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Miscellaneous - 554 FOSTER STREET 4/30/2018
'-55y 1 554 FOSTER STREET / 210/104.6-0005-0000.0 t L Sawyer, Susan From: Sawyer, Susan Sent: Wednesday,April 30, 2014 9:52 AM To: Iamyharley22@yahoo.com' Subject: information request for 554 Foster Street Attachments: 554 Foster- Approval Letter 12-18-12.doc; Deed Restriction Form- U PDATED-7.28.2O11.doc Dear Amy, I have had the opportunity to review the file for 554 Foster Street in regards to your questions concerning a house addition. I will try to briefly outline our discussion and the findings. I will keep this communication in the folder for future reference by the Health Dept.Staff in case you decide to move forward. 1) What size house is the septic system? The subsurface disposal system is designed for 330 gallons per day; which is a 3 bedroom home (with no greater than 8 rooms at current regulation)This includes a finished basement. (Not including laundry room, mudroom, unfinished attic space or bathrooms) 2) Are there restrictions on putting on a building addition? Upon request of the septic designer and property owner,the NA Board of Health granted a 1 foot reduction to the ground water; as well as two other local upgrades for distance to the wetlands.This was to provide the best possible septic system, but to try to limit things like "system height above the ground" and in consideration of the need and cost of the homeowner. (see approval letter)These were granted with the requirement that there be no increase in the flow rate to the home and that the home remain a "3 bedroom home" unless a fully compliant system is installed. 3) What about an addition with 4 rooms upstairs?At any room#total,clearly in the future,a buyer or realtor could construe that this was a 4-bedroom home with that described configuration. 4 rooms upstairs with a total of no greater than 8 rooms could be approved only if the owner would grant to the Board of Health a restriction that would be placed on the property deed. (see sample form provided by the DEP)This form or one similar would be submitted to the Health Department along with proof of recording. Please let me know if you have any further questions regarding this issue. I hope I was able to provide you with the information you need to make your decisions. Thank you, Susan Susan Sawyer Public Health Director Town of North Andover 1600 Osgood Street Suite 2035 North Andover,MA 01845 Phone 978.688.9540 Fax 978.688.8476 Email mailto:ssawver@townofnorthandover.com Web www.TownofNorthAndover.com xa l/ l Ar) ' lTarlc 1 ' Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for VoluntaryAssessments i 554 Foster Street i Property Address Keith Harley Owner Owner's Name information is required for North Andover MA 01845 12/14/2015 every page. Citylrown State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. RECEIVED Important: A. General Information When filling out DEC 18 2015 forms on the computer,use 1. Inspector: only the tab key TOWN OF NORTH ANDOVER V� to move your Neil J. Bateson HEALTH DEPART , NT IU cursor-do not Name of Inspector use the return key. Bateson Enterprises Inc. Company Name VQ 111 Argilla Road Company Address Andover MA 01810 City/Town State Zip Code 978475-4786 S115 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000).The system: Z Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority ` 12/14/2015 Ins ectol' Signatur Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection`does not address how the system will perform in the future under the same or different conditions of use. t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 17 ' Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for!Voluntary Assessments 554 Foster Street Property Address Keith Harley Owner Owner's Name information is required for North Andover MA 01845 12/14/2015 every page.a e. Cityfrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND(Explain below): t5ins•3/13 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System-Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 554 Foster Street Property Address Keith Harley Owner Owner's Name information is required for North Andover MA 01845 12/14/2015 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes(cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y -1 N El ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced [IY [IN ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•3/13 Title',5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 ' Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments r� 554 Foster Street Property Address Keith Harley Owner Owner's Name information is required for North Andover MA 01845 12/14/2015 every page. CityrFown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate Yes"or No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ❑ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than %day flow t5ins•3/13 Title:5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 ys Commonwealth of Massachusetts r` Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 554 Foster Street Property Address Keith Harley Owner Owner's Name information is required for North Andover MA 01845 12/14/2015 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins-3/13 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 5 of 17 ' Commonwealth of Massachusetts UV9 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments U" 554 Foster Street Property Address Keith Harley Owner Owner's Name information is required for North Andover MA 01845 12/14/2015 every page. Citylrown State Zip Code Date of Inspection C. Checklist K 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 norma!flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ElWas the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms(design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Insp ec tion Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 554 Foster Street Property Address Keith Harley Owner Owner's Name information is required for North Andover MA 01845 12/14/2015 every page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 4 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes E No information in this report.) Laundry system inspected? ❑ Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage d Yes 9 ( Y 9 (gP ))� Detail: Sump pump? ® Yes ❑ No Last date of occupancy: Current Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•3113 Title-5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 ' Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 554 Foster Street Property Address Keith Harley Owner Owner's Name information is required for North Andover MA 01845 12/14/2015 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Pumped August, owner Was system pumped as part of the inspection? ® Yes ❑ No If yes, volume pumped: 1500 gallons How was quantity pumped determined? Measured tank Reason for pumping: Inspect tank&tees Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 ' Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 554 Foster Street Property Address Keith Harley Owner Owner's Name information is required for North Andover MA 01845 12/14/2015 - every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: 2years old,4/26/2013, as built plan Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 2.2 feet Material of construction: ® cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): 4"Cast iron through wall, 3" PVC in house, no leaks visible Septic Tank(locate on site plan): Depth below grade: 1.2 feet Material of construction: Z concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 10'x 5'x 4' Sludge depth: 2" t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments °r 554 Foster Street Property Address Keith Harley Owner Owner's Name information is required for North Andover MA 01845 12/14/2015 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 31" 3,. i Scum thickness 81, Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle 12" How were dimensions determined? Tape Measure Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Pumped septic tank. Inlet tee ok. Outlet tee ok. Outlet filter was clean. Depth of liquid at outlet invert. No evidence of Ieakage.Outlet cover has riser to grade. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 ' Commonwealth of Massachusetts Title 5 Official Inspection Form i Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 554 Foster Street Property Address Keith Harley Owner Owner's Name information is North Andover MA 01845 12/14/2015 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): "Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•3/13 Title 6 Official Inspection Forth:Subsurface Sewage Disposal System•Page 11 of 17 ' Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 554 Foster Street Property Address Keith Harley Owner Owners Name information is required for North Andover MA 01845 12/14/2015 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0 Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): D-box level&distribution equal. No evidence of carryover. No evidence of leakage. Pump Chamber(locate on site plan): Pumps in working order: ® Yes ❑ No* Alarms in working order: ® Yes ❑ No* Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): Pump cycled cled on then off.Alarm has both audible&visual. Pump ok. Floats ok. Pum tank has P riser cover to grade over floats&pump. *If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 554 Foster Street Property Address Keith Harley Owner Owner's Name information is required for North Andover MA 01845 12/14/2015 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 30 ❑ 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.): Five rows of chambers with six chambers per row Soil ok. Vegetation ok. No sign of ponding. Opened up inspection port, no water present. