUSE TO CENTER OF TANK& D-BOX ORIGINAL STAMP& SIGNATURE IMPERVIOUS AREAS -DRIVEWAYS, ETC. NORTH ARROW LOCATION & ELEVATIONS OF BENCHMARK USED I V%ORTH 4 O�tt�eo X6.5 O �► F- 70 T Oq4 c"..cnlwKw 0 ATeo#I 5 �SSAC HUS�� I PUBLIC HEALTH DEPARTMENT Community Development Division ONSITE WASTEWATER SYSTEM CONSTRUCTION NOTES LOCATION INFORMATION ADDRESS: 534 Boston Street MAP: 107D LOT: 81 INSTALLER: Jim Kellet DESIGNER: New England Engineering PLAN DATE: June 5, 2007 BOH APPROVAL DATE ON PLAN: gl 9 1 d1 INSPECTIONS TANK INSPECTION: DATE OF BED BOTTOM INSPECTION: DATE OF FINAL CONSTRUCTION INSPECTION: November 26, 2007 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 ® 1 gallon tank has been installed 600 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 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com %%0RTkj q �O O A� O COCMIL1!KM y�` RA°RAre° 9SSAC HU`�� PUBLIC HEALTH DEPARTMENT Community Development Division ® 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: Clean Solutions Alternative System was installed utilizing a combo Septic Tank and treatment unit PUMP CHAMBER Bottom of tank hole has 6" stone base ❑ Weep hole plugged ❑ Combo Tank installed. Size: ® 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 floats working ® Separate on/off floats ® Drain hole in pressure line ® 24" inch cover to within 6" of final grade installed over pump access port ® Water tightness of tank has been achieved Visual testing ® Hydraulic cement around inlet & outlet Comments: Hydromatic Pump Installed as specified DISTRIBUTION-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: Not applicable 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com I tkORT#1 q O tree 6 ti +6 O L 0 ti 0 A.O•pA COCMICMC WI[M 7 ��SSACHUS PUBLIC HEALTH DEPARTMENT Community Development Division SOIL ABSORPTION SYSTEM (General) ❑ Bottom of SAS excavated down to 6 in into C soil layer, as provided on plan ® Size of SAS excavated as per plan ® Title 5 sand installed, if specified on plan ® 40 Mil HDPE barrier installed ❑ Retaining wall (boulder/ concrete /timber/ block) ❑ Final cover as per plan Comments: specified squirt height was achieved during start up SOIL ABSORPTION SYSTEM (Gravel-less Chambers) ® Brand and Model of Chamber: Infiltrator Quick 4 Std ® Number of chambers per row: 11 ® Number of rows (trenches): 3 ❑ Laterals installed and ends connected to header (and vented if impervious material above) ® Elevations of laterals and chambers installed as on approved plan Comments: Splash block and inspection ports installed as specified CONTROLPANEL ® Alarm & Pump are on separate circuits ® Alarm sounds when float is tripped ® Location of control panel: Interior ® Rated for exterior if placed outside ® Alarm signal located inside Comments: 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com i NORTFf O�4.0.2 0 16 OL FO- 0 e° O Coc M1[wt Kw 1` �•9 g04 r1D PPP,`(y SSACHUS� PUBLIC HEALTH DEPARTMENT (ommunity Development Division SYSTEM ELEVATIONS INVERT IN FIELD PLAN INVERT ELEV. Benchmark HI =103.50 / 114.04 102.65 Building Sewer OUT 98.57 N/A Septic Tank IN 98.42 98.47 Septic Tank OUT 98.25 98.22 Pump Chamber IN 98.21 98.17 Pump Chamber OUT 98.56 N/A Pressure Lateral 1 Invert Beg. 111.52 111.67 Lateral 1 Invert End 111.52 111.67 Lateral 2 Invert Beg. 111.52 111.67 Lateral 2 Invert End 111.52 111.67 Lateral 3 Invert Beg. 111.52 111.67 Lateral 3 Invert End 111.52 111.67 Lateral 4 Invert Beg. 111.52 111.67 Lateral 4 Invert End 111.52 111.67 Top of Septic Tank 99.55 N/A Top of Pump Chamber 99.55 N/A top of HDPE Barrier 111.90 112.00 I 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 918.688.9540 Fax 918.688.8416 Web www.townofnorthandover.com I ~ O� NO RTF s'° �O O N A 0`0 Top �SSAC HUS�� PUBLIC HEALTH DEPARTMENT Community Development Division CRITICAL SETBACK DISTANCES Mark those distances checked in the field against the design plan and regulatory setback Tank SAS Sewer ® Property line 10 10 -- ® Cellar wall 10 20 -- ❑ Inground pool 10 20 -- ❑ Slab foundation 10 10 -- ® Deck, on footings, etc 5 10 -- ❑ Waterline 10 10 10' ❑ Private drinking well 75 1002 50 ❑ Irrigation well 75 100 ❑ Surface Water 25 50 ❑ Bordering Vegetated Wetland , Salt Marsh, Inland/Coastal Banka 75 100 ❑ Wetlands bordering surface water supply or trib. (in Watershed) 150 150 ❑ Trib.to surface water supply 325 325 ❑ Public well 400 400 ❑ Interim Wellhead Prot. Area ❑ Reservoirs 400 400 ❑ Drains (wat. supply/trib.) 50 100 ❑ Drains(intercept g.w.) 25 50 ❑ Drains (Other)Foundation 10(5) 20(10) ❑ Drywells 20 25 1 Suction line 222(2) 2 100 feet is a minimum acceptable distance and no variance is allowed for a lesser distance(NA 5.02). 3 As defined in 310 CMR 10.55, 10.32, 10.54,and 10.30,respectively,pursuant to 15.211(3),also by NA wetland bylaws 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com i ,ApRtw ; Commonwealth of Massachusetts Map-Block-Lot 3?° &'° °•.:�oo� 107.D-0081 - Board of Health "MmdaL Permit No .' BHP-2007-0265 North Andover --____--.---_--_- . ,` + P.I. FEE cwust� F.I. $250.00 ----------------------- Disposal Works Construction Permit Permission is hereby granted James-Kellett ----------------------------------------------------------------------------------------------------- to(Repair)an Individual Sewage Disposal System. at No 534 BOSTON STREET as shown on the application for Disposal Works Construction Permit No. BHP-2007-026 Dated September 11,2007 ------------------------------------------------------------- Issued On: Sep-11-2007 Board of Health 111/P Of pORTN q Application for Septic Disposal System 9 'Y' 3 7. ° O� TODAY pConstruction Permit — TOWN OF { F; ORTH ANDOVER, MA 01845 $125.00 -Component SACHUS Important: Application is herebv made fora permit to: When filling out ❑ Constru new on-site sewage disposal system* forms on the computer, use air or replace an existing on-site sewage disposal system* only the tab key to move your Repair or replace an existing system component—What? cursor-do not use the return A. Facility Information key. .5_3,f 13� +�/ f �1 w 1 ✓ Address or Lot#�� O /Uet-t), City/Town 2. TYPE OF SEPTIC SYSTEM*: ® Pump ❑ Gravity (choose one) ***If pump system, attach copy of electrical permit to application*** ❑ Conventional System(pipe and stone system) ❑ Infator or Biodiffuser(Gravel-Less) (Attach a copy of your certification to install this type of system. ressure Distribution S.A.S. (No D-Box) (Attach Draft Maintenance Agreement) ❑ Pressure Dosed (D-Box Present)S.A.S. 2. Owner Information Name $ 3Y dos Address(if different from above) ,44' H ,e►�„��, , � ores City/Town State Zip Code Telephone Number 3. Installer Information 07- ' 4/C.-04 t Cs'q L Name Name of Company �U4,, S4 Address �� L,h,4 CityfP6wn State Zip Code ';7d/- 75-7- 711'11� Telephone Number(Cell Phone#if possible please) 4. Designer Information Name 10, Name of Company z G 6ro Address /vet--& '0"?X 7� City/Town State Zip Code Telephone Number(Best#to Reach) Application for Disposal System Construction Permit•Page 1 of 2 pORTIi ' Application for Septic Disposal Svstem 3r Oe, o,;e q�00G y AConstruction Permit — TOWN OF TODAY'S DATE ',�•-o,,,,o�.:.