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WYMAN STREET08/05/2013 11:18 0207041711 1. d: System Owner Lowell Susan 2 Wyman Street Salem, MA, 01979 (978)-430-9750 x Type: Em Cesspool: No Dote of Pumping system Pumped By Contents Transferred to: 9762814869 WINDRIVER Commonwealth of Massachusetts Massachusetts System Pumping Record Routine Yes System Location Primary Home 2 Wyman Street Salem, Ari+, 01970 (978)-430-9750 u Lot�ll PAGE 02/02 0712712010 !soy Form 4 -- system Pumping Record Septic Tank: No = Yes Quantity Pumped: Gallons Wind River Environmental, LLC Permit #: a Contents Disposed at: Date: Aa4� ,Condition of System/Other Comments Dep Approved Form -12/07/95 Uszs. ` �'I .. Y�X il System Owner Lowell Susan 2 Wyman Street Salem, MA, 01970 (9781-430-9750 x Type: Em Cesspool: No Date of Pumping: System Pumped By: Contents Transferred to: Contents Disposed at: Date: Commonwealth of Massachusetts Massachusetts System Pumping Record Routine Yes Wind River Environmental, LLC SEP 13 2010 Condition of System/Other Comments System Location Primary Home 2 Wyman Street Salem, MA, 01970 (Q7R)-440—Q750 x Form 4 -- System Pumping Record Septic Tank: No = Yese! Quantity Pumped: loao Gallon Permit #: „1r a.lA Salem, MA. Pumper Signature: WE ® Pdr«don=ndpaPer Dep Approved Form - 12/07/95 t�2Ls71i2'�>a�� Commonwealth of Massachusetts Massachusetts System Pumping Record System Owner Tdlwe1).. Type: Em Cesspool: No Date of Pumping: System Pumped By: Contents Transferred to: Contents bisposed air Date: Routine Yes Wind River Environmental. 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PFR SC N5 ENC711d�tw':R- SCALE AS NOTC:D , r:Pi `�i , • o? xx a j g PARsors v i I m1w 15.242: LTAR - Effluent Loadine Rates (1) The effluent loading rates set forth below are adjusted to account for the long term acceptance rate (LTAR) of the proposed soil absorption system. The LTAR is limited in large part by both the texture of the most hydraulically restrictive soil layer included within the four - foot zone beneath the proposed soil absorption system and the formation of a biomat based on the strength of effluent applied to the soil. As such the effluent loading rates have been based on the strength of typical settled sanitary sewage and may be adjusted proportionately downward if the proposed effluent strength is determined by the local approving authority or the Department to exceed that of typical sanitary sewage. Soil textural classes and soil types comprising the classes are defined in 310 CMR 15.243 and 310 CMR 15.244. (a) The following effluent loading rates shall apply prior to January 1, 2004: EFFLUENT LOADING RATE gpd/sq.ft (cm/day) PERC. RATE SOIL CLASS (min./inch) CLASS I CLASS II CLASS III CLASS IV <5 .74 (3.0) 0.60 (2.5) - - 6 0.70 (2.9) 0.60 (2.5) - - 7 0.68 (2.8) 0.60 (2.5) - - 8 0.66 (2.7) 0.60 (2.5) - - 10 - 0.60 (2.5) - - 15 - 0.56 (2.3) 0.37(l.5) - 20 - 0.53 (2.2) 0.34(l.4) - 25 - 0.40(l.6) 0.33 (1.3) - 30 - 0.33 (1.3) 0.29(l.2) - Loading Rate Criteria Listed Below Apply Only to the Upgrade of Existing Systems pursuant to 310 CMR 15.405(1)(c) or Systems Constructed pursuant to 310 CMR 15.417. 0.25(l.0) - 0.15 (0.6) 0.15 (0.6) (b) The following effluent loading rates shall apply as of January 1, 2004: EFFLUENT LOADING RATE gpd/sq.ft (cm/day) PERC. RATE SOIL CLASS (min./inch) CLASS I CLASS 11 CLASS III CLASS IV <_5 .74 (3.0) 0.60 (2.5) - 6 0.70 (2.9) 0.60 (2.5) - 7 0.68 (2.8) 0.60 (2.5) - 8 0.66 (2.7) 0.60 (2.5) - 10 0.60 (2.5) - 15 0.56 (2.3) 0.37(l.5) 20 0.53 (2.2) 25 0.40(l.6) 30 0.33 (1.3) 40 - 50 60 0.34(l.4) 0.33 (1.3) 0.29(l.2) 0.25(l.0) 0.20 (0.8) 0.15 (0.6) 0.20 (0.8) 0.15 (0.6) (2) Effective January 1, 2004, the effluent loading rates set forth in 310 CMR 15.242(2) may be used in place of those listed in 310 CMR 15.242(1)(b) when the effluent from aseptic tank, installed in compliance with 310 CMR 15.223, is distributed over the soil absorption system using pressure distribution designed in compliance with 310 CMR 15:254(2). SEPTIC TANK EFFLUENT LOADING RATE WITH PRESSURE DISTRIBUTION gpd/sq.ft (cm/day) PERC.RATE SOIL CLASS (min./inch) CLASS I CLASS II CLASS III CLASS IV 40 50 60 15.243: Types of Soil Textural Classes 0.29(l.2) 0.25(l.0) 0.25(l.0) 0.20 (0.8) 0.20 (0.8) (1) The following soil textural classes apply to soil types of which they are composed: CLASS I Sands, Loamy Sands CLASS II Sandy Loams, Loams CLASS III Silt Loams, Sandy Clay Loams with less than 27% clay, Silt CLASS IV Clays, Silty Clay Loams, Sandy Clay Loams with 27% or more clay, Clay Loams and Silty Clays 15.244: Types of Soils Sands: Soil is 85% or more sand and the percentage of silt plus 1.5 times the percentage