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System-Page 13 of 17 ' Commonwealth of Massachusetts Title 5 Oficial Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 554 Foster Street Property Address Keith Harley Owner Owner's Name information is North Andover MA 01845 12/14/2015 required for every page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 15 Official Inspection Form Subsurface Sewage Disposal! Form-Not for Voluntary Assessments r 554 Foster Street Property Address Keith Harley Owner Owner's Name information is North Andover MA 01845 12/14/2015 required for every page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System:Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately LU �3a S W(c)I LA � t(stt u 3 L4 c t� � y (3- = a3-SI � 2�L e 3 :- �(c)<< t5ins-3/13 Title 5 official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments �I 554 Foster Street _ Property Address Keith Harley Owner Owner's Name information is required for North Andover MA 01845 12/14/2015 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells . Estimated depth to high ground water: 4 feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: 11/1/2012 Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health -explain: Design plan ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Test pit data on design plan Before fling this Inspection Report, please see Report Completeness Checklist on next page. t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts l Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 554 Foster Street Property Address Keith Harley Owner Owner's Name information is North Andover MA 01845 12/14/2015 required for every page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 : Commonwealth of Massachusetts QtYnown of . System Pumping.Record Farm 4 DEO has provided this form for use•by local Boards of Health. Other forms may be'used, but the information'must be substantially the same as that provided here. Before using.this form, check with your local Board of Health to determine the form they use.The System Pumping Record must be submitted,to the local Board of Health or other approving authority. A. Facility. Information 1. System Location: Left/Right front of Hous , L Igh of house Left/right side of house, Left/ Right side of building, Left/Right front of building, Left/Right rear of building, Under deck . address �� • ��� <�'s ��%��- - c4frown State Zip Code 2: System Owner. Name ¢V 1 Address(d different from location) City/Town ' state- Zip Code '7 4 Telephone Number .6. Pumping record 1. Date of Pumping Date 2. Quantity Pumped: Gallons 3. Type-of system: ❑ Cesspool(s) eptic Tank ❑ Tight Tank ❑ Other(describe): 4. Effluent Tee Filter present? ❑ No If yes,was it cleaned? es ❑ Na ' 5. Condition of System: 0CV1ACXA Uo-'U'P'L 4*c� 6. System Pumped By: Neil.Bateson F5821 Name Vehicle Uoense Number Bateson Enterprises Inc Company 7. Location here contents•were disposed: S. Lowell Waste Water C3 Sign a Haut Date t5formCdoc•06/03 System Pumping Record•Page 1,of 1 + Summary Record Card generated on 12/3/2015 2:34:47 PM by Karen Hanlon Page 1 Town of North Andover Tax Map # 210-104.6=0005-0000.0 Parcel Id 16334. 554 FOSTER STREET AMY& KYLE HARLEY 554 FOSTER STREET NORTH ANDOVER MA 01845 Class 101 Single Family Property Type 1 Residential Zonin 3 1 Residential Zonin 2 1 Residential 9 9 Size Total 1 Acres FY 2016 UB Mailing index Name/Address Type Loan Number Active/Inact. From Until AMY&KYLE HARLEY Owner 554 FOSTER STREET NORTH ANDOVER MA 01845 ANDRUKAITIS,E. Previous Customer Inactive 10/31/2013 554 FOSTER ST NO.ANDOVER,MA 01845 UB Account Maint. Account NoCycle Occupant Name Active/Inactive Bldg Id. 18083.0-554 FOSTER STREET Last Billing Date 10/8/2015 3180111 03 Cycle 03 Active UB Services Maint. Account No.3180111 Service Code Rate Charge Multiplier/Users MISCFEEADMIN FEE 0.635/8 7.82 1/ WTR WATER 01 ALL METER SIZE 38.00 /1 UB Meter Maintenance Account No.3180111 Serial No Status Location Brand Type Size YTD Cons 32422050 a Active 00 b Badger w Water 0.63 0.63 129 Date Reading Code Consumption Posted Date Variance 9/11/2015. 173 aActual 10 10/16/2015 -29% 6/11/2015 163 a Actual 13 7/24/2015 9% 3/18/2015 150 a Actual 13 4/28/2015 14% 12/15/2014 137 a Actual 11 1/15/2015 -10% 9/16/2014 126 a Actual 13 10/15/2014 11% 6/12/2014 113 a Actual 11 7/16/2014 -10% 3/14/2014 102 aActual 12 4/11/2014 9% 12/16/2013 90 aActual 6 1/17/2014 475% 10/29/2013 84 f Final Bill 1 10/30/2013 98% 9/13/2013 83 a Actual 1 10/15/2013 -53% 6/14/2013 82 a Actual 2 7/24/2013 -100% 3/20/2013 80 a Actual 0 4/22/2013 -100% 12/13/2012 80 aActual 1 1/9/2013 -100% 9/19/2012 79 a Actual 0 10/15/2012 -100% 6/18/2012 79 a Actual 1 7/16/20.12 -100% 3/20/2012 78 a Actual 0 4/14/2012 -100% 12/19/2011 78 a Actual 1 1/17/2012 1% 9/16/2011 77 a Actual 1 10/13/2011 -5% 6/13/2011 76 a Actual 1 7/20/2011 -100% 3/15/2011 75 a Actual 0 4/13/2011 -100% 12/15/2010 75 aActual 0 1/12/2011 -100% 9/16/2010 75 a.Actual 2 10/15/2010 -6% 6/14/2010 73 a Actual 2 7/15/2010 -29% 3/18/2010 71 a Actual 3 4/14/2010 -43% 12/14/2009 68 aActual 5 1/12/2010 -100% 9/16/2009 63 a Actual 0 10/15/2009 -100% Y SUMMARY OF INVERTS BUILDING TIES SEWER ® FDTN. 93.28 BLDG. CORNER A I B C DNOTE: THIS PLAN & CERTIFICATION IS NOT SEPTIC TANK IN 93.11 SEPTIC TANK OUT 22.2 24.5 — — A WARRANTY OF THE SUBSURFACE DISPOSAL SEPTIC TANK OUT 92.75 PUMP TANK OUT 24.8 25.3 — — SYSTEM, IT IS A RECORD OF THE LOCATION DIST. BOX IN 96.21 DIST. BOX — — 15.5 41.8 AND ELEVATION OF THE EXISTING SYSTEM DIST. BOX OUT 96.06 COMPONENTS. INV. IN CHAMBER 95.91 BOTT. CHAMBER 95.66 *NOTE SEPTIC TANK WAS INSTALLED 47'.t FROM THE WETLAND WHERE 52' WAS PROPOSED "I HEREBY CERTIFY THE LOCATIONS, ELEVATIONS, TIES, COVER MATERIAL; EXPOSED COMPONENT COVERS ETC., SHOWN ON THIS AS-BUILT SUBSTANTIALLY AGREE WITH THE APPROVED PLAN AND HAVE. DETERMINED THAT THE BREAK OUT ELEVATIONS, IF APPLICABLE, HAVE BEEN MET." APPROVED DESIGNS PLANS. SIGNATURE OF DESIGNER DATE c VIH OF Mgss,9 VLADIMIMR L �yG r o NEMCHENOK m co fSS�ONAL.E�d I IA 9 WlW JW 104D 201w 6 (1.0 At*) , i 1 1 EDW OFW BY NOME F.N1MNQ 0Pit4�tit . !1 4 ' � w 00160 I 4 •Pf TAM n N es lo' w � X53; f d oxk. s, t 100.0 4'SEEtiE - ° LEACH FGD ! t wremm Poar ,a,T AS BUILT PLAN OF SUBSURFACE DISPOSAL SYSTEM LOCATED IN NORTH ANDOVER, MASS./554 FOSTER STREET AS PREPARED FOR ELIZABETH ANDRUKAITAS TM: 104B DATE: 4-26-13 TL: 5 r%iii SCALE: 1"=40' 0 20 40 80 a MERRIMACK ENGINEERING SERVICES 66 PARK STREET ANDOVER, MASSACHUSETTS 01810 - w 1 44 Commercial Street Raynham,MA 02767 Tel: (508)880-0233 Fax: (508)880-7232 April 30, 2014 RECEIVED NY Q 6 2014 TOWN OF NOR)ti ANDOVER North Andover Board of Health HEALTH DEPARTMENT 1600 Osgood Street North Andover, MA 01845 Attention: Health Agent Reference: FAST' Wastewater Treatment System- Serial Number: 2N281 Attached please find the Field Inspection & Service Report with field test results for services performed on 2-11-14 at the property of Karen Herman located 45544 Foster Street, North Andover, MA. Please call if you have any questions or require additional information. Sincerely, Wastewater Treatment Services, Inc. Service Department Enclosures Copy to: Karen Herman Massachusetts DEP R A.T E D 8450 Cole Parkway, Shawnee, KS 66227, Phone 913-422-0707, Fax 913-422-0808 e-mail:onsite .biomicrobics.com, www.biomicrobics.com, 800-753-FAST(3278) FIELD INSPECTION & SERVICE REPORT For Bio-Microbics Single Home FAS " System - INSTALLATION AUTHORIZED SERVICE PROVIDER Installation Address: 544 Foster Street Name:Wastewater Treatment Services,Inc. North Andover,MA 01845 Owner Name:Karen Herman Mail Address: 544 Foster Street Mail Address: 44 Commercial Street North Andover,MA 01845 Raynham,MA 02767 Phone:978-689-3599 Fax: e-mail: Phone:(508)880-0233 Fax:(508)880-7232 e-mail: INSTALLATION INFORMATION Model No. Serial No. Date of Installation Date of last pump out MicroFAST.5 2N281 5/29/2002 8/1/2004 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 Aerobic Treatment Zone EFFLUENT(optional) LIMIT RESULT Estimated Daily Flow 440 gpd pH(Standard Units) 7 Color Clear Temperature 49 Odor Earthy Comments: TECHNICIAN SERVICE DATE David Zavelle 2-11-14 y � S Massachusetts Department of Environmental Protection Bureau of Resource Protection -Title 5 i DEP Approved Inspection and O&M Form for Title 5 I/A Treatment and Disposal Systems A. Installation - Karen Herman Owner 544 Foster Street Facility Street Address North Andover 01845 City Zip Mailing address of owner, if different: 544 Foster Street Street Address/PO Box: North Andover MA 01845 City State Zip 978-689-3599 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 David Zavelle 12920 Certified Operator Name Certification Number C. Facility/System Information 2N281 Bio-Microbics Inc. MicroFAST .5 DEP ID Manufacturer ID Model Number 5/29/2002 5/29/2002 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 2-11-14 Inspection Date Previous Inspection Date Pumping Recommended [J Yes [x] No p 9 Sludge Depth(to be checked yearly) 1 Massachusetts Department of Environmental Protection LlBureau 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 [x] clear [] turbid [] Other(specify): Odor: [] musty [x]earthy [] moldy [] offensive []turbid Effluent Solids: [x] no [] some pH 7 SU DO 5.87 mg/L Turbidity 7.13 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 Notes and Comments: 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 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. ` 2-11-14 Operator Signature Date System owner must submit this report, technology 0&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 3 •; EDI . PUBLIC HEALTH DEPARTMENT Town of North Andover Community Development Division CERTIFICATE OF COMPLIANCE As of: 6/10/13 This is to certify that the individual subsurface disposal system has been installed in accordance with the provisions of Title 5 of the State Environmental Code: Complete Repair and Construction of an On-Site Sewage Disposal System By: James Kellett At: 554 Foster Street Map 104B Lot 0005 North Andover, MA 01845 The Issuan e f this certificate shall not be construed as a guarantee that the system will function satisfactorily. sa Sawy FF I LE�, COPY Public H lth A ent 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com r10RTir ACM11S i PUBLIC HEALTH DEPARTMENT fommunity Development Division TOWN OF NORTH ANDOVER SEPTIC DISPOSAL.SYSTEM—]INSTALLATION C'ERTJFI A-TFTO RECEIVED The_undersigned hereby certify that the Sewage Disposal System(instructed;( )re ed; �U� 2 13 By. i�� �EU` ^ TOWN OF NORTH ANDOVER (Print Name) HEALTH DEPARTMENT Located at: (Installation Address) Was installed in _ conformance ce with the North Andover Board of Health approved plan,originally dated �`L I and last revised on _.-. I&.—0— I-Z-*" with a design flow of 116710 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 p the As-built which leas been submitted to the Board ofi Health. '*POM y p'fIG I�T2Kr_Z pW0f 9 - �I(,�• Bottom of Bed Inspection Date: Engineer Representative(Signature) And—Print Name II Final Construction Inspection Date: — 't V� Engineer Represen five(Signature) F2_ And—Print Name Installer: _(Signature) Date: _ ® And Pri_ Name Enginer: Vlx&I'L A4'o4&1e 4a (Signature) Date: 0.