• ' ORTH ANDOVER, MA 01845 $ 250.00-Full Repair qss^�McsF< $125.00 -Component PAGE 2OF2 A. Facility Information continued.... 5. Type of Building:VResidential Dwelling or❑Commercial B. Agreement The undersigned agrees to ensure the construction and maintenance of the afore-described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code, as well as the Local Subsurface Disposal Regulations for the Town of North Andover, and not to place the system in operation until a Certificate of Compliance has bD isd by this Board of Health.su Name Dat Application Approved By: (Board of Health Representative) Name Date Application Disapproved for the following reasons: 9 � ,)�r 7;� o ' For Office Use Only: Fee Attached? Yes`' No 2. Project Manager Obli ation Form Attached. Yes No s 3Pump S v tem? If so,Attach copy of Electrical Permit Yes_ I No 0. 4. Foundation As-Built. (new construction ronly): Yes No (Same scale as approvedplan) 5. Floor Plans?(new construction only): Yes No Application for Disposal System Construction Permit•Page 2 of 2 SEPTIC SYSTEM INSTALLER PROJECT MANAGEMENT OBLIGATIONS As"the North Andover licensed installer for the construction for the septic system for the property at: 3 L/ /-30sy-o,N S?, (Address of septic system) For plans by � j (Engineer) Relative to the application of V/, "t (Installer's name) And dated J de --57 ;_qo-7 Dated o nng�in ate � </� � � �I o ay s ate With revisions dated (Last revised date) I understand the following obligations for management of this project: 1. As the installer, I am obligated to obtain all permits and Board of Health approved plans p1jor to performing any work on a site. I must have the approved plans and the permit on site when any work is being done. 2. As the installer, I must call for any and all inspections. If homeowner, contractor,project manager, or any other person not associated with my company schedules an inspection and the system is not ready, then item three shall be applicable. 3. As the installer, I am required to have the necessary work completed prior to the applicable inspections as indicated below. I understand that requesting an inspection,without completion of the items in accordance with Title 5 and the Board of Health Regulations may result in a $50.00 fine being levied against me and/or my company. a. Bottom of Bed—Generally, this is the first (VS inspection unless there is a retaining wall,which should be done first. The installer must request the inspection but does not have to be present. b. Final Construction Inspection—Engineer must first do their inspection for elevations, ties, etc. As-built of verbal OK (or e-mail to: healthdeptQtownofnorthandover.com) from the engineer must be submitted to the Board of Health,after which installer calls for an inspection time. Installer must be present for this inspection. With a pump system, all electrical work must be ready and able to cause pump to work and alarm to function. c. Final Grade—Installer must request inspection when all grading is complete. Installer does not have to be on-site. 4. As the installer, I understand that only I may perform the work (other than simple excavation)and I am required to complete the installation of the system identified in the attached application for installation. I further understand that work done b others unlicensed to install septic stems in North Andover can constitute y p y 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: z / d 7 (Today's Date) (Name—Print) me—Signed) I I Sep 12 07 06: 58a Jim Kellett 781 -595-3330 p. l ATT:Pane I James Kellett give Patty Meehan permission to pick up permit for 534 Boston st. Thank You, amts Kel ett i Commonwealth of Massachusetts official Use Only Department of Fire Services Permit No. Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/071 leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: g /07 r City or Town of: NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) ,�D$'{�r! �S�(Zee Owner or Tenant Tnorra,5 Q 7}'t' l4 Telephone No. Owner's Address &Me Is this permit in conjunction with)a building permit? Yes ❑ No (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd❑ No.of Meters New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: ,4],�,c table may be waived by the Inspector of Wires. o.of Tota Transformers KVA Date...... ......................... fZ Generators K No.of Emergency Lighting f NoRrM 1 Battery Units 3?;.t„`` a;L TOWN OF NORTH ANDOVER FIRE ALARMS INo.of Zones PERMIT FOR WIRING o.o Detection and Initiating Devices No.of Alerting Devices �,SSACMUs� ° o.of Self-Containe t Detection/Alerting Devices ❑ Municipal ❑ This certifies that .............. . C!�. �r Local Connection Other Security Systems: No.of Devices or Equivalent has permission to perform ....... ................................ �. ............................. Data Wiring: No.of Devices or Equivalent wiring in the building of ' 7- f............ ................................... Telecommunications Wirmg: No.of Devices or E uivalent .5"....y /,,,�....w.ts S r- ................ at.............J ......................................,... .,N in And ass. c/ i� �j !esired or as required by the Inspector of Wires. Fee..................... Lic.No.............. ......................... . .. ........... a- ELE CAL INSPECTOR ipal policy.) �f 9 Check # IEC Rule 10,and upon completion. _ >rmance of electrical work may issue unless . ?:verage or its substantial equivalent. The7163t- o the permit issuing office. I certify,under the ins aLnf pen ties of erjuty,that the information on this application is true and complete. FIRM NAME: AV�cT CP I; LIC.NO.: Licensee: Sq(0c Signatur LIC.NO.: (Ifapplicable,enter "ex mp 11 in the liceue number Iv�}Ag) Bus.Tel.No. �`� 0 Address: ;lu 4 ( 1r)WIVC t-Q,eA Alt.Tel.No.:'?2f—.33� *Per M.G.L c. 147,s.57-61,security work requires DepartMent of Public Safety"S"License: Lic.No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one ❑ owner ❑owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE: $ / NORT#1 O�4-0-S 0 16,, 0 eya M O cu.uCwwK■,1Are 0 1� ��SSAC H4b US PUBLIC HEALTH DEPARTMENT Community Development Division August 9, 2007 Thomas Petraila 534 Boston Street North Andover, MA 01845 RE: Septic System Design, 534 Boston Street,North Andover,Map 107D, Lot 81 Dear Mr.02ftWoW, �T-,4 � 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, dated August 2, 2007. This plan has been approved. The approval includes a Local Upgrade Approval as found attached. This plan is valid for two years from the date of this approval. The design has been approved for use in the construction of an onsite septic system for a 4- bedroom house (maximum '-room). During this time, a licensed septic system installer must obtain a permit and complete this work and a C p p Certificate of Compliance be endorsed b the . P Y installer, designer and the Town of North Andover. In the event an imminent health problem such as sewage backup into the dwelling is occurring,the North Andover Board of Health may reduce the time period for which this plan is valid. This approval includes the following: Local Upgrade Approval Reduction in separation distance between the ESHGWand septic tank/pump chamber inverts from 12 inches to 1.5 inches This approval is subject to the following conditions: 1. The owner shall keep the attached form 9b for their records 2. 