of clay is 15 or less. Loamy sands: At the upper limit soil is 85 to 90% sand and the percentage of silt plus 1.5 times the percentage of clay is 15 or less; at the lower limit, soil is 70 to 85% sand and the percentage of silt plus twice the percentage of clay is 30 or less. Sandy loams: Soil is 20% or less clay and 52% or more sand and the percentage of silt plus twice the percentage of clay exceeds 30; or soil is less than 7% clay, less than 50% silt, and between 43 and 52% sand. Loam: Soil is 7 to 27% clay, 28 to 50% silt, and less than 52% sand. Silt loam: Soil is 50% or more silt and 12 to 27% clay; or 50 to 80% silt and less than 12% clay. Silty clay loam: Soil is 27 to 40% clay and less than 20 sand. Clay: 40% or more clay, less than 45% sand, and less than 40% silt. Silt: 80% or more silt and less than 12% clay. Sandy clay loam: 20 to 35% clay, less than 28% silt, and more than 45% sand. Clay loam: 27 to 40% clay and 20 to 46% sand. Sandy clay: 35% or more clay and 45% or more sand. 15.245: Soil Absorption System Siting Requirements (1) Prior to January 1, 2004, new systems shall not be sited in areas with percolation rates slower than 30 minutes per inch. Effective January 1, 2004, new systems shall not be sited in areas with percolation rates slower than 60 minutes per inch. (2) When recorded percolation rates are between those listed in 310 CMR 15.242, the next slower rate shall be used for design purposes. (3) Prior to January 1, 2004, soils with percolation rates between 30 - 60 minutes per inch may only be used for upgrade of existing systems where no other suitable area for sewage disposal is available and where approval has been granted in accordance with 310 CMR 15.405 (local upgrade approval). This limitation shall not apply subsequent to January 1, 2004. (4) Soils with percolation rates in excess of 60 minutes per inch are impermeable and shall not be used for the construction of a soil absorption system except in conjunction with a tight tank approved by the Department pursuant to 310 CMR 15.260 and 15.261. (5) Surface and subsurface drainage shall be directed away from the soil absorption system. 15.249: Design Criteria for Soil Absorption Systems (1) Every soil absorption system shall consist of one or more trenches, beds, fields, pits, galleries or chambers. (2) Effluent disposal area requirements shall be determined in accordance with 310 CMR 15.242. (3) System designs employing equipment designed to distribute effluent without the use of aggregate (i.e., "gravelless systems") are prohibited except in accordance with the procedures set forth at 310 CMR 15.280 through 15.289. (4) Soil absorption systems for Class III and IV soils with percolation rates greater than 30 minutes per inch shall not include beds or fields except in accordance with 310 CMR 15.255. 15.405: Contents of Local Upgrade Approval (1) In granting local upgrade approvals pursuant to 310 CMR 15.404(2) where full compliance as defined in 310 CMR 15.404(1) is not feasible, the local approving authority shall consider the impact of the proposed system and shall vary to the least degree necessary the requirements of 310 CMR 15.100 through 15.293 so as to allow for both the best feasible upgrade within the borders of the lot, and have the least effect on public health, safety and the environment. The local approving authority is allowed to diverge from the goal of full compliance only to the extent necessary to achieve a feasible upgrade. In determining whether full compliance is feasible, the approving authority should appropriately consider not only physical possibility as dictated by the conditions of the site, but also the economic feasibility of the upgrade costs. The approving authority should emphasize protection of water resources and treatment of the sanitary sewage. Absent conditions which would result in a different outcome based on best professional judgment, the options set forth below should be considered in the order in which they appear with 310 CMR 15.405(1)(a) being the first option to be considered and rejected or adopted and 310 CMR 15.405(1)(i) being the last option to be considered and rejected or adopted: (a) Reduction of system location setbacks otherwise established in 310 CMR 15.211 for property lines provided that a survey of the property line shall be required if a component is to be placed within five feet of the property line, and no such reduction shall result in the soil absorption system being located less than ten feet from a soil absorption system on an abutting property; (b) Reductions of system location setbacks from cellar wall, swimming pool, or slab foundations; (c) Placement