�t7J And—Print Name 1600 Osgood Street, North Andover,Massachusetts 01845 Phone 978.688.9540 Fox 978.688.8476 Web http://www.townofnorthandover.com LL /J May 23, 2013 Em- North North Andover Board of Health Andover, MA Re: 554 Foster Street Dear Susan: I am writing to you to explain the reason for the septic tank being installed three feet into the 50 foot buffer zone instead of as planned at 52 feet away from wetland flags. As being a long time licensed septic installer in the Town of North Andover,the Board of Health requires that a building sewer pipe from the house be completely straight without any bends. Therefore, when we uncovered the building sewer pipe, we found that it came out at an angle not as planned. We had to make a field change by turning the tank to accept the building sewer pipe to an inlet on the tank. While we were installing this, we were obtaining severe ground water and collapsing soil due to the high water table. It became so bad that we were nervous about undermining the existing foundation and stairs at the back of the house. Michelle Grant, the N.Andover Health Inspector,was present during this situation and witnessed this unmanageable situation. After taking ties to the property line,the foundation and existing wetland flags placed in the ground, we were all within setbacks set by the code and plan. It has come to my attention after the septic as-built was completed; Merrimac Engineering explained to me that the tank was inside the 50 foot buffer zone. I explained to them that we measured from the flags in the ground and were out of the buffer zone. He then explained to me that there was a new delineation line for the wetlands that never got staked out. As you can see,this was a very simple mistake on my part and I am looking for help to solve this matter any way away from moving the tank due to the unstable soil we ran into setting the tank originally. I am looking for the committee to understand this simple mistake and hope this can be taken care of by a simple variance on the plan. I truly appreciate your attention to this matter. Best regards, m lett North Andover Health Department Community Development Division ONSITE WASTEWATER SYSTEM CONSTRUCTION NOTES LOCATION INFORMATION ADDRESS: 554 Foster St. MAP: 104B LOT: 5 INSTALLER: Jim Kellett DESIGNER: Vladimir Nemchenok PLAN DATE: 11/8/12 BOH APPROVAL DATE ON PLAN: 12/18/12 INSPECTIONS TANK INSPECTION: DATE OF BED BOTTOM INSPECTION:4/18/13 DATE OF FINAL CONSTRUCTION INSPECTION: 4/25/13 DATE OF FINAL GRADE INSPECTION: 6..6`13 SITE CONDITIONS ® Contractor reports any changes to design plan ® Existing septic tank properly abandoned ® Internal plumbing all to one building sewer ® Topography not appreciably altered Comments: Re-routed plumbing internally instead of externally as shown on design plan. This is a better option. Old dug well collapsed and backfilled during the construction. The well was previously abandoned. SEPTIC TANK ® Building sewer in continuous grade, on compacted firm base N/A Cleanouts per plan ® Bottom of tank hole has 12" stone base ® Weep hole plugged ® 2000 gallon tank has been installed H-10 loading f' a Z Monolithic tank construction ® Watertightness of tank has been achieved by visual testing ® Inlet tee installed, centered under access port ® Outlet tee installed, centered under access port (effluent filter) ® 20" inch cover to finish grade installed over middle and outlet access ports ® Hydraulic cement around inlet & outlet Comments: Septic/Pump combo tank PUMP CHAMBER ❑ Bottom of tank hole has 6" stone base ® Weep hole plugged ® 2000 gallon Septic/Pump Combo installed ® H-10 loading ® Monolithic tank 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 ® 20" cover at final grade installed over pump access port ® Water tightness of tank has been achieved by Visual testing ® Hydraulic cement around inlet & outlet Comments: CONTROLPANEL ® Alarm & Pump are on separate circuits ® Alarm sounds when float is tripped ® Location of control panel: basement ® Alarm signal located inside: basement Comments: DISTRIBUTION-BOX ® Installed on stable stone base ® H-20 D-Box N/A Inlet tee (if pumped or >0.08'/foot) ® Hydraulic cement around inlet & outlets ® Observed even distribution N/A Speed levelers provided (not required) Comments: Baffle D-Box installed 2" x 4" coupling installed 4' before D-Box for p 9 velocity reduction SOIL ABSORPTION SYSTEM (General) ® 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 ® 40 Mil HDPE barrier installed ® Laterals installed and ends connected to header (and vented if impervious material above) ® Elevations of laterals and chambers installed as on approved plan N/ Retaining wall (boulder/ concrete /timber/ block) Final cover as per plan Comments: SOIL ABSORPTION SYSTEM (Gravel-less Chambers) ® Brand and Model of Chamber: Standard Quick Low Profile 4 Infiltrator Chambers ® Number of chambers per row: 6 ® Number of rows (trenches): 5 Comments: Total Chambers = 30 BM = 100.00 HR = 0.68 HI = 100.68 SYSTEM ELEVATIONS ROD AS-BLT INVERT DESIGN INVERT ELEVATION ELEV ELEV Benchmark 0.68 100.00 Building Sewer OUT 7.04 93.29 95.6 Septic Tank IN 7.23 93.10 93.00 2" )Septic Tank OUT 7.65 92.86 92.75 Distribution Box IN 4.08 96.25 96.20 Distribution Box OUT 4.21 96.12 96.03 Lateral 1 TOP 4.33 Lateral 1 INVERT 96.00 95.98 Lateral 2 TOP 4.33 Lateral 2 INVERT 96.00 95.98 Lateral 3 TOP 4.33 Lateral 3 INVERT 96.00 95.98 Lateral 4 TOP 4.33 Lateral 4 INVERT 96.00 95.98 Lateral 5 TOP 4.33 Lateral 5 INVERT 96.00 95.98 Top of Chamber 4.33 96.35 96.37 Bottom of Bed/Chamber 95.68 95.70 CRITICAL SETBACK DISTANCES Mark those distances checked in the field against the design plan and regulatory setback Tank SAS Sewer ® Property line 10 10 -- ® Cellar wall 10 20 -- ® Inground pool 10 20 -- ® Slab foundation 10 10 -- ® Deck, on footings, etc 5 10 -- ® Waterline 10 10 101 ® Private drinking well 75 1002 50 ® Irrigation well 75 100 ® Surface Water 25 50 ❑ Bordering Vegetated Wetland , Salt Marsh, Inland/Coastal Banka 75 100 *As approved by BOH & Con Com ® 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 a .C � Allq -41 s r # r �`u ° � s NO °rod i;` �6f VVW s x� R,ce. ' lit :moi � f� 9 "" 3�-" WellIf rk 41 lz 44, 4 x ate so �� # 1� ts F p et4 g �` 1 ��t{ F At -ntkn, �' ' sffi,�,k �� � �s � a• `�ti �`�ra ar s'��� � �...� ,4` 4 .C' -y ✓+�i1+. ef#� 'S"a1L " � A* +f �F' " "-r•'y �k� ♦.� 7"��' ' .F�*�y . " .*�^ 16 is � K � � !.F G' _` at � ,ate x t � r d � `�r� +f "� £a i.A� ` -i-#` �7E+ '�1'k�. C 'i•�#'� `g ..€r' .-�'z F > rwm qt A0,; lo s- 3 s t - .;i4.4�� � r.*... �,.t"'°r fir• �, � ^,,�.' ='y -�"°='fib` "d. •�. ,t �,�,*� _ �. Sawyer, Susan From: Sawyer, Susan Sent: Tuesday, May 28, 2013 1:43 PM To: jmrunions@comcast.net' Cc: Grant, Michele Subject: 554 Foster Street Attachments: 20130528120721960.pdf Dear Joanne, As we just spoke about, I have attached the letter recently received by the Health Department in regards to the septic system at 554 Foster Street. In addition, below is an excerpt from the BOH minutes in November.At this time the Health Department cannot sign off on the septic system at this site; as the location of the tank is five feet closer to the wetlands than approved by Health and Conservation. I understand Mr. Kellett is also in contact with the Conservation Department on the procedures regarding this error. It is unfortunate that he did not confirm the change with Mr. Dufresne prior to backfilling the tank;this is protocol and was verbally reasserted by Ms. Grant, in the field the day of the inspection.The Health Department has supported changing components for reasons such as eliminating bends in a line, but our regulation requires that installers confirm changes from the approved plan to avoid problems such as this.Our inspector told Mr. Kellett that this office had no issue with the change of tank location; as long as Mr. Dufresne was in favor of it. In speaking with Mr. Dufresne; he stated that he had no recollection of receiving that request from Mr. Kellett. The Board of Health approved the distance that Conservation approved; hence there will be no reason to attend a second BOH meeting assuming the Conservation Department comes to a resolution. If it involves moving the tank;we will be present to observe and inspect the work by the installer.Once Conservation makes a decision; our office will look again at the issuance of the health Dept. Certificate of Compliance. Thank you Susan Sawyer Motion: Mr. Pease motioned to grant an out of season variance to section 4.2 of the North Andover Subsurface Wastewater Disposal Regulations. Mr. Fixler seconded the motion.All were in favor.The second issue was a variance to the distance from a septic leaching area to the wetland.This matter will be before the NA Conservation Commission in early December.The next BOH meeting won't be until December 20th.At that meeting the BOH members could approve the variance. Dr.Trowbridge stated that since this is a completely failed system it is in the best interest to grant these variance requests now to allow the homeowner to move the installation forward faster. Motion: Mr. Fixler motioned to approve the waivers and local upgrades shown on the plan provided by Mr. Kellett,or to approve any change in distance to the wetlands as approved by the NA Conservation Commission. Mr. Pease seconded the motion and all were in favor. Susan Sawyer Public Health Director Town of North Andover 1600 Osgood Street Suite 2035 North Andover,MA 01845 Phone 978.688.9540 1 Fax . 978.688.8476 Email mailto:ssawver@townofnorthandover.com Web www.TownofNorthAndover.com 2 Sawyer, Susan From: Sawyer, Susan Sent: Tuesday, May 28, 2013 1:43 PM To: jmrunions@comcast.net' Cc: Grant, Michele Subject: 554 Foster Street Attachments: 20130528120721960.pdf Dear Joanne, As we just spoke about, I have attached the letter recently received by the Health Department in regards to the septic system at 554 Foster Street. In addition, below is an excerpt from the BOH minutes in November.At this time the Health Department cannot sign off on the septic system at this site; as the location of the tank is five feet closer to the wetlands than approved by Health and Conservation. I understand Mr. Kellett is also in contact with the Conservation Department on the procedures regarding this error. It is unfortunate that he did not confirm the change with Mr. Dufresne prior to backfilling the tank;this is protocol and was verbally reasserted by Ms. Grant, in the field the day of the inspection.The Health Department has supported changing components for reasons such as eliminating bends in a line, but our regulation requires that installers confirm changes from the approved plan to avoid problems such as this.Our inspector told Mr. Kellett that this office had no issue with the change of tank location; as long as Mr. Dufresne was in favor of it. In speaking with Mr. Dufresne; he stated that he had no recollection of receiving that request from Mr. Kellett. The Board of Health approved the distance that Conservation approved; hence there will be no reason to attend a second BOH meeting assuming the Conservation Department comes to a resolution. If it involves moving the tank;we will be present to observe and inspect the work by the installer.Once Conservation makes a decision;our office will look again at the issuance of the health Dept. Certificate of Compliance. Thank you Susan Sawyer Motion: Mr. Pease motioned to grant an out of season variance to section 4.2 of the North Andover Subsurface Wastewater Disposal Regulations. Mr. Fixler seconded the motion.All were in favor.The second issue was a variance to the distance from a septic leaching area to the wetland.This matter will be before the NA Conservation Commission in early December.The next BOH meeting won't be until December 20th.At that meeting the BOH members could approve the variance. Dr.Trowbridge stated that since this is a completely failed system it is in the best interest to grant these variance requests now to allow the homeowner to move the installation forward faster. Motion: Mr. Fixler motioned to approve the waivers and local upgrades shown on the plan provided by Mr. Kellett,or to approve any change in distance to the wetlands as approved by the NA Conservation Commission. Mr. Pease seconded the motion and all were in favor. Susan Sawyer Public Health Director Town of North Andover 1600 Osgood Street Suite 2035 North Andover,MA 01845 Phone 978.688.9540 1 Fax , 978.688.8476 Email mailto:ssawver@townofnorthandover.com Web www.TownofNorthAndover.com 2 Sawyer, Susan From: Sawyer, Susan Sent: Tuesday, May 28, 2013 3:27 PM To: 'Lois Christiansen' Cc: Blackburn, Lisa (LBlackburn@townofnorthandover.com) Subject: 848 johnson Hi Lois, I would like to offer to not have another tree cut down, by asking if we can do two things via email Rather than printing out a new copy,could you put in writing answers to the following; Or request and give approval to change the plan I have. I will leave it to your discretion. Thank you Susan 1. Please reference the Lake Cochichewick watershed in the notes on sheet 1 (NA 3.2). 