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 p pp pp Y Disposal Systems Construction Permit (3 10 CMR 15.020(1)). 3. It is the responsibility of the applicant and/or the applicant's designer, installer or other representative to ensure that all other state and municipal requirements are met. 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com r These may include review b the Conservation Commission Zoning Board Planning Y Y � g � S � 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. 4. The approval letter issued by the Massachusetts Department of Environmental Protection (DEP) for the treatment unit which is part of this onsite wastewater system requires: a) "Operation and Maintenance Agreement: 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 maintenance agreement (O&M). No O&M agreement shall be for less than one year." Maintenance shall consist of observing the system and monitoring effluent from the system at least semi-annually. A signed maintenance agreement must be returned to this office prior to issuance of a Disposal Systems Construction Permit. The maintenance agreement is to be for all the components of the on-site wastewater system including the tank, treatment unit and soil absorption system. b) "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 of Environmental Protection prior to the issuance of the Certificate of Compliance." c) The owner of the System shall provide a copy of the DEP Approval letter, 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. Your effort to provide a properly functioning septic s stem for your dwelling is greatly appreciated. The Health Department may be reached at 978-688-9540 with any questions you may have. Sincerel , usan Y. Sawyer, REHS/� Public Health Director Encl: list of licensed septic system installers Form 9B for owner records Cc: New England Engineering Services 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com Commonwealth of Massachusetts City/Town of 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. A. Facility Information When ng out 1. Facility Name and Address forms to the Thomas Petralia computer,use only the tab key Name to move your 534 Boston Street cursor-do not use the return Street Address key. No.Andover MA 01845 City/Town State Zip Code 2. Owner Name and Address(if different from above): Name Street Address Cityrrown state 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 5. System Designer: Ben Osgood ® PE ❑ RS Name 1600 Osgood Street No Andover MA 01845 Address Cityrrown State,ZIP B. Approval 1. Local Upgrade Approval is granted for: ❑ Reduction in setback(s)—specify: ❑ Reduction in SAS area of up to 25%: sns size ft. 96 reductionsq 534 Boston Street form 9B 6.07•rev.7106 Local Upgrade Approval- Page 1 of 1 r Commonwealth of Massachusetts City/Town of Local Upgrade Approval Form 9B B. Approval (continued) ❑ Reduction in separation between the SAS and high groundwater. Separation reduction ft Percolation rate min.Anch Depth to groundwater ft ❑ Relocation of water supply well(explain): ® Reduction of 12-inch separation between inlet and outlet tees and high groundwater ❑ Use of only one deep hole in proposed disposal area ❑ Use of a sieve analysis as a substitute for a perc test List local variances granted not requiring DEP approval per 310 CMR 15.412(4): List variances granted requiring DEP approval: North Andover Health Dept. Approving Authority Susan Sawyer, REHS/RS .June 28,2007 Print or Type Name and Title / Si re Date rr f 534 Boston Street form 9B 6.07•rev.7/06 Local Upgrade Approval- Page 2 of 2 NEw ENGLAND IENGINEIEPJNG SERVICES, INC. 1600 Osgood Street Building 20 Suite 2-64 North Andover, MA 01845 'Pel: (978) 686-1768 • Fax: (978) 327-6138 Benjamin C. Osgood, Jr., P.E. President July 26,2007 Susan Sawyer North Andover Board of Health 1600 Osgood Street _____ North Andover, MA 01845 r,Y. _' _ . AUG - 6 200777 Re: 534 Boston Street,North Andover Subsurface Sewage Disposal Design TOWN O NORTH AND HEALTH DEFARTMF T Dear Susan: Enclosed are revised Subsurface Sewage Design plans for the above referenced property. These plans incorporate revisions to address the comments in you letter dated July 13, 2007 as follows: 1. A special design note has been added to the plans. 2. This design uses a bed in lieu of trenches to save trees. The area where the system is located is a wooded hillside. By using trenches the footprint of the system would double,the slopes would require more area, and many more trees would be lost. In addition to the loss of the trees the cost of the system would increase' dramatically due to the increased amount of septic sand needed. 3. The notes have been corrected. 4. The barrier location has been clarified 5. The pipe layout detail on sheet 2 specifies an 8"x 8"splash block beneath the downward facing orifice. 6. A draft maintenance agreement is enclosed. 7. A draft deed notice is enclosed. Additional suggestions have been addressed as follows: ` 1. The system manufacturer has been contacted and he indicated that the tanks are provided with rubber boots. Rubber boots have been specified for both the pump chamber and septic tank. 2. Although the loading rate could be higher we have elected to keep the size of the system the same since the reduction would be minimal. '` If you have any questions,or need additional information,please do not hesitate to contact this office. Sincerely, 9`2 Benjamin C. Osgood, Jr., P.E. President Page 1 of 1 DelleChiaie, Pamela From: Dan Ottenheimer[info@millriverconsulting.com] Sent: Monday, July 16, 2007 7:31 AM To: 'Dan Obrzut'; Grant, Michele; Marianne Peters; DelleChiaie, Pamela; Sawyer, Susan Subject: 534 Boston Street Plan Review Sue, Michelle, Pam— We completed this review a while ago but had a question about this for New England Engineering. I called over a week ago and never got a return call. If they squawk about it, let them know we were waiting to hear back from them. Anyway, the design is generally acceptable given the site conditions but enough problems were found to suggest they complete a re-design. We also gave them a few suggestions at the end of the letter which might be beneficial to the project. Speak with you soon. Dan Alill, River f/consultin Daniel