of the leaching structure within an area where percolation rate is between 30 and 60 minutes per inch, in accordance with 310 CMR 15.242, for applications filed prior to January 1, 2004; (d) Up to a 25% reduction in the required subsurface disposal area design requirements; (e) Where upgrade is required pursuant to 310 CMR 15.303(1) because it is within Zone I of public well or within 100 feet of private well, relocation of the well. Any relocation of a public well shall be performed pursuant to 310 CMR 22.00 (water supply source approval); (f) Reduction of system location setbacks from bordering vegetated wetlands; (g) Reduction of system location setbacks from surface waters, salt marshes, inland and coastal banks, certified vernal pools in accordance with 310 CMR 15.211(1)[2], leaching catch basins, dry wells, or surface or subsurface drains other than those which discharge to surface water supplies or tributaries thereto; (h) Reduction of system location setbacks from water supply lines, private water supply wells (but not within 50 feet of the well), tributaries to surface water supplies, surface water supplies, but not within 100 feet of the surface water supply or tributary thereto or open, surface or subsurface drains which discharge to surface water supplies or tributaries thereto. (i) the local approving authority may reduce the required four foot separation (in soils with a recorded percolation rate of more than two minutes per inch) or the required five foot separation (in soils with a recorded percolation rate of two minutes or less per inch) between the bottom of the soil absorption system and the high groundwater elevation only if all of the following conditions are met: 1. An approved Soil Evaluator who is a member or agent of the local approving authority determines the high groundwater elevation. 2. A minimum three foot separation (in soils with a recorded percolation rate of more than two minutes per inch) or a minimum four foot separation (in soils with a recorded percolation rate of two minutes or less per inch) between the bottom of the soil absorption system and the high groundwater elevation is maintained. 3. The system is a failed or non -conforming system serving an existing building with a design flow of less than 2,000 gpd 4. No increase in design flow or square footage of the building is allowed. 5. No reduction in required leaching field size or setbacks from public or private wells, bordering vegetated wetlands, surface waters, salt marshes, coastal banks, certified vernal pools, water supply lines, surface water supplies or tributaries to surface water supplies, or drains which discharge to surface water supplies or their tributaries, is allowed. 15.417: Variances from Percolation Rate (1) To assist in determining the advisability of revising the slowest allowable percolation rate as set forth in 310 CMR 15.245, the Department may permit the construction of up to 20 single family dwellings per year in accordance with 310 CMR 15.417. All other provisions of 310 CMR 15.000 shall apply to such sites. (2) Process. No earlier than March 31, 1995 the Department shall publish a request for proposals informing applicants how to apply for such approvals, including any deadlines, information requirements, and preference criteria. A completed application shall include a proposed monitoring plan, and a letter from the local approving authority stating its support for the application. Upon the Department's approval of a site under 310 CMR 15.417, the applicant shall obtain a Disposal System Construction Permit from the local approving authority. (3) The Department shall not approve under 310 CMR 15.417 any site located within a nitrogen sensitive area. (4) The Department and the local approving authority shall impose such conditions as they deem appropriate for the protection of public health and safety and the environment. Any approval under 310 CMR 15.417 shall include a monitoring plan which includes at least an annual inspection of the system for at least the first seven years of operation. (5) The owner or operator shall provide written notice to any new owner or operator that the system has been constructed pursuant to 310 CMR 15.417. Such notice shall include notice of the general conditions and any special conditions applicable to the system. (6) No applicant shall be deemed to be entitled to selection of his or her site under 310 CMR 15.417, and the selection determination shall not be subject to the review process set forth in 310 CMR 15.422. A rejected applicant may file an application for a Disposal System Construction Permit pursuant to 310 CMR 15.020, and if necessary may seek a variance pursuant to 310 CMR 15.410 through 15.415. (7) As provided at 310 CMR 15.245(1), variances from percolation rate pursuant to this section 310 CMR 15.417 shall not be required for percolation rates between 30 and 60 minutes per inch after January 1, 2004. 