2. Please demonstrate that a conventional system in compliance with 310 CMR 15.000 can be built on the site in order to use the Infiltrator Chamber system according to Section 1(3)of the DEP General Use approval letter. An outline and brief description of a conventional system on the site plan is sufficient. 3. The design plan references two different Infiltrator Chamber models(High Capacity and Standard Low Profile). It appears the design is based on the Standard Low Profile model. Please modify the design accordingly to correct the discrepancy. 4. Please indicate if the existing garage adjacent to the leaching facility has a slab foundation. If so, it must be 10 feet away from the proposed leaching facility. Susan Sawyer Public Health Director Town of North Andover 1600 Osgood Street Suite 2035 North Andover,MA 01845 Phone 978.688.9540 Fax 978.688.8476 Email mailto:ssawver@townofnorthandover.com Web www.TownofNorthAndover.com .0 w,,. Y� 1 General Laws: CHAPTER 140, Section 51 Page 1 of 1 p p0 THE 10GENERAL COURT OF Home Glossary FAQs site search THE COMMONWEALTH OF MASSACHUSETTS Options co Massachusetts Laws Bills State Budget People Committees I Educate 8 Engage Events Massachusetts Laws General Laws Print Page Massachusetts Constitution PART I ADMINISTRATION OF THE GOVERNMENT General Laws (Chapters 1 through 182) PREV NEXT Session Laws -- — —-- —-- --—--— - —__r TITLE XX PUBLIC SAFETY AND GOOD ORDER Rules PREV NEXT CHAPTER 140 LICENSES PREV NEXT Section 51 Facial and scalp massage; bath houses PREV NEXT Section 51. (a) No person shall practice massage therapy unless licensed in accordance with sections 227 to 236, inclusive,of chapter 112, except that a person registered as a barber or apprentice under section 87H or 87I of said chapter 112 or as a hairdresser,operator or student under sections 87T to 8733, inclusive,of said chapter 112 may practice facial and scalp massaging without a license. Local boards of health may regulate other fields not licensed as massage therapy under said sections 227 to 236, inclusive,of said chapter 112. (b)No person shall establish businesses for vapor, pool,shower or bath houses unless authorized by the board of health in the municipality where the establishment is to be operated.The board of health may grant the authorization upon such terms and conditions, and may make such rules and regulations in regard to the carrying on of the occupation so licensed, as it considers proper and may revoke any authorization granted by it for such cause as it considers sufficient,without a hearing.A person authorized to establish the giving of vapor, pool,shower or other baths in a municipality may,at the request of a physician, attend patients in another municipality without additional authorization from the other municipality. No massage therapist,whose license to practice massage therapy is revoked or suspended for more than 1 year with regard to insurance claims, shall own,operate, practice in,or be employed by a massage therapy office,clinic,or other place designated for the practice of massage therapy, physical therapy or chiropractic. Show/Hide Site Map Mass.00v I Site Mao I Terms of Use I Privacy Policy I Accessibility Statement I Contact Us Copyright©2013 The General Court,All Rights Reserved http://www.malegislature.gov/Laws/GeneralLaws/PartI/Title)DuChapter 140/Section5 l 5/28/2013 North Andover Board of Health Meeting Minutes Thursday,November 15,2012 7:00 p.m. 120 Main Street,2nd Floor Selectmen's Meeting Room North Andover,MA 01845 Present: Thomas Trowbridge,Larry Fixler,Frank MacMillan(left meeting at 7:58),Edwin Pease,Susan Sawyer,(Joseph McCarthy was not in attendance) I. CALL TO ORDER The meeting was called to order at 7:08 pm II. PLEDGE OF ALLEGIANCE III. PUBLIC HEARINGS IV. APPROVAL OF MINUTES Meeting minutes from October 25,of 2012 were presented for signature.Motion was made by Dr. MacMillan to approve the minutes,the motion was seconded by Mr.Fixler,all were in favor and the minutes were approved. V. OLD BUSINESS VL NEW BUSINESS A.A request made by the owners of Van Otis for a variance to the State labeling requirements to allow holiday wrapped boxed chocolates to be placed for sale without external ingredient labels. Susan Sawyer presented the background information regarding the request by Van Otis. She stated that Megan Baldwin,consultant for Public Protection Specialists,did her inspections to make sure the proper labeling requirements were on the products. Megan reported that she had observed holiday wrapped boxes available for purchase placed on the shelves without the ingredient and allergen information visible per state rules and regulations. These must have labels that give minimum requirements for labeling.Boxes don't need labels if they are behind the counter but when on the shelves out on the floor they do.Jack McCarthy,former owner of Van Otis and his daughter Ann Paul,current owner who runs the business,were present.Jack McCarthy approached the podium and gave a brief history on the business. The company currently sells one product only,which is a Swiss truffle in 9 different combinations.Mr.McCarthy presented two boxes of chocolates to be viewed by the Board.One box was unwrapped and the other box was wrapped with holiday paper.During the holidays,the boxes are gift wrapped in paper.Mr.McCarthy stated that there are signs on the shelves to indicate what type of chocolate is in the box. The consumer then brings the box of chocolate to the counter for purchase.The employee behind the counter checks the box and confirms with the consumer what type of chocolate they are purchasing.Mr.McCarthy stated that sixty to seventy percent of their business is done from Thanksgiving to Christmas.Many people buy the chocolates in bulk.Mr.Fixler asked Mr. McCarthy if they could store the wrapped boxes behind the counter.Mr.McCarthy stated that the store would need November 15,2012 North Andover Board of Health Meeting-Meeting Agenda Page 1 of 4 Note: The Board of Health reserves the right to take items out of order and to discuss and/or vote on items that are not listed on the agenda. Board of Health Members: Thomas Trowbridge,DDS,MD,Chairman;Mr.Fixler,Member/Clerk;Francis P.MacMillan,Jr., M.D.;Joseph McCarthy,Member; Mr.Pease,Member Health Department Staff:Susan Sawyer,Health Director; Debra Rillahan,Public Health Nurse;Michele Grant,Public Health Inspector;Lisa Blackburn,Health Department Assistant North Andover Board of Health Meeting Minutes Thursday,November 15, 2012 7:00 p.m. 120 Main Street,2nd Floor Selectmen's Meeting Room North Andover,MA 01845 to be changed around in order to keep the many boxes of the product behind the shelves. The way the store is set up now is very practical for the consumers who come in and would be an imposition to change the way things are done. Since the room is very small it would be an issue.Mr.Fixler stated that the allergen part is a real concern for the public.Dr.MacMillan asked Mr.McCarthy if their boxes have stickers on them now.Mr.McCarthy stated that there are no stickers on the gift wrapped boxes.He did state that after the boxes are wrapped,employees handwrite letters on the side of the box to indicate what type of boxed chocolates the consumer is purchasing.Dr.Trowbridge stated that it is important for the consumer to know of any possible allergens in the product.Dr.MacMillan asked if they could use a printed sticker listing possible allergens and affix it to the box. Since tape is used to gift wrap the box,why not use the sticker as the tape?Mr.McCarthy said that using stickers would be an added cost to the company.In order to give an exception to the regulation,Dr.MacMillan needs to know where the hardship is.He doesn't see the hardship in using a sticker label instead of tape.Dr.Trowbridge pointed out that using the sticker label instead of the tape would also alleviate the process of hand labeling with a marker on the side of the box.Ann Paul approached the podium.Ms.Paul stated that since this is the busiest season,with most of the product needing to go out soon,could they possibly start the labeling process after the first of the year?Mr.Pease questioned the State labeling requirements and why would someone eat something not knowing what it is?Susan Sawyer stated the labeling is there so the consumer can see what they are buying.Dr.MacMillan stated he understood what Mr.Pease was saying but stated that it prevents allergic reactions from happening.He also stated that the Board's role is notto change the law but to hear the request for relief from a state regulation that already exists.Mr.Pease stated that if allergens are the concern then why not make a sticker that indicates the product may contain nuts and put it on the box.Mr.Fixler stated that basic allergens need to be listed not just nuts.Dr.MacMillan referred to the labeling guide for packaged foods and listed some of the potential allergens.He stated that by keeping the product behind the counter an authoritative person would be there to answer basic questions regarding the product.Mr.McCarthy would like the thousands of boxes that are already wrapped to be sold without the labeling but after first of the year would add the labels to their product.Dr.MacMillan explained that this labeling law was put into effect in the year 2000.Mr.McCarthy asked why there wasn't a problem during the past years. Susan Sawyer explained that many of the inspections were primarily done in restaurants but now since selling premade products have come to light during the inspections,the Health Department needs to be equal across the board and not just in restaurants to ascertain full compliance. Mr.Fixler stated that food labeling is responsibility of the owner.Dr.Trowbridge asked again about the signs on the display shelves.Mr.McCarthy stated again that each display shelf is labeled with a sign,but there is not a label on the gift wrapped boxes.Dr.MacMillan asked Susan Sawyer how long ago this problem was noticed. Susan Sawyer stated that the inspection was done on October 12,2012. She then read the