Ottenheimer,President Mill River Consulting,Inc. On-Site Wastewater Management Services 2 Blackburn Center Gloucester, MA 01930-2259 978-282-0014 or 1-800-377-3044 fax: 978-282-0012 www.millriverconsulting.com O.aRQ@mil.1ri-verconsu-Itin.g.com i I i 7/16/2007 i E �LORTol 1 O t��eo „e•~O 3,SS�1CNU5 t� Health Department July 13, 2007 Benjamin Osgood, P.E. New England Engineering Services, Inc. 1600 Osgood Street - Building 20, Suite 2-64 North Andover, MA 01845 Re: Wastewater Treatment and Dispersal System Plan for 534 Boston Street, Map 107D, Lot 81 Dear Mr. Osgood: The proposed wastewater system design plan for the above site dated June 5, 2007 and received on June 11, 2007 has been reviewed. Unfortunately,the design cannot be approved until the following items are corrected. The specific section in Title 5: 310 CMR 15.000, or North Andover regulation that is not met by this design follows each item. 1. It is implied on the design plan, and understood from the field investigation,that the parent soil layer is not considered to be suitable. Please provide some type of written notation to that effect on the design plan so future property owners or others reviewing this plan will understand the site limitations and reasons for selecting the design approach presented on this plan. 2. The design uses a field instead of trenches, and no explanation is provided as to why trenches are not used(3 10 CMR 15.240) 3. Some of the notes on the plan refer to distribution boxes and other features not proposed for this project 4. It is not clear where the impervious barrier is proposed to be installed as shown on the site plan 5. Please provide a splash block or other means of preventing scouring beneath the down- facing orifices in the pressurized soil absorption system 6. Please provide a draft maintenance agreement for the treatment unit and pressure distribution system 7. Please provide a draft notice to be recorded on the deed indicating the presence of a wastewater pre-treatment system i 1600 Osgood Street HEALTH DEPARTMENT Page 1 of 1 Building 20;Suite 2-36 E-Mail: healthdept@townofnorthandover.com North Andover,MA 01845 Phone:978.688.9540 Fax:978.688.8476 Additionally,you are encouraged to consider the following items in the revised design plan: ➢ Since a Local Upgrade Approval is proposed for reduced separation from the tank openings to the seasonal high ground water table, it may be prudent to specify tanks with cast-in-place rubber boot connections to help assure a water tight connection. ➢ It appears that a Long Term Acceptance Rate of 0.61 GPD/sq. ft. may be used in this design rather than the 0.56 GPD/ sq. ft. shown Please feel free to contact the office with any questions you may have. We look forward to working with you to obtain a wastewater treatment and dispersal system which will be in compliance with all regulations and assure protection of public health and the environment of North Andover. Sincere y S an Y. Sa er, REHS S Public Health Directo cc: Owner File TOWN OF NORTH ANDOVER �DT, Office of COMMUNITY DEVELOPMENT AND SERA%ICES ��'` g•`'�� HEALTH DEPARTMENT 1.600 OSGOOD STREET;BEET; 131:111 DING 20; SHITE 2-36 �"; . i"��• NORT11 ANDOVER,MASSACHUSETTS 01845 978.688.9540-Plione Susan Y.Sawyer,RI HS/RS 978.688.8476-FAX Public Health Director E-MAIL:llealthdeptirz.townofnorthandover.com WEBSITE:httn:%/Nkww.torvnofnorthandover.com SEPTIC PLAN SUBMITTAL FORM o' R��D Date-of Submission: / � '2 -{- JUN 1 1 2007 Site Location: 3 S I T /)d ✓� � TOW OF NORTH ANDOVER HEALTH DEPARTMENT Engineer: New Plans? Yes X$225/Plan Check# (includes 1St submission and one re- review only) Revised Plans?Yes $75/Plan Check# Site Evaluation Forms Included? Yes No Local Upgrade Form Included? Yes No Telephone#: D (�Q(�-r1 I,�Q Fax#: E-mail: hos � WUT •CN X Homeowner Name OFFICE USE ONLY When the submis ion is complete (including check): ➢ Date stamp plans and letter .5-Xe-S ➢ ✓/ Complete and attach Receipt ➢ / Copy File; Forward to Consultant ➢ Enter on Log Sheet and Database ' � � � �� ..� � . ,i . . . , Commonwealth of Massachusetts City/Town of No. Andover W 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. 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 15.404(1), is not feasible. 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 15.415. 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 Thomas Petralia only the tab key Name to move your 534 Boston Street cursor-do not use the return Street Address key. No Andover MA 01845 City/Town State Zip Code VQ 2. Owner Name and Address (if different from above): Same as Above 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: 5. Type of Existing System: ❑ Privy ❑ Cesspool(s) ® Conventional ❑ Other(describe below): Installation of a subsurface sewage disposal system 6. Type of soil absorption system (trenches, chambers, leach field, pits, etc): Leach Field Form 9A Application for Local Upgrade Approval revised.doc•rev. Application for Local Upgrade Approval* Page 1 of 4 7106 " Commonwealth of Massachusetts City/Town of No. Andover W Form 9A - Application for Local Upgrade Approval A` 5 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) 7. Design Flow per 310 CMR 15.203: Design flow of existing system: 440 gpd Design flow of proposed upgraded system 440 gpd Design flow of facility: 440 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: Unknown date of inspection 2. Describe the proposed upgrade to the system: Replace leach field and system components 3. Local Upgrade Approval is requested for(check all that apply): ® Reduction in setback(s)—describe reductions: Reduction in separation distance between the ESHGW and septic tank/pump chamber inverts from 12" required by Title 5 Section 15.227(5)to 1.5" ❑ 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. Form 9A Application for Local Upgrade Approval revised.doc•rev. Application for Local Upgrade Approval* Page 2 of 4 7/06 Commonwealth of Massachusetts City/Town of No. Andover W 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): ❑ Reduction of 12-inch separation between inlet and outlet tees and high groundwater ❑ Use of only one deep hole in proposed disposal area ® Use of a sieve analysis as a substitute for a perc test ❑ 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)(h)(1). The soil evaluator must be a member or agent of the local approving authority. High groundwater evaluation determined by: Armond Parrazzo 4-17-07 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 on the lot 2. An alternative system approved pursuant to 310 CMR 15.283 to 15.288 is not feasible: An alternative system would be cost prohibitive. Form 9A Application for Local Upgrade Approval revised.doc•rev. Application for Local Upgrade Approval• Page 3 of 4 7/06 Commonwealth of Massachusetts City/Town of No. Andover W 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. C. Explanation (continued) 3. A shared system is not feasible: No other adjacent is available 4. Connection to a public sewer is not feasible: Public sewer is not 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. 