inspection report made by Megan Baldwin.The company was then re-inspected on November 2,2012 by Megan.Megan listed options that were given to the Van Otis Company to comply with the labeling requirements. Susan Sawyer read the options that were on the re-inspection sheet.Mr.Fixler asked Mr.McCarthy if they had an alternative plan.Mr.Fixler explained again the allergen concern.Mr.McCarthy stated that there are many boxes that are already wrapped and ready to go. The concern by the Board is not the boxes that are ready to be shipped,just the ones that will be sold in the store November 15,2012 North Andover Board of Health Meeting-Meeting Agenda Page 2 of 4 Note: The Board of Health reserves the right to take items out of order and to discuss and/or vote on items that are not listed on the agenda. Board of Health Members: Thomas Trowbridge,DDS,MD,Chairman;Mr.Fixler,Member/Clerk;Francis P.MacMillan,Jr., M.D.;Joseph McCarthy,Member; Mr.Pease,Member Health Department Staff:Susan Sawyer,Health Director; Debra Rillahan,Public Health Nurse;Michele Grant,Public Health Inspector;Lisa Blackburn,Health Department Assistant North Andover Board of Health Meeting Minutes Thursday,November 15,2012 7:00 p.m. 120 Main Street,2"d Floor Selectmen's Meeting Room North Andover, MA 01845 front.Dr.MacMillan said the boxes that are not labeled behind the counter are in compliance.Ann Paul stated that to reconfigure the store is overwhelming in order to put all the boxes behind the counter.Dr.MacMillan stated that he was having a hard time seeing the hardship.Ann Paul stated that they were there to see what the board can do. Mr.Fixler asked again if Van Otis would consider the sticker suggestion given to them by the Board.Dr. Trowbridge stated he understood Mr.McCarthy's position but the law states that if the product is in the store display area,a label listing possible allergens need to be listed on the outside of the box.Dr.MacMillan also gave a suggestion for a sticker to be put on at the point of sale as needed.The label can be any size and placed anywhere on the box,and the proper wording is in the regulation. Susan Sawyer asked the Board what time period would be reasonable for the company to comply. Motion was made by Dr.MacMillan for Van Otis to have ten business days to comply fully with labeling requirements according to state regulation.Mr.Pease seconded the motion and all were in favor.(At this time Dr. MacMillan left the meeting.) B.Out of season permit for the installation of a new septic system at 554 Foster Street(owner Elizabeth Audrukaitis). Susan Sawyer gave information on the permitting season for septic installations.November 15d'is the last day to apply for an installation and the installation needs to be completed by November 30th.The variance is there to protect the public. Susan Sawyer gave examples of what could happen to septic systems installed out of season due to snow etc. The Consumer is allowed go before the board to ask for a relief from this variance. Susan Sawyer stated that the original system inspection for this particular system was done on June 4,2012.The system failed and at that point an application for a soil tests was submitted on October 12,2012.The soil tests were complete however no plans have been submitted to the Health Department. Susan Sawyer has not seen the plans and states that wetlands may be involved.The septic system is not at a point of installation yet and we don't know when it might be.Mr.Kellett,licensed installer for the town and Joanne Runions,who has power of attorney for mom Elizabeth Audrukaitis,were present.Joanne Runions approached the podium. She stated that the home needs to be sold and found that the septic needs to be replaced. Susan Sawyer stated to the Board that a home can be sold with a failed septic system however the new homeowner would be responsible for replacing it.Joanne Runions said the plans were supposed to be delivered to the Health Dept.No plans were received yet.Mr.Fixler asked if anyone would be living in the home in the winter?Joanne Runions stated that no one would be living there. Susan Sawyer stated that there are different types of septic failures. She read the Title 5 report for the type of failure of this particular system had.Dr.Trowbridge asked Joanne Runions if the installer reviewed the installation timing process and if she understood the liability of installing a septic system in the winter.Joanne Runions stated that she understood.Mr.Kellett approached the podium to answer questions.Mr.Kellett stated that once ready to install the system,it would take about seven to ten days to install.Mr.Pease asked about the process for installing the system and Mr.Fixler asked about the timeframe involved. Susan Sawyer gave a synopsis of how the installation process could go.Mr.Kellett brought copies of the septic plans.Mr.Kellett says the plan shows that the septic installation November 15,2012 North Andover Board of Health Meeting-Meeting Agenda Page 3 of 4 Note: The Board of Health reserves the right to take items out of order and to discuss and/or vote on items that are not listed on the agenda. Board of Health Members: Thomas Trowbridge,DDS,MD,Chairman;Mr.Fixler,Member/Clerk;Francis P.MacMillan,Jr., M.D.;Joseph McCarthy,Member; Mr.Pease,Member Health Department Staff:Susan Sawyer,Health Director; Debra Rillahan,Public Health Nurse;Michele Grant,Public Health Inspector;Lisa Blackburn,Health Department Assistant North Andover Board of Health Meeting Minutes Thursday,November 15,2012 7:00 p.m. 120 Main Street,2nd Floor Selectmen's Meeting Room North Andover, MA 01845 will be sixty-three feet away from the wetlands.The plan was given to Susan Sawyer and Dr.Trowbridge to review. Mr.Kellett reviewed the plans with the Board. Motion:Mr.Pease motioned to grant an out of season variance to section 4.2 of the North Andover Subsurface Wastewater Disposal Regulations.Mr.Fixler seconded the motion.All were in favor.The second issue was a variance to the distance from a septic leaching area to the wetland.This matter will be before the NA Conservation Commission in early December.The next BOH meeting won't be until December 20"'.At that meeting the BOH members could approve the variance.Dr. Trowbridge stated that since this is a completely failed system it is in the best interest to grant these variance requests now to allow the homeowner to move the installation forward faster. Motion: Mr.Fixler motioned to approve the waivers and local upgrades shown on the plan provided by Mr.Kellett,or to approve any change in distance to the wetlands as approved by the NA Conservation Commission. Mr.Pease seconded the motion and all were in favor. VII. COMMUNICATIONS,ANNOUNCEMENTS,AND DISCUSSION A.Emergency preparedness and alerts.Dr.Trowbridge wants the public to know that there are training programs put in place and people at governmental levels to assist in emergencies and alerts.The FEMA website has links for training.Local emergency response preparedness information and training for North Andover is also provided through the fire department,Board of Health,and police department.There is a very good team headed by Jeff Coco assisted by Conner and Jon Savastano.When there are warnings,the team goes into play.Dr. Trowbridge also stated that the Eagle Tribune links to national weather alerts.You can also get alerts on smart phones,through texts or emails.The Massachusetts Emergency Management Association is partnered with Ping 4 that will put out alerts that come from the National Weather Service.This is a good way for the public to be connected rather than just depending on the radio or television.Dr. Trowbridge wants the public to know that there are other ways to gain information to be prepared and be in the know. Susan Sawyer also stated that there is a town Facebook account and the NAPD website Blackboard,where residents can sign up to receive text or telephone alerts. VIII. CORRESPONDENCE/NEWSLETTERS IX. ADJOURNMENT X. MOTION was made by Mr.Pease to adjourn the meeting,Mr.Fixler seconded the motion,and all were in favor.The meeting was adjourned at 8:33 pm. November 15,2012 North Andover Board of Health Meeting-Meeting Agenda Page 4 of 4 Note: The Board of Health reserves the right to take items out of order and to discuss and/or vote on items that are not listed on the agenda. Board of Health Members: Thomas Trowbridge,DDS,MD,Chairman;Mr.Fixler,Member/Clerk;Francis P.MacMillan,Jr., M.D.;Joseph McCarthy,Member; Mr.Pease,Member Health Department Staff:Susan Sawyer,Health Director; Debra Rillahan,Public Health Nurse;Michele Grant,Public Health Inspector;Lisa Blackburn,Health Department Assistant r . 1 pf NpRTp , Application for Septic Disposal System 3?'`'' •`'�`p� AConstruction Permit — TOWN OF TODAY'S DATE ORTH ANDOVER, MA 01845 $250.00—Full Repair $125.00-Component S�cNus Important: Application is hereby made for a permit to: When filling out ❑Construct a new on-site sewage disposal system* forms on the computer,use Repair or replace an existing on-site sewage disposal system* only the tab key to move your ❑ Repair or replace an existing system component—What? cursor-do not use the return key. A. Facility Information 5_-S_47-- raa Address or Lot# & .41VDvye-R RECEIVED City/Town 2.-*TYPE OF SEPTIC SYSTEM*: A 1 5 2013 ,]c'Pu El Gravity(choose one) JAIN * f pump system,attach copy of electrical permit to application** TOWN OF NORTH ANDOVER HEALTH DEPARTMENT ElConventional System (pipe and stone system) Infiltrator or Biodiffuser(Gravel-Less)(Attach a copy of your certification to install this type of system. /❑ Pressure Distribution S.A.S. (No D-Box)(Attach Draft Maintenance Agreement) ❑ Pressure Dosed (D-Box Present)S.A.S. 2. Owner Information �G1'2,4 Q 4 b�A i 7-/-r Name Address(if differ nt f City/Town State Zip Code Telephone Number 3. Installer Information ZL—WM es /?- Ke Ile- Name Name of Company �a d 6S.�G•,•� d'-z� Address !(_$ ti 17 iG,4/ 11114 of I yo City/T wn State Zip Code Telephone Number(Cell Phone#if possible please) 4. Designer Information , gG G li �/LA�' C SC Name l 1 Name of Company Address City/Town State Zip Code J-0Z - c 20 6 Telephone Number(Best#to Reach) Application for Disposal System Construction Permit-Page 1 of 2 r i Application for Septic Disposal System l-l3= 13 3?•�fi `'�' °c TODAY'S DATE k =Construction Permit - TOWN OF ''�' • - ' ORTH ANDOVER MA 01845 $250.00—Full Repair $125.00-Component Ss�cKus� PAGE 2OF2 A. Facility Information continued.... 5. Type of Building: Residential 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 been . sued by this Board 9,f Health. ; Date Application Approved By: (Board of Health Representative) Name Date I Application Disapproved for the following reasons: For Office Use Only: / L Fee Attached?A h Y� d. Yes No I 2. Project Manager Obligation Form Attached? Yes No 3. Pump Svstem? Ifso,Attach cony ofElectrical Permit Yes No 4. Foundation As-Built?(new construction ronly): Yes No (Same scale as approved plan) 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: ,f(AdS75- y F0 5,��� 5,1- (Address dress of septic system) Fox plans by (Engineer) Relative to the application of f 4 kA 4S Ll��( G (Installer's name) And dated l�'O 1 2� o (Originalate Dated / -15-- l-3 o ay s ate With revisions dated /'2 (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 pbor 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(1'� 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. i b. Final Construction Inspection—Engineer must first do their inspection for elevations,ties, etc. As-built of verbal OK (or e-mail to: healthdel2tQtownofnorthandover.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 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, p pes, 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: (Today's Date) (Name me—Print) Oa6e— igne N • • rtcrEn North Andover Health Department Community Development Division December 18, 2012 Elizabeth Andrukaitis 554 Foster Street North Andover, MA 01845 Re: Subsurface Sewage Disposal System Plan for 554 Foster Street, Map 104B, Lot 5 Dear Mrs. Andrukaitis: The proposed wastewater system design plan for the above site dated November 8,2012 and received on November 19, 2012 has been reviewed and the final revision dated December 8, 2012 has been approved for a 3 bedroom(maximum 7 room)home. This approval includes the following as granted at the regularly scheduled Board of Health meeting on November 15,2012. 1) Local Upgrade for a Vertical offset from S.A.S. to Estimated water table from 5 feet to 4 feet 2) Local waiver from Distance from S.A.S. to wetland from 100 feet to 63 feet 3) Local waiver from Distance from a septic tank to a wetland from 75 feet to 52 feet The design has been approved for use in the construction of a replacement onsite septic system. This plan is generally good for 3-years from the date of approval however, as this is for a repair system, this is reduced to 2-years. During this time, a licensed septic system installer must obtain a permit and complete this work, and a Certificate of Compliance be endorsed by the installer, designer and the Town of North Andover. In the event an imminent health problem such as sewage backup into the dwelling is occurring,the North Andover Board of Health may reduce the time period for which this plan is valid. This approval is also subject to the following conditions: 1. Please keep a copy of the form 9b for your records. 2. With the understanding that the granting of the reduction of the distance to the high water table restricts future expansion of the buildings flow capacity beyond 330 Page 1 of 2 North Andover Health Department, 1600 Osgood Street, Building 20, Suite 2035, North Andover, MA 01845 Phone: 978.688.9540 Fax: 978.688.8476 s s 554 Foster Street December 18, 2012 gallons per day(3 bedroom,maximum 7 rooms), unless the system is upgraded to a compliant distance of five feet to the water table. 310 CMR 15.405(4) 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. Please feel free to contact the office with any questions you may have. We look forward to working with you to obtain a wastewater treatment and dispersal system which will be in compliance with all regulations and assure protection of public health and the environment of North Andover. Sincerely, san Y. awyer HS JS Public Health or cc: Merrimack Engineering File Page 2 of 2 North Andover Health Department, 1600 Osgood Street, Building 20, Suite 2-36, North Andover, MA 01845 Phone: 978.688.9540 Fax: 978.688.8476 Blackburn, Lisa From: Isaac Rowe[irowe@millriverconsulting.com] Sent: Thursday, December 13, 2012 10:15 AM To: Sawyer, Susan; Blackburn, Lisa; 'Dan Ottenheimer'; plally@millriverconsulting.com; Grant, Michele Cc: 'Isaac Rowe' Subject: RE: 554 Foster Street Susan, The drywell/laundry system is proposed to be connected to the new system. I was requiring a cleanout at the bend in the new building sewer pipe. After reviewing my comment, I probably should have worded it better but I certainly was not allowing the continued use of the drywell/laundry system. I hope this offers clarification. Thanks, Isaac M. Rowe, R.S. Project Manager Mill River Consulting 6 Sargent Street Gloucester, MA 01930-2719 Phone: (978) 282-0014 Fax: (978) 282-1318 irowe(@millriverconsulting.com www.millriverconsulting.com -----Original Message----- From: Sawyer, Susan [mailto:ssawyer(townofnorthandover.com] Sent: Thursday, December 13, 2012 10:00 AM To: 'Isaac Rowe'; Blackburn, Lisa; 'Dan Ottenheimer'; plally(amillriverconsulting.com; Grant, Michele Subject: 554 Foster Street I received Bill D. 's changes for this repair and just really looked at the plan. I had not noticed the drywell before. This is what happens when things move too quickly. 1) since the Title V failed; I didn't notice there were not 2 separate reports (one for drywell and one for the system itself) as required by the code. 2) I rushed the review out to Bill and still didn't notice there was a notation to add a cleanout to the dry well. It is our policy in NA and reg. That we fail all cesspools. That has always included drywells. We require the laundry to be hooked into the new system as it will be sized appropriately. Please make a note just in case this type of thing gets through again. Thank you, Susan 1 -----Original Message----- From: Isaac Rowe [mailto:irowe@millriverconsulting com] Sent: Thursday, November 01, 2012 3:39 PM To: Blackburn, Lisa; 'Dan Ottenheimer'; plally@millriverconsulting.com Cc: 'Isaac Rowe'; Sawyer, Susan Subject: RE: soil test app 554 Foster Street Susan, Attached are the soil test results for the above referenced property. Good soil but a high groundwater table related to the adjacent stream. Final inspection at 466 Salem St went well too. We will prepare the final report within a couple of days. Lisa - please forward or let Susan know about this email as she sometimes does not receive my emails. Thanks, Isaac M. Rowe, R.S. Project Manager Mill River Consulting 6 Sargent Street Gloucester, MA 01930-2719 Phone: (978) 282-0014 Fax: (978) 282-1318 irowe(@millriverconsulting.com www.millriverconsultine.com -----Original Message----- From: Blackburn, Lisa [mailto:LBlackburnOtownofnorthandover.com] Sent: Thursday, October 18, 2012 2:15 PM To: Dan Ottenheimer; 'Isaac Rowe' ; plally@millriverconsulting.com Subject: FW: soil test app 554 Foster Street Bill Dufresne would like you to schedule this as soon as possible. Please give him a call. Lisa Blackburn Health Department Town of North Andover 1600 Osgood Street North Andover, MA 01845 Phone 978.688.9540 Fax 978.688-8476 Email lblackburn(@townofnorthandover.com Web www.TownofNorthAndover.com -----Original Message----- From: Sawyer, Susan Sent: Tuesday, October 16, 2012 11:37 AM To: Blackburn, Lisa 2 K .. Subject: soil test app When Heidi says ok send this to Mill River for review. Thanks -----Original Message----- From: noreply(@townofnorthandover.com [mailto:noreply@townofnorthandover.com] Sent: Tuesday, October 16, 2012 10:14 AM To: Sawyer, Susan Subject: This E-mail was sent from "RNPOA428C" (Aficio MP C5000) . Scan Date: 10.16.2012 10:13:47 (-0400) Queries to: noreply(@townofnorthandover.com Please note the Massachusetts Secretary of State's office has determined that most emails to and from municipal offices and officials are public records. For more information please refer to: http://www.sec.state.ma.us/pre/preidx.htm. Please consider the environment before printing this email. Please note the Massachusetts Secretary of State's office has determined that most emails to and from municipal offices and officials are public records. For more information please refer to: http://www.sec.state.ma.us/pre/preidx.htm. Please consider the environment before printing this email. Please note the Massachusetts Secretary of State's office has determined that most emails to and from municipal offices and officials are public records. For more information please refer to: htty://www.sec.state.ma.us/pre/preidx.htm. Please consider the environment before printing this email. 3 t a % Sawyer, Susan Subject: FW: 554 Foster Street From: wrdufresne@comcast.net fmailto:wrdufresne@comcast.net] Sent: Tuesday, December 18, 2012 10:57 AM To: Sawyer, Susan Subject: Re: 554 Foster Street Susan Because the logistics of trying to get the 2 pipes connected in the basement is very difficult and could result in an internal pump. From: "Susan Sawyer" <ssawyer ,townofnorthandover.com> To: "wrdufresne(a).comcast.net" <wrdufresne(),comcast.net> Sent: Tuesday, December 18, 2012 8:41:50 AM Subject: RE: 554 Foster Street Bill, I am approving the plan, however before I send it out...for the file,can you provide me with an answer as to why I should not require the plumbing to be tied in to the piping inside the building, rather than having 2 building sewers. Also, the 64 Old Cart Way was sent just yesterday to Mill River after Heidi gave it the ok. Thanks Susan From: wrdufresne@comcast.net [mailto:wrdufresne@comcast.net] Sent: Friday, December 14, 2012 9:29 AM To: Sawyer, Susan this email. 1 Qmtits to: noreply@townofnorthandover.com Please note the Massachusetts Secretary of State's office has determined that most emails to and from municipal offices and officials are public records. For more information please refer to: http://www.sec.state.ma.us/pre/preidx.htm. Please consider the environment before printing this email. Please note the Massachusetts Secretary of State's office has determined that most emails to and from municipal offices and officials are public records. For more information please refer to: http://www.sec.state.ma.us/pre/preidx.htm. Please consider the environment before printing this email. 2 Blackburn, Lisa From: Sawyer, Susan Sent: Thursday, December 13, 2012 1:02 PM To: 'Isaac Rowe'; Blackburn, Lisa; 'Dan Ottenheimer'; plally@millriverconsulting.com; Grant, Michele Subject: RE: 554 Foster Street Great thank you. We are all set then. They have received permission for out of season installation from the BOH, so if an application comes in we will let you know. Susan -----Original Message----- From: Isaac Rowe [mailto:irowe@millriverconsulting.com] Sent: Thursday, December 13, 2012 10:15 AM To: Sawyer, Susan; Blackburn, Lisa; 'Dan Ottenheimer'; plally millriverconsulting.com; Grant, Michele Cc: 'Isaac Rowe' Subject: RE: 554 Foster Street Susan, The drywell/laundry system is proposed to be connected to the new system. I was requiring a cleanout at the bend in the new building sewer pipe. After reviewing my comment, I probably should have worded it better but I certainly was not allowing the continued use of the drywell/laundry system. I hope this offers clarification. Thanks, Isaac M. Rowe, R.S. Project Manager Mill River Consulting 6 Sargent Street Gloucester, MA 01930-2719 Phone: (978) 282-0014 Fax: (978) 282-1318 iroweRmillriverconsulting.com www.millriverconsulting.com -----Original Message----- From:. Sawyer, Susan [mailto:ssawyer(@townofnorthandover.com] Sent: Thursday, December 13, 2012 10:00 AM To: 'Isaac Rowe'; Blackburn, Lisa; 'Dan Ottenheimer'; plally(@millriverconsulting com; Grant, Michele Subject: 554 Foster Street I received Bill D. 