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." _-1- &/�� Facility-61w Prs Sign Date Benjamin C. Osgood Jr. P.E. (Agent for Owner) Print Name New England Engineering Services, Inc. fly i Date 1600 Osgood Streeet No. Andover, MA Preparer's address City/Town 01845 (978)686-1768 State/ZIP Code Telephone I Form 9A Application for Local Upgrade Approval revised.doc•rev. Application for Local U 7/06 PP pgrade Approval* Page 4 of 4 _ �I Commonwealth of Massachusetts City/Town of NoR-vw 4-vDo v F R, Percolation Test Form 12 M 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: When filling out A. Site Information forms on the computer,use Thomas Petrallia only the tab key Owner Name to move your 534 Boston Street cursor-do not Street Address or Lot# use the return key. Nrth Andover MA 01845 Cityfrown State Zip Code ras Contact Person(if different from Owner) Telephone Number B. Test Results 5-8-07 9:00 5-17-07 1:00 Date Time Date Time Observation Hole# PT1 PT2 (B horizon) Depth of Pere 33'718" 18" Start Pre-Soak 9:28 1:20 End Pre-Soak 9:43 1:35 Time at 12" 9:43 1:35 Time at 9" 12:46 1:52 Time at 6" 4:25(7") 2:26 li Time(9"-6") Aborted @ 7" 32 Minutes Rate(Min./Inch) Due to rate >90 MPI 15 min. /inch Test Passed: ❑ Test Passed: 19 Test Failed: ® Test Failed: ❑ Thomas Hector Test Performed By: PT1 -Armand Parrazzo PT2 - Randy Burley— Mill River Consulting Witnessed By: Comments: t5form12.doc•06403 Perc Test•Page 1 of 1 { \ Commonwealth of Massachusetts Cit /Town of �v(`��1 oJe r 1 Y " k Forte 1 - Soil Suitability Assessment f®r ®n-Site Sewage Disposal DEP has provided this form for use by on-site professionals and local lBoards fofHealth. Other formsl Board of Heath be used, but the the informationforrin y n must be substantially the same as provided here. Before using this form, Your A. Facility Information 1. Facility Information Pe �.�g9,�a O Owner Name 52J Map/Lot 101 Street Address State Zip Code City/Town B. Site Information 1 (Check one) New Construction ❑ Upgrade ❑ Repair, q Published Soil Survey available? Yes .� No ❑ If yes: _ � a —-- Pub y / Year Published Publication Scale Soil M.:+p Unit 2-JLill e 5! t f G�tW1 S�ow Soil Name Soil limitations Surficial Geological Report available? Yes No ❑ If yes: year Published Publication Scale Mit Ulmt Geologic Material Landform 4. Flood Rate Insurance Map: Above the 500 year flood boundary? Yes ,�' No Within the 100 year flood boundary? Yes ❑ No El Within the 500 year flood boundary? Yes ❑ No ❑ Within a Velocity Zone? Yes El NO ❑ Wetland Area. National Wetland Inventory Map ipp Name WN't� Map flit Wetlands Conservancy Program Map Name Map Unit DEP 1 11 Soil Suitability Assessment for On-Site Sewage Disposal • F'ag(2 1 of 7 Commonwealth of Massachusetts F= __ -'_- CityrTown of /vaC��N jeT Form Soil Suitability Assessment f®r ®n-Side Sewa.cle Disposal Apt, Normal [j Below Normal ❑) Water Resource Conditions (USGS) Pit 0x001 Range: Above Normal 6. Current W ftMo th/Yeai 7. Other references reviewed: C. on-Site Review (minimum of two holes required at every proposed disposal area) 8;30 J�vnn�Ssa Deep Observation Hole Number: o'Date Time �Neather 1. Location Ground Elevation at Surface of Hole .515_0 Location (Identify on Plan ) R�� \� '^' 2 Land Use: est L" ,a Surface Stones Slope(%) (e.g.woodland, agricultural neld,vacant lot,etc,.) 90& O l5(DU arm Position on land (�ach sheet) Landforrn Veget n Drainage Way RLL) Possible Wet Area _L� 3 Distances from: Open Water Body feet O� g y feet feet Property Line_� Drinking Water Well ��o�o Other feet feet �t QUnsuitable Materials Present: Yes E] No 4. Parent Material: �R�rzN__ It Yes Disturbed Soil❑ Fill Material[] Impervious Layer(s) El Weathe red/F ractu red Rock❑ Bedrock❑ 5 Groundwater Observed: Yes �No ❑ � If .'es: Depth Weeping from Pit 5_7Depth Standing Water in Hole Estimated Depth to High Groundwater: 3x4 I�e�oK DEP Form 11 Soil Suitability Assessment for on-Site Sewage Disposal • Page 2 of 7 ` Commonwealth f %assacht�setts �� =, Cit /Town of oQr l`t 5 = is Form 'I I - Soil Suitability �ssessr�ent f®r On Sewage Disposal inches elevation ` Deep Observation Hole Number: - Soil Soil Matrix: Redoxirnorphic Features Soil Coarse Fragments Soil Structure Consistence Other mottles Texture % by Volume Horizon/ Color-Moist (mottles) (USDA) (Moist) Depth Layer (Munsell) _ (In.) Depth Color Percent Gravel Cobbles &Stones ---------— �_ $ iDYR S L - tDY�231`i S L l5 30i - --- I - - - 1 q 5yR �T I a G ' asy 3a a �� r io°`� i Additional Notes 05 DEP Form III Soil Suitability Assessment for on-Site Sewage Disposal Paye 3 of 7 \ Commonwealth of Massachu etts t } City/Town of ko r-� N Aoyer U 1 �_- 4i- '''i ®rna `� o Soil Suitability Assessment for On Sewage Disposal C. ®n-Site Review (Cont.) Deep Observation Hole Number: T111e vveail ei Dale 1. Location Ground Elevation at Surface of Hole 104-73 Location (Identify on Plan ) 1 e6tr rj k 2. — 5-71 Land Use: Sl" " ti°t Surface -- (e.g.woodland, agricultural field,vacant lot,etc.) Landform Position on la ndscape'(attach sheet) Vegetat'iLdi Body (jb Drainage Way y_ Possible Wet Area 13S 3. Distances from Open Water 6 g yfeet feet e�feet Property Line ;t8 Drinking Water Well —X-1�_ Other feet feet �I l Unsuitable Materials Present: Yes ElNo� 4. Parent Material: a 1 ov&_.,—.T l If Yes: Disturbed Soil❑ Fill Material❑ Impervious Layer(s) ❑ Weathered/Fractured Rock❑ Bedrock❑ 5 Groundwater Observed: Yes k No ❑ h If Yes: Depth Weeping from Pit—_Q----- Depth Standing Water in Hole Estimated Depth to High Groundwater: Q inches elevation DEP Form 11 _Soil Suitability Assessment for on-Site Sewage Disposal • Page 4 of 7 commonwealto of Massach setts Cit own of 1�JoT4N Aw,jef, m IIc= , rl Form '� - Soil Suitability Assessment for On Sewage Disposal Deep Observation Hole Number: TF ---- Soil Coarse Fragments Soil Soil ____ Othcr Soil r Soil Matrix: Redoximorphic Features Texture % by Volume Structure Consistence mottles (Moist) Horizon/ Color-Moist ( ) (USDA) Depth Layer (Munsell) _ (1n.) y I Depth Color Percent Gravel Cobbles &Stones6 -1 as 13 ---- SL -14 3 , 1 Ia YR --- - -- --- --- -- -- - , P-3a IDIR I SL - - - - - 75y� - ---- -- a,SY�sy s to°ta 3) _ 0 c� G �.5 Y 3a � I l Additional Notes IN Ge,O� 72 ----- — DEP Foran 11 Soil Suitability Assessment for On-Site Sewage Disposal Page 5 of 7 Commonwealth �f Npsac�iusrt`tsr City/Town of /ve �tn o Form 11 - Soil Suitability Assessment for On Sewage Disposal C. On-Site Review (Cont.) -e' ,� 17 b 1 2 '�a vPr cr- 5a� Deep Observation Hole Number: Date Time Weather 1. Location Ground Elevation at Surface of Hole I_O$,47(0 Location (Identify on Plan ) Reo � °`sj e-F &r \t V, W o JS F I7° a 2. Land Use. Z6 0 IV4 G at Surface Stones Slope(%) (e.g.woodland,agricultural field,vacant lot,etc.) /� r I,� 2wk.