's changes for this repair and just really looked at the plan. I had not noticed the drywell before. This is what happens when things move too quickly. 1 1) since the Title V failed; I didn't notice there were not 2 separate reports (one for drywell and one for the system itself) as required by the code. 2) I rushed the review out to Bill and still didn't notice there was a notation to add a cleanout to the dry well. It is our policy in NA and reg. That we fail all cesspools. That has always included drywells. We require the laundry to be hooked into the new system as it will be sized appropriately. Please make a note just in case this type of thing gets through again. Thank you, Susan -----Original Message----- From: Isaac Rowe [mailto:iroweRmillriverconsulting com] Sent: Thursday, November 01, 2012 3:39 PM To: Blackburn, Lisa; 'Dan Ottenheimer'; plally(amillriverconsulting.com Cc: 'Isaac Rowe'; Sawyer, Susan Subject: RE: soil test app 554 Foster Street Susan, Attached are the soil test results for the above referenced property. Good soil but a high groundwater table related to the adjacent stream. Final inspection at 466 Salem St went well too. We will prepare the final report within a couple of days. Lisa - please forward or let Susan know about this email as she sometimes does not receive my emails. Thanks, Isaac M. Rowe, R.S. Project Manager Mill River Consulting 6 Sargent Street Gloucester, MA 01930-2719 Phone: (978) 282-0014 Fax: (978) 282-1318 irowe(@millriverconsulting.com www.millriverconsulting.com -----Original Message----- From: Blackburn, Lisa [mailto:LBlackburn@townofnorthandover.com] Sent: Thursday, October 18, 2012 2:15 PM To: Dan Ottenheimer; 'Isaac Rowe'; plally@millriverconsulting.com Subject: FW: soil test app 554 Foster Street Bill Dufresne would like you to schedule this as soon as possible. Please give him a call. Lisa Blackburn Health Department Town of North Andover 1600 Osgood Street 2 North Andover, MA 01845 Phone 978.688.9540 Fax 978.688-8476 Email lblackburn(@townofnorthandover.com Web www.TownofNorthAndover.com -----Original Message----- From: Sawyer, Susan Sent: Tuesday, October 16, 2012 11:37 AM To: Blackburn, Lisa Subject: soil test app When Heidi says ok send this to Mill River for review. Thanks -----Original Message----- From: noreply(@townofnorthandover.com [mailto:noreply(utownofnorthandover.com] Sent: Tuesday, October 16, 2012 10:14 AM To: Sawyer, Susan Subject: This E-mail was sent from "RNPOA428C" (Aficio MP C5000) . Scan Date: 10.16.2012 10:13:47 (-0400) Queries to: noreply@townofnorthandover.com Please note the Massachusetts Secretary of State's office has determined that most emails to and from municipal offices and officials are public records. For more information please refer to: http://www.sec.state.ma.us/pre/preidx.htm. Please consider the environment before printing this email. Please note the Massachusetts Secretary of State's office has determined that most emails to and from municipal offices and officials are public records. For more information please refer to: http://www.sec.state.ma.us/pre/Dreidx.htm. Please consider the environment before printing this email. Please note the Massachusetts Secretary of State's office has determined that most emails to and from municipal offices and officials are public records. For more information please refer to: http://www.sec.state.ma.us/pre/preidx.htm. Please consider the environment before printing this email. 3 Sawyer, Susan From: Sawyer, Susan Sent: Thursday, December 13, 2012 10:05 AM To: wrdufresne@comcast.net Cc: Blackburn, Lisa; Grant, Michele Subject: 554 Foster Bill, I just realized that the drywell is not proposed to be abandoned at this property; rather it was requested a cleanout be put on the plan.This was incorrect direction by us.All types of drywells/cesspools automatically fail in NA. The rest of the plan is approvable, however I am going to require the plumbing be changed internally and the drywell abandoned. I was not aware our reviewer did not know of N.Andover's requirement. As the designer;would you prefer to send a letter and I will alter your plan with your approval?Or would you like to just send over new plans? Your choice. Thank you Susan Susan Sawyer Public Health Director Town of North Andover 1600 Osgood Street Bldg.20,Unit 2035 North Andover,MA 01845 Phone 978.688.9540 Fax 978.688.8476 Email mailto:ssawver@townofnorthandover.com Web www.TownofNorthAndover.com 1 � S�TTGED j�� North Andover Health Department (ommunity Development Division December 3, 2012 Vladimir Nemchenok Merrimack Engineering Services 66 Park Street Andover, MA 01810 Re: Subsurface Sewage Disposal System Plan for 554 Foster Street,Mal) 104B,Lot 5 Dear Mr. Nemchenok: The proposed wastewater system design plan for the above site dated November 8, 2012 and received on November 19, 2012 has been reviewed. Unfortunately, the plan cannot be approved until the following items are corrected. The specific section in Title 5: 310 CMR 15.000, or Forth Andover regulation that is not met by this design follows each item. Please revise the Form 9A Local Upgrade Approval request form to reflect the correct __-percolation rate (<2 mins/inch) and explain why an alternative system is not available. i� he detail for the proposed septic tank/pump chamber appears to depict a 2-piece tank. A (� monolithic tank is required(NA 3.2). Please revise the SHEA model number, pump ltufflations and buoyancy calculations accordingly for the monolithic tank. `3. Please provide a note that the septic tank/pump chamber shall be watertight(3 10 CMR 15.221(1)). `? 4. Please provide a cleanout to finish grade for the connection to the existing building sewer leading to the existing drywell (3 10 CMR 15.222(8)). 5. Please provide the elevation for the bottom of the impervious barrier to ensure it will not be installed below the ground water elevation. 6. Please provide a water line crossing detail for the force main. A sleeve 10 feet on either side of the water line crossing is recommended for the force main. 7. On sheet 1,please revise the grading note on the site plan. It refers to the "new slope not to exceed 12 horizontal to 1 vertical". 8. On sheet 2,the liquid depth in the pump chamber is incorrect based on the elevations provided. Page 1 of 2 North Andover Health Department- 1600 Osgood Street-Suite 2035 North Andover, MA 01845 Phone: 978.688.9540 Fax: 978.688.8476 f �r Although not reasons for disapproval, the following are recommendations you may want to consider: a. It appears the 96 contour could be moved closer to the leach field. It is unclear why the breakout elevation of 96.37 is maintained 10 feet beyond the leach field with the use of an impervious barrier. C,, b. There have been past problems regarding excess pressure into the D-box needing onsite changes to the plan. Possible solution; propose a 4' section of 4"pipe with a 2"x 4" l coupling prior to the distribution box to ensure the reduction of velocity as the effluent enters the distribution box. 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. i Sincerely, Susan Y. Sa er, RE IRS Public Health Director cc: Elizabeth Andrukaitis File Page 2 of 2 North Andover Health Department- 1600 Osgood Street—Suite 2035 North Andover, MA 01845 Phone: 978.688.9540 Fax: 978.688.8476 N TOWN OF NORTH ANDOVER o<�lU@TPI . Office of COMMUNITY DEVELOPMENT AND SERVICES Z- HEALTH ..I o HEALTH DEPARTMENT 1600 OSGOOD STREET; BUILDING 20• SUITE 2-36 'A --�• a'' NORTH ANDOVER,MASSACHUSETTS 01845 ;'Ss,CHU 978.688.9540—Phone Susan Y.Sawyer,REHS/RS 978.688.8476—FAX Public Health Director E-MAIL:healthdept@townofnorthandover.com WEBSITE:http://www.townofnorthandover.com SEPTIC PLAN SUBMITTAL FORM Date of Submission: Site Location: Engineer: 1�1 New Plans? Yes !$225/Pl Check# -76 1St submis ' and one=re review only) R �� � Revised Plans?Yes $75/Plan Check# Site Evaluation Forms Included? Yes No TOWN NORTH ANDOVER HEALLTT H DEPARTMENT Local Upgrade Form Included? Yes No / Telephone#: ) � � Fax#: E-mail: JAKVu Fftl f.jg! eCH CAST—o Oe Homeowner Name: 1077i4&VEIW A QQ LA OFFICE USE ONLY When the submission is complete (including check): ➢ Date stamp plans and letter ➢ Complete and attach Receipt ➢ Copy File; Forward to Consultant ➢ Enter on Log Sheet and Database Commonwealth of Massachlmsetts City/Town of North Andover 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: NA 4. Connection to a public sewer is not feasible: None Available 5. The Application for Local Upgrade Approval must be accompanied b 1571 0,the foliorn/ing (+rhec the appropriate boxes): ® Application for Disposal System Construction Permit , ' 4. ® Complete plans and specifications TOWN OF NORTH ANDOVER HEALTH DEPARTMENT ® 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." 11-16-12 Facility Owner's Signature Date Joann Runions c/o Elizabeth Andrukaitis Print Name Bill Dufresne/Merrimack Engineering 11-16-12 Name of Preparer Date 66 Park Street Andover Preparer's address City/Town MA/01810 (978)475-3555 State2lP Code Telephone t5form9a.doc•rev.7/06 Application for Iyocal;Upgrade Approval*Page 4 of 4 Commonwealth of Massachusetts 1 City/Town of North Andover a 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) 7. Design Flow per 310 CMR 15.203: Design flow of existing system: Unknown gpd Design flow of proposed upgraded system 330 gpd Design flow of facility: 330 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: 5-19-12 date of inspection 2. Describe the proposed upgrade to the system: Total replacement (see plan) 3. Local Upgrade Approval is requested for(check all that apply): ❑ Reduction in setback(s)—describe reductions: ❑ Reduction in SAS area of up to 25%: SAS size,sq.ft. %reduction ® Reduction in separation between the SAS and high groundwater: Separation reduction 1.0 ft. Percolation rate 2 min./inch Depth to groundwater JA 4.0� t5form9a.doc•rev.7/06 Application for Local Upgrade Approval* Page 2 of 4 Commonwealth of Massachusetts City/Town of North Andover h Form 9A - Application for Local Upgrade Approval a 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 Elizabeth Andrukaitis Residence only the tab key Name to move your 554 Foster Street 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): jr SAME ISI 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: 3 BDRM. House 5. Type of Existing System: ❑ Privy ❑ Cesspool(s) ® Conventional ❑ Other(describe below): 6. Type of soil absorption system (trenches, chambers, leach field, pits, etc): Field t5form9a.doc•rev.7/06 Application for Local Upgrade Approval*Page 1 of 4 Commonwealth of Massachusetts City/Town of Local Upgrade Approval Form 913 GSM 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 Important:When filling out forms 1. Facility Name and Address on the computer, use only the tab Elizabeth Andrukaitis key to move your Name cursor-do not 544 Foster Street use the return Street Address key. North Andover MA 01845 r� Cityrrown State Zip Code 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. Design flow per 310 CMR 15.203: 330 gpd 5. System Designer: Vladimir Nemchenok ® PE ❑ RS Name 66 park Street Andover MA 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 554 Foster form 9b 12.18.12.doc•rev.7/06 Local Upgrade Approval* Page 1 of 2 Commonwealth of Massachusetts v City/Town of a a Local Upgrade Approval Form 9B B. Approval (continued) ® Reduction in separation between the SAS and high groundwater: Separation reduction 1 ft. < Percolation rate 2min./inch Depth to groundwater 4 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): Distance from SAS from 100 feet to 63 feet and Distance from Tank to BVW 75 feet to 52 feet List variances granted requiring DEP approval: N. Andover Health Dept Approving Authority Susan Sawyer, Health Dir 12/18/12 Print or Type Name and Titleignatur Date (11 554 Foster form 9b 12.18.12.doc•rev.7/06 Local Upgrade Approval, Page 2 of 2 Commonwealth of Massachusetts` City/Town of North Andover Fora 11 - Soil Suitability Assessment for On-Site Sewage Disposaij'a ° �1 TO1.rVN of N0K t-i ANo0VER A. Facility Information HEA.IH0D5A1(TM NT Elizabeth Andrukaitis Owner Name --- — ------- --- - 554 Foster Street 1048/5 Street Address Map/Lot# North Andover MA 01845 City State Zip Code B. Site Information 1. (Check one) ❑ New Construction ® Upgrade ❑ Repair 2. Published Soil Survey Available? Yes ❑ No If yes: Aug 11, 2008 1:4,050 260 Year Published Publication Scale Soil Map Unit Sudbury High Water Table Soil Name Soil Limitations 3. Surficial Geological Report Available? ❑ Yes ® No If yes: - Year Published Publication Scale Map Unit Geologic Material Landform 4. Flood Rate Insurance Map Above the 500-year flood boundary? ❑ Yes ❑ No Within the 100-year flood boundary? ® Yes ❑ No Within the 500-year flood boundary? ❑ Yes ❑ No Within a velocity zone? ❑ Yes ❑ No 5. Wetland Area: National Wetland Inventory Map Map Unit Name Wetlands Conservancy Program Map Map Unit Name 6. Current Water Resource Conditions(USGS): October Range: ❑ Above Normal ® Normal ❑ Below Normal 2012 7. Other references reviewed: - — Soil Evaluation Forms.doc•rev. 1/10 Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal •Page 1 of 8 <C\ Commonwealth of Massachusetts Cityrrown of North Andover Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal C. On-Site Review (minimum of two holes required at every proposed primary and reserved disposal area) Deep Observation Hole Number: T-1 11-1-12 gam sunny 55 Date Time Weather 1. Location Ground Elevation at Surface of Hole: 94'7 Location (identify on plan): See Plan 2. Land Use Residential House Lot none 0-3 _ (e.g.,woodland, agricultural field,vacant lot,etc.) Surface Stones Slope(%) Lawn Plain on Plain Vegetation Landform Position on Landscape(attach sheet) 3. Distances from: Open Water Body 90t Drainage Way 90t Possible Wet Area 80t Property Line 35 Drinking Water Well '100 Other feet feet feet 4. Parent Material: Outwash Unsuitable Materials Present: ❑ Yes ® No If Yes: ❑ Disturbed Soil ❑ Fill Material ❑ Impervious Layer(s) ❑ Weathered/Fractured Rock ❑ Bedrock 5. Groundwater Observed: ® Yes ❑ No If yes: 56 - Depth Weeping from Pit Depth Standing Water in Hole Estimated Depth to High Groundwater: 36 91.7 inches elevation Soil Evaluation Forms.doc•rev. 1/10 Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal • Page 2 of 8 Commonwealth of Massachusetts City/Town of North Andover Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal C. On-Sete Review (continued) Deep Observation Hole Number: T-1 Redoximorphic Features Coarse Fragments Soil Horizon/Soil Matrix:Color- (mottles) Soil'texture % by Volume Soil Soil Depth(in.) Layer Moist Munsell Consistence l Other y (Munsell) (USDA) Cobbles& Structure (Moist) Depth Color Percent Gravel Stones 0-12 A 10YR2/2 FSL Wk. Gran. Friable 12-18 B 10YR4/6 FSL Massive Friable 18-120 C 2.5Y6/4 36 7.5YR4/6 >5 M Sand Loose S.G. Additional Notes: Soil Evaluation Forms.cloc•rev. 1/10 Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal • Page 3 of 8 Commonwealth of Massachusetts City/Town of North Andover Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal C. On-Site Review (continued) Deep Observation Hole Number: T-2 11-1-12 gam Date Time Weather 1. Location Ground Elevation at Surface of Hole: 94.7 Location (identify on plan): See Plan 2. Land Use Residential House Lot None 0-3 _ (e.g.,woodland, agricultural field,vacant lot,etc.) Surface Stones Slope (%) Lawn Plain On Plain _ Vegetation Landform Position on Landscape(attach sheet) 3. Distances from: Open Water Body 0 Drainage Way 0 Possible Wet Area 8feeet Property Line e0t Drinking Water Well >1fee00 Other feet 4. Parent Material: Outwash Unsuitable Materials Present: ❑ Yes ® No If Yes: ❑ Disturbed Soil ❑ Fill Material ❑ Impervious Layer(s) ❑ Weathered/Fractured Rock ❑ Bedrock 5. Groundwater Observed: ® Yes ❑ No Ifes: 54 _ y Depth Weeping from Pit Depth Standing Water in Hole Estimated Depth to High Groundwater: 36 91.7 inches elevation Soil Evaluation Forms.doc•rev. 1/10 Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal •Page 4 of 8 �L\ Commonwealth of Massachusetts City/Town of North Andover Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal PY C. On-Site Review (continued) Deep Observation Hole Number: T-2 Redoximorphic Features Coarse Fragments Soil Horizon/Soil Matrix:Color- (mottles) Soil Texture % by Volume Soil S Depth(in.) Layer Moist(Munsell) (USDA) Structure Consistence tence Other Depth olor Percent ravel Cobbles 8 (Moist) Stones 0-12 A 10YR2/2 FSL Wk. Gran. Friable 12-22 B 10YR4/6 FSL Massive Friable 22-110 C 2.5Y6/4 36 7.5YR4/6 >5 M. Sand Loose S.G. Additional Notes: Soil Evaluation Forms.doc-rev. 1/10 Form 11 -Soil Suitability Assessment for On-Site Sewage Disposal - Page 5 of 8 Commonwealth of Massachusetts City/Town of North Andover Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal 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.inches inches ® Depth to soil redoximorphic features (mottles) A. 36 B. 36incnes inches F-1 Groundwater B.Groundwater adjustment(USGS methodology) inches inches 2. Index Well Number Reading Date Index Well Level Adjustment Factor Adjusted Groundwater Level E. Depth of Pervious Material 1. Depth of Naturally Occurring Pervious Material a. Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? ® Yes ❑ No b. If yes, at what depth was it observed? Upper boundary: 18/22 Lower bounds 120 /110 inches rY inches Soil Evaluation Forms.doc•rev. 1/10 Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal •Page 6 of 8 Commonwealth of Massachusetts City/Town of North Andover Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal uv� F. Certification I certify that I am currently approved by the Department of Environmental Protection pursuant to 310 CMR 15.017 to conduct soil evaluations and that the above analysis has been performed by me consistent with the required training, expertise and experience described in 310 CMR 15.017. 1 further certify that the results of my soil evaluation, as indicated in the attached Soil Evaluation Form, are accurate and in accordance with 310 CMR 15.100 through 15.107. f la,W 11-1-12 _ Signature of Soil Evalua r Date William Dufresne SE #640 5-9-96 Typed or Printed Name of Soil Evaluator/License# Date of Soil Evaluator Exam Isaac Rowe (Mill River) North Andover Name of Board of Health Witness Board of Health !Vote: In accordance with 310 CMR 15.018(2)this form must be submitted to the approving authority within 60 days of the date of field testing, and to the designer and the property owner with Percolation Test Form 12. Soil Evaluation Forms.doc•rev. 1110 Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal •Page 7 of 8 Commonwealth of Massachusetts 14- City/Town of North Andover 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: A. Site Information When filling out forms on the computer, use Elizabeth Andrukaitis only the tab key Owner Name to move your 554 Foster Street cursor-do not Street Address or Lot# use the return key. North Andover MA 01845 CitylTown State Zip Code Joann Runions (978) 599-7934 n ct Person if different from Owner Telephone Number Co to ( ) p B. Test Results 11-1-12 10:40 Date Time Date Time Observation Hole# P-1 Depth of Perc 38" Start Pre-Soak 10:40 End Pre-Soak Time at 12" Time at 9" - Time at 6" Time (9"-6") Rate (Min./Inch) 24 Gallons used 2 mpi Test Passed: ® Test Passed: ❑ Test Failed: ❑ Test Failed: ❑ Bill Dufresne SE#640 Test Performed By: Isaac Rowe Witnessed By: Comments: t5form12.doc•06/03 Perc Test•Page 1 of 1 r VED TOWN OF NORTH ANDOVER Office of COMMUNITY DEVELOPMENT AND SERVICES '3 CE p`eD HEALTH DEPARTMENT 1600 OSGOOD STREET; BUILDING 20; SUITE 2-36 �41;i�z- °. itt +4�ttu► t NORTH ANDOVER,MASSACHUSETTS 01845 Susan Y.Sawyer,REBS,RS 978.688.9540-Phone Public Health Director 978.688.8476-FAX healthdept@townofnorthandover.com www.townofnorthandover.com T. M APPLICATION FOR SOIL TESTS E_ � X c ITS DATE: 10-It— Y-z- MAP&PARCEL: D I �j J a Mc _.� -�— �— m h LOCATION OF SOIL TESTS: F' � 5_ ����� M OWNER: 411ERTH A,1-2 lA-AV�h{�`i Contact#: C' G APPLICANT: Contact#: ADDRESS: _ I.EVI �Jf'- L.yu)fflnA2 , H& o{ I ENGINEER:h MLI"ACI- f 0,610EM 0 i Contact#: CERTIFIED SOIL EVALUATOR: la�VJ��dL� Intended Use of Land: EResFiden ' Subdivision Single Family Ho Commercial Is This: Repair Testing: Undeveloped Lot Testing 1 Upgrade for Addition: In the Lake Cochichewick Watershed? Yes No THE FOLLOWING MUST BE INCLUDED WITH THIS FORM ➢ Proof of land ownership(Tax bill,or letter from owner permitting test) ➢ 8.5"x 11"Plot plan&Location of Testing(please indicate test nit sites on the plan) ➢ 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 upgrades. GENERAL INFORMATION ➢ Only Certified Soil Evaluators may perform deep hole inspections. ➢ Only Mass.Registered Sanitarians and Professional Engineers can design septic plans. At least two deep holes and two percolation tests are required for each septic system disposal area. ➢ Repairs require at least two deep holes and at least one percolation test,at the discretion of the BOH representative. ➢ Full payment will be required for all additional tests within two weeks of testing. ➢ Within 45 days of testing,a scaled plan(no smaller than 1"-100')shall be submitted to the Board of Health showing the location of all tests(including aborted tests). ➢ Within 60 days of testing soil evaluation forms shall be submitted. Please Do Not Write Below This Line N.A. Conservation Commission Approval Date: Signature of Conservation Agent: , Date back to Health Department: (stamp in): �� �d 6 ��rn w�� 1 - mum tca--n,s. SM41-61931709 PLAN OF LAND IN NORTH ANDOVER 3428041. Brasseur Associates, Surveyors December 9, 1965 at at. p ylllea R(opofd N• �,o.rm r� 0ao0 E � h ets i , OS_ I.P. � 1�{JYY►Q�Q�... :1 RECEIVED FO' itEGISTRATION ' r�Cl�CCK��m �M "ERTIFICATE NO—A4-14-- IN 0. a—_.,_ ?_.- !N REGISTRATION BOOKAO-PAGE3I 1 ti e O � . ! 6 W: e � e O ID a° 47. w c m a c `o c ' e Q � v e� b 1 1 1 , J aq, - Aos R �B 'STREET LAND REG/STRAT/ON OFRCE JAN. 26 /966---- scale,ofthahJan 3b feet to an inch C.M.Andevsmn,Er>g wrorcourt✓5 PB o i✓