-Jo0e,1 ,\ C�to L)ick. ' I.p ra.n� 1 a�4 W Oy�S Landform Position on landsca a(attach sheet) Vegetation 3. Distances from: Open Water Body ( C)00 Drainage Way 0Lff0 Possible Wet Area 9 Teet feet feet Property Line 3 S Drinking Water Well feet r65 Other feet 4. Parent Material: ck I ,� Unsuitable Materials Present. Yes ❑ Noe 4 ' If Yes: Disturbed Soil❑ Fill Material❑ Impervious Layer(s) ❑ Weathered/Fractured Rock❑ Bedrock❑ 5. Groundwater Observed: Yes N- No ❑ n t• If Yes: Depth Weeping from Pit ` s- De th Standing Water in Hole ea �Estimated Depth to High Groundwater: 36' t06. y� inches elevation DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal • Page 4 of 7 ` Commonwealth of Massa ch}�setts City/Town of �or-�� AM-7 Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal c, Deep Observation Hole Number: TP2 Soil Soil Matrix: Redoximorphic Features Soil Coarse Fragments Soil Soil Depth Horizon/ Color-Moist (mottles) Texture % by Volume Structure Consistence Other Layer (Munsell) (USDA) (Moist) (In') Depth Color Percent Gravel Cobbles &Stones 1K X31 iDYR S� b�o�Vky r )K �3a Ua jD�YF a-5 Y s 3YD a '��, Gr S L / a551 Additional Notes LA)12 e DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal • Page 5 of 7 Commonwealth of IVlassa husetts PM City/Town of lVor-�n Av& oer Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal G„M C. On-Site Review (Cont.) Deep Observation Hole Number: 1 S 1-7 v-7 la:3a Oveic as'f Date Time Weather 1. Location Ground Elevation at Surface of Hole 109. 37 (' Location (Identify on Plan ) Rear VAtj 10-F+ t Ar tv. 2. Land Use: (e.g.woodland,agricultural field,vac/ant lot,etc.) / rAwa,qL4L Surface Stones / Slope�.i�lti+ L)podS &1. 01 �ac($51 2e Vegetation Landform Position on lands pe(attach sheet) 3. Distances from: Open Water Body 1060 Drainage Way 11D Possible Wet Area l 6 8 feet feet feet Property Line VS Drinking Water Well 165 Other . feet feet 4. Parent Material: a1'�aYt �[ Unsuitable Materials Present: Yes ❑ No If Yes: Disturbed Soil❑ Fill Material❑ Impervious Layer(s) ❑ Weathered/Fractured Rock❑ Bedrock❑ 5. Groundwater Observed: Yes N No ❑ If Yes: Depth Weeping from Pit_q_ Depr Standing Water in Hole Estimated Depth to High Groundwater: _364 k ? I 0 6.8 7 inches elevation DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal • Page 4 of 7 Commonwealth of Massachusetts City/Town of /1oAk Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal Deep Observation Hole Number: I �� Soil Soil Matrix: Redoximorphic Features Soil Coarse Fragments Soil Soil Depth Horizon/ Color-Moist (mottles) Texture % by Volume Structure Consistence Other Layer (Munsell) (USDA) (Moist) (In.) Depth Color Percent Gravel Cobbles &Stones OI � L $vLa��✓ 1� UZ bl,6c.t,� a Y Additional Notes �o �D A"J', DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal • Page 5 of 7 \ Commonwealth of Massach etts ,- ❑=rte_? City/Town of Ailer t= (��,,❑,,_ ��i Form Soil Suitability Assessment for ®n-Site Sewage Dssp®sa D. Determination of High Groundwater Elevation 1. Method used ❑ Depth observed standing water in observation hole A. B. inches inches ❑ Depth weeping from side of observation hole A B.niches aches l Depth to soil redoximorphic features (mottles) �:- A. " !)B. 29 inches inches ❑ Groundwater adjustment(USGS methodology)' q B. inches inches 2. Index Well Number Reading Date Index Well Level Adjustment Factor Adju ed Groundwater Level E. Depth of perviou7Perviou 1 Depth of Naturally Occurrteriala. Does at least fouroccurring pervious materialst in arl�,eas observed throughout ihl03`'proplOfor file soil absorption syNo❑ Lower boundary I�bti� Ozb. If yes, at what dep ? Upper boundary= inches inches F. Ceri:ificatio I certify that I ave passed the soil evaluator with the retied tpproved by the rainiing, expertise Deand experience artment fvironmental described in 31x0 CIMrP 15.0i17t the above analysis w perforr ed by me consistent q 5110107 Date Signat r of Soil Eval toI G� QGf U P Date o So Evaluator Exam Type or Printed Name of Soil Evaluator r'�a Parr�Zza--�/ ' ( /Up � -- Board of Health N� ne of Board of Health Witness Note: This form must be submitted to the approving authority with Percolation Test Form 12 DEP Foran 11 Soil Suitability Assessment for on-Site Sewage Disposal • P�39"` 6 of 7 C of Vlassaehysetts ti` t a City[Town of �or�V` �nc�vJer �- Form 1 e SOH SuitabilityAssessment for On-Site e age 3isp®s i use this sheet for field diagrams: See DEP Form 11 Soil Suitability Assessment for on-Site Sewage Dispose_fl 7 of 7 NEw ENGL NDENGI MMG SERVICES, INC. 1600 Osgood Street Building 20 Suite 2-64 North Andover, MA 01845 'rel: (978) 686-1768 • Fax: (978) 327-6138 June 7, 2007 Project fi 1365 Ms. Susan Sawyer North Andover Board of Health 1600 Osgood Street No. Andover, MA 01845 ,' Re: 534 Boston Street,No.Andover JUN 1 1 2007 Local Upgrade Approval Request TOWN UF NORTH ANDOVER HEALTH DEPARTMENT Dear Ms. Sawyer, The purpose of this letter is to request that the above refer n q e cedro p perty be included in the upcoming Board of p g Health meeting agenda to discuss the following Local upgrade approvaf request: Local Up ade Approvals Required: t. Reduction in separation distance between the ESHGW and septic tank/pump chamber inverts from 12" . LlMassachusetts Department of Environmental Protection Bureau of Resource Protection -Title 5 DEP Approved Inspection and O&M Form for Title 51/A Treatment and Disposal Systems A. Installation RECEIVIED Important:When Gutman filling out forms Owner on the computer, use only the tab 534 Boston Road key to move your Facility Street Address OWN ER HEALTH DEPARTMENT cursor- et not North Andover 01845 use the return key. City Zip Mailing address of owner, if different: Street Address/PO Box: peen City State Zip ( ) - ext. Telephone Number B. Authorized Service Provider Scott Kraihanzel O&M Finn -- — -- -- --- - -- 5 Susan Carsley Way Street Address Sandwich MA 02563 City State Zip (508)681 -8323 ext. Telephone Number Scott Kraihanzel 12580 Certified Operator Name Certification Number C. Facility/System Information Clean Solution DEP ID Manufacturer ID Model Number Installation Date Start of Operation — Approval Type: ❑ General ❑ Provisional ❑ Piloting to Remedial Seasonal Residence—used less than 6 mo./year: ❑ Yes ® No D. Operating Information 10/11/2009 ✓ _ 4/25/2009 Inspection Date Previous Inspection Date - 2.5"+/- Sludge Depth(to be checked yearly) Pumping Recommended ❑ Yes ® No t5aiom.doc•rev.11-07-05 Page 1 of 3 LlMassachusetts 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 E. Field Testing Field Inspection: Color: ❑ gray ❑ brown ® clear ❑turbid ❑ Other(specify): Odor: ® musty ❑ earthy ❑ moldy ❑ offensive ❑ turbid Effluent Solids: ❑ no ❑ some 6.9 SU 2.2 mg/L 16 NTU pH 6 to 9 DO 2 or greater Turbidity 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: gpd Parameters sampled: ❑ pH ❑ BOD ❑ CBOD ❑ TSS ❑TN ❑ Other(list below) Other 1 Other 2 Other 3 G. Inspection and Maintenance Description of any maintenance performed since previous inspection&during this inspection: Notes and Comments: System is operating as designed. t5aiom.doc•rev.11-07-05 Page 2 of 3 RMassachusetts Department of Environmental Protection Bureau of Resource Protection -Title 5 DEP Approved Inspection and O&M Form for Title 5 IIA Treatment and Disposal Systems H. Certification I certify: 1 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. _ 10/11/2009 Operator Signature Date I 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 n of each year for the previous calendar year Piloting Use-within 45 days of inspection date Provisional Use—by March 31t'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, 5t Floor Boston, MA 02108 I t5aiom.doc-rev.11-07-05 Page 3 of 3 Massachusetts Department of Environmental Protection 1�LlBureau of Resource Protection -Title 5 DEP Approved Inspection and O&M Form for Title 5 I/A Treatment and Disposal Systems RE' 'I!! A. Installation ` Important:When GutmanQ�� filling out forms OwnerVP Q► TH AN on the computer, HEALTH OPARTM N1 L . Vuse only the tab 534 Boston Road key to move your Facility Street Address cursor-do not North Andover 01845 use the return key. city Zip Mailing address of owner, if different: Street Address/PO Box: City State Zip ( ) - ext. Telephone Number B. Authorized Service Provider Scott Kraihanzel _ O&M Firm -" --- — 5 Susan Carsley Way Street Address Sandwich MA 02563 City State Zip (508)681 -8323 ext. Telephone Number Scott Kraihanzel 12580 Certified Operator Name Certification Number C. Facility/System Information Clean Solution _ DEP ID Manufacturer ID Model Number — Installation Date Start of Operation -- Approval Type: ❑ General ❑ Provisional ❑ Piloting ® Remedial Seasonal Residence—used less than 6 mo./year: ❑ Yes ® No D. Operating Information 4/25/2009 / 11/3/2008 Inspection Date Previous Inspection Date �- 2.5"+/- Sludge Depth(to be checked yearly) Pumping Recommended ❑ Yes ® No t5aiom.doc•rev.11-07-05 Page 1 of 3 -� s i M f. �. k Massachusetts Department of Environmental Protection Bureau of Resource Protection -Title 5 DEP Approved Inspection and O&M Form for Title 5 1/A Treatment and Disposal Systems E. Field Testing Field Inspection: Color: ❑ gray ❑ brown ® clear ❑turbid ❑ Other(specify): Odor: ® musty ❑ earthy ❑ moldy ❑ offensive ❑ turbid Effluent Solids: ❑ no ❑ some pH 7.1 SU DO y 2.4 mg/L Turbidity 8 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: gpd Parameters sampled: ❑ pH ❑ BOD ❑ CBOD ❑ TSS ❑ TN ❑ Other(list below) Other 1 Other 2 Other 3 G. Inspection and Maintenance Description of any maintenance performed since previous inspection &during this inspection: Notes and Comments: System is operating as designed. t5aiom.doc•rev.11-07-05 Page 2 of 3 LlMassachusetts 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 H. Certification I certify: 1 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. 4/25/2009 OperatdMignattjM 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"t of each year for the previous calendar year Piloting Use-within 45 days of inspection date Provisional Use—by March 31t'of each year for the previous 12 months General Use—by September 30"'of each year for the previous 12 months Send to: Department of Environmental Protection Attention: Title 5 Program One Winter Street, 5` Floor Boston, MA 02108 t5aiom.doc•rev. 11-07-05 Page 3 of 3 LlMassachusetts 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 A. Installation _ RECEIVED Important: Mr. Daniel Gutman When filling out Ownerrcr❑ 2009 forms on the FEB D computer,use 534 Boston Street only the tab key Facility Street Address TOWN OF NORTH ANL)OVER to move your North Andover 01945 HEALTH DEPARTMENT cursor-do not use the return City Zip key. Mailing address of owner, if different: Street Address/PO Box: ICI City State Zip ( ) - ext. Telephone Number B. Authorized Service Provider WasteWater Alternatives of New England, LLC. O&M Fir 27 Kensington Road Street Address Hampton Falls NH 03844 City State Zip (603) 926-9053 ext. Telephone Number Scott Kraihanzel 12580 Certified Operator Name Certification Number C. Facility/System/S stem Information The Clean Solution DEP ID Manufacturer ID Model Number Installation Date Start of Operation Approval Type: ❑ General ❑ Provisional ❑ Piloting ® Remedial Seasonal Residence—used less than 6 mo./year: ❑ Yes ® No D. Operating Information 4/20/2008 NA Inspection Date Previous Inspection Date NA Pumping Recommended ❑ Yes ® No Sludge Depth(to be checked yearly) t5aiom.doc•rev. 11-07-05 Page 1 of 3 � � ±. ,_ ` � . ,' .d� 4 1 _ . ✓ r .4 Y LlMassachusetts 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 E. Field TestingED Field Field Inspection: Color: Elgray Elbrown ® clear ❑turbid FES 3 2009 .,,,r NORTH ANDOVER ❑ Other(specify): IHEALTH T Odor: ® musty ❑ earthy ❑ moldy ❑ offensive ❑ turbid Effluent Solids: F1no ❑ some pH 6 to s SU DO 2 or gree erg/L Turbidity 40 or less TU 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: gpd Parameters sampled: ❑ pH ❑ BOD ❑ CBOD ❑ TSS ❑ TN ❑ Other(list below) Other 1 Other 2 Other 3 G. Inspection and Maintenance Description of any maintenance performed since previous inspection &during this inspection: None. The residence appears unoccupied. Notes and Comments: The system appears to be working as designed and to manufacturers specifications. t5aiom.doc•rev.11-07-05 Page 2 of 3 r ' � .. � t ,,, f r �A ^r LlMassachusetts Department of Environmental Protection Bureau of Resource Protection - Title 5 DEP Approved Inspection and O&M Form f _ Treatment and Disposal Systems EIVED H. Certification FEB -3 21 u"Unall certify: I have inspected the sewage treatment and disposal system conducted the required Field Testing and/or sample collection in acro s, 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. 4/20/2008 Operator gri 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 31t 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, 6 Floor Boston, MA 02108 t5aiom.doc•rev.11-07-05 Page 3 of 3 LlMassachusetts Department of Environmental Protection Bureau of Resource Protection -Title 5 DEP Approved Inspection and O&M Form Treatment and Disposal Systemsrcpc�'o fl I)rie%^ A. Installation TOWN Oh ri Ai'4)OVER Important: Mr. Daniel Gutman HEALTH When filling out Owner forms on the computer,use 534 Boston Street only the tab key Facility Street Address to move your North Andover 01945 cursor-do not use the return City Zip key. Mailing address of owner, if different: Street Address/PO Box: City State Zip ( ) - ext. Telephone Number B. Authorized Service Provider WasteWater Alternatives of New England, LLC. O&M Firm 27 Kensington Road Street Address Hampton Falls NH 03844 City State Zip (603)926-9053 ext. Telephone Number Scott Kraihanzel 12580 Certified Operator Name Certification Number C. Facility/System Information The Clean Solution DEP ID Manufacturer ID Model Number Installation Date Start of Operation Approval Type: ❑ General ❑ Provisional ❑ Piloting ® Remedial Seasonal Residence—used less than 6 mo./year: ❑ Yes ® No D. Operating Information 11/2/2008 4/20/2008 Inspection Date Previous Inspection Date NA Pumping Recommended ❑ Yes ® No Sludge Depth(to be checked yearly) t5aiom.doc•rev.11-07-05 Page 1 of 3 r f E _ r i LlMassachusetts 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 E. Field Testing ::14 �'E Field Inspection: LT0PWNOF.N0 Color: ❑ gray ❑ brown ® clear ❑ turbi ,EF/� ❑ Other(specify): Odor: ® musty ❑ earthy ❑ moldy ❑ offensive ❑ turbid Effluent Solids: ❑ no ❑ some pH s to 9 SU DO 2 or greaterm /L Turbidity TU 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: gpd Parameters sampled: ❑ pH ❑ BOD ❑ CBOD ❑ TSS ❑TN ❑ Other(list below) Other 1 Other 2 Other 3 G. Inspection and Maintenance Description of any maintenance performed since previous inspection&during this inspection: None. Notes and Comments: The system appears to be working as designed and to manufacturers specifications. Went over operation with the new homeowner. t5aiom.doc-rev.11-07-05 Page 2 of 3 LlMassachusetts 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 H. Certification 1 certify: I have inspected the sewage treatment and disposal system A the 69'ess BbMd hav conducted the required Field Testing and/or sample collection in ac c dance with Standard Met ds, have completed this report and the attached technology operation an 'oaWe'?i an i�he(31Q 41 d the information reported is true, accurate, and complete as of the tim Y�' Massachusetts ce ified operator in accordance with 257 CMR 2.00. 11/2/2008 Operator Si ature 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"t 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, 6 Floor Boston, MA 02108 t5aiom.doc•rev. 11-07-05 Page 3 of 3 s. A - � . � r � 1 • Commonwealth of Massachusetts City/Town of 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. A. Facility Information When filling out 1. Facility Name and Address forms on the computer,use Thomas Petralia only the tab key Name to move your 534 Boston Street cursor-do not Street Address use the return key. No.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): ® Residential ❑ Institutional ❑ Commercial ❑ School 4. per Design flow r 310 CMR 15.203: 440 gpd 5. System Designer: Ben Osgood Name ® PE ❑ RS 1600 Osgood Street No Andover MA 01845 Address City(Town state,ZIP B. Approval 1. Local Upgrade Approval is granted for: ❑ Reduction in setback(s)—specify: ❑ Reduction in SAS area of up to 25%: SAS size,sq.ft. %reduction 534 Boston Street form 98 6.07 rev.7/06 Local Upgrade Approvele Page 1 of 1 r Commonwealth of Massachusetts City/Town of Local Upgrade Approval Form 9B B. Approval (continued) ❑ Reduction in separation between the SAS and high groundwater. Separation reduction ft Percolation rate min finch Depth to groundwater ❑ Relocation of water supply well (explain): ® Reduction of 12-Inch separation between inlet and outlet tees and high groundwater ❑ Use of only one deep hole in proposed disposal area ❑ Use of a sieve analysis as a substitute for a pert test List local variances granted not requiring DEP approval per 310 CMR 15.412(4): List variances granted requiring DEP approval: North Andover Health Dept. Approving Authority Susan Sawyer, REHS/RS s .June 28,2007 Print or Type Name and Title i'`S store Date /r. 534 Boston street form 9B 6.07•rev.7106 Local Upgrade Approval- Page 2 of 2 TDVVNDFNORTH ANDOVER T | Offi[mof COM K8UN!TY DE\/ELOPk8 ENT AND SERVICES � H EA LTH [)E P/\RTM E NT . 1600[)SGU0DSTREET, BU|LD!NB2O; SUITE 2-36 NDRT-1 AN00VER. K8ASS1ACHUSB'TS01845 Y 3awvyo . RB�|3. R5 97R088Q540 Phone � PuUiioifea|ihOire(J.m 878.888.8470 FAX � �\eg(�hd��y�wD��ot-Lhg[dgy��oi-ii vmxw,1uwno8nor1ho/xJoverzom A PPL I CAT ION FOR SOIL TES7S DATE: 49K8AP& PARCEL: LOCATION 0FSOIL TESTS: X {��NBl Contad;*. APPLICANT: Contact#: ADDRESS: CERTIFIED SOIL EVALUATOR: _Rwiftalli Intended Use of Land: Residential Subdivision rig!eifamily HQM6 Commercial '/'- �iZ]�� Repair Te� _��_ing� Undeveloped Lot Twsting:____ UpgrodeyorAddition:_____ |nthe Lake CoohiuhewiokWatershed? YemNo - THE FOLLOWING MUST BE INCLUDED WITH THISFORM > Proof ofland ownership(Ta(bill,orletter fnnnowner perm|ttingtest) > 8.5-x 11-Plot plan& Location of Testing(please indicate test pit siteson theplan) � Feeof$425{0per lot for Iewmmstrudion This oovermtbaminimum two deep holes and two percolation tests required for each disposal area. Feof$3800 per lot for repairsor upgrades. GENERAL INFORMATION � Only Certified Soil Evaluatocamayperform deep hole inspections � (}niyK8ass. Registered Senitohamuand Prof es§omdEnginoemcan design eWiuplonu � A1|east two deep hol es;and two percol ati on tests are requi red for each sWi c system disposal area � Repai rs requi re a I east two deep hol es and at I east one percol ati on test, at the discreti on of the BOH representative. > Ful I payment wi I I be requi red for al I additi onal tests withi n two weeks of testi ng. > VVithin45days oftesti ng, aeoadedpIan(no small Ierthan 1-71OO)ehal| besubmitted tothe Board o[Health ehowingthe|mc*tion/f al|tests(imdudingaborted tmstp). � > VVithin80days oftest ingooi| eva|uaiionfurmoehaU be submitted. Please OmNot VVriteBel mwThis Line N.A. Conservation Commission Approval Date. - . � Signature o|Cmnoervation Agent:_ Date back toHealth Department: (stamp in): �M �� L.�L aK�h� ��' � 1.16 A 1.08 AC 1.22 A 1.19 AC, 1.07 A � �C. -zc 1� 5 � 1' 11 � 9C 09 A 14, 13 12 1.31 A a �5 l n �0 2 148 1 �2 �c 17 6 -2, '19 L 3 ca �ro2 t1� 5 � 6 3 5 � `* 2 1 4 5 g V,34 ac SCALE -- 7 .50 FEET Page 1 of 1 i DelleChiaie, Pamela From: Marianne Peters [mpeters@millriverconsulting.com] Sent: Wednesday, May 30, 2007 12:59 PM To: Dan Ottenheimer; 'Lisa Kozel LeVasseur'; Marianne; Grant, Michele; DelleChiaie, Pamela; Sawyer, Susan Subject: Soil Eval Results-534 Boston - May 8, 2007 Results from the soil eval @ 534 Boston Street done on May 8, 2007 are attached. Please call if you have any questions. Marianne Peters Mill River Consulting 2 Blackburn Center Gloucester, MA 01930 978-282-0014 ph 978-282-0012 fx www.millriverconsu.Itina.com 5/30/2007 i AN vi i 6-ID Of cS t} 30 .jc1y_l_.j_ � oriti _ Z i -� A SLt I aj4 i 1;4` tc 'a*ZtP.m aril s V TO: NORTH ANDOVER, MASS IVO �Z 19 7-3— BOARD OF HEALTH FROM: DESIGN ENGINEER Re: Soil Absorption Sewage System Inspection This is to certify that I have inspected the construction of the said disposal system at d 7` J asTci w ..5'7" North Andover, Mass. SITE LOCATION The grades and construction are as specified in my plans and specifications dated eg. �rOf.' y` neeryReg,tS i Yian V�E-k) • `F' . ; �� 1�� / �� t:s s� C!�t 13 X*4, k;w Wt6W C�e A) 4 cts TT 21' ti 4 ZA � 10 LU ter C�esaa css�a�,o ep�exS cg�»�?C9i�c`x�Q - a' , i�,T o�j 6T. . 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