310 CMR: DEPARTMENT OF ENVIRONMENTAL PROTECTION 15.104: Percolation Testing (1) The standard percolation test is intended to give an approximate measure of the soil's percolating capacity. Unsaturated hydraulic conductivities vary dramatically from the saturated hydraulic conductivity with changes in soil characteristics and moisture content. Percolation testing may be conducted at any time of the year and the data obtained in accordance with the procedures specified by 310 CMR 15.000 may be deemed valid for an indefinite period provided the soils within the site evaluated remain undisturbed and unaltered. (2) A percolation test shall provide data necessary to assess the suitability of the soil to transmit water from the soil absorption system and to a depth of four feet below this iyy elevation. Where the soil varies with depth as indicated by the results of the deep observation hole testing performed pursuant to 310 CMR 15.102, percolation tests shall be required in the soil which is identified to be the most restrictive by the Soil Evaluator with the concurrence of the approving authority. (3) Percolation tests shall be performed by a Massachusetts Registered Professional Engineer, Massachusetts Registered Sanitarian, a Soil Evaluator, or a person who: (a) in the opinion of the approving authority is qualified to perform such tests; (b) has one year of documented experience in satisfactorily performing such tests; and (c) has used or gained skills that demonstrate sufficient competence to perform such tests. All percolation testing shall be performed in the presence of an authorized representative of the approving authority. (4) At least two percolation tests shall be performed at the proposed disposal area, one in the primary area in which the soil absorption system is to be located and one in the proposed reserve area. Additional tests shall be required where soil conditions vary or where system design exceeds 2,000 gpd. In such instances, a minimum of three percolation tests, spaced uniformly over the proposed soil absorption area, shall be performed in addition to the test in the proposed reserve area. (5) Where 310 CMR 15.104(4) requires multiple percolation tests, the results of the test providing the slowest rate shall be used for system design. Averaging of percolation test rates across the site is prohibited. (6) Percolation tests may be performed at anytime of the year provided the soil to be tested is below the frozen soil layer. (7) Percolation tests shall not be performed in holes that have remained open to the atmosphere for more than three consecutive days. (8) Percolation tests shall not be performed in filled or disturbed ground 15.105: Procedure 1'or Perforating a Percolation Test A percolation test shall be conducted by performing the following steps in sequence: (1) Prepare a test hole located within the proposed disposal area which, in the judgment of the Soil Evaluator or the Approving Authority, is the most limiting. The�testhole_shall-have :a7diameter of as precisely as possible, withi7crrtical.sidessl8_inchesdee_p__not, including any. allowable liners -or filter layers.-on-either_the_bottotri_or-sides.� (2) .Establish a fixed point at the too or bottom ofthe _test -hole fromwhich- all -nieasurements, will ae taken (3) Scratekthe_bottom and sides of the test:fiole to remove any smeared"soil surfaces; taking - care _not to significantly change. the .hole dimensions. Add -two. inchesofcoarse sand --to&% protect the bottom.from scouring; or mserta-board or otherimperyiousobject. in the hole- so, that water may be poured down or on it during the filling operation. A mesh or perforated liner designed to maintain the test hole dimensions in extremely loose soils while allowing essentially unrestricted flow of water may be used with permission of the approving authority. 12/27/96 310 CMR - 506 310 CMR: DEPARTMENT OF ENVIRONMENTAL PROTECTION 15.105: continued (4) Qarefulty_fill--the:hole-with-clear-water-to-a.minimum-depth=of 12-.itfci s-from-the=bottom+ ofitheLhole. dN16ifitainn..thi�-,—minim mm-12'_inch_oe greater:water-level>by adding water as necessary in order to saturate surrounding soils.fora_geriod of no less than-l_5_minutes after> ,firsyfilling_the hole. (5) - eioh, if the water level drops to a depth of nine inches in fewer than 30 minutes, measure the length of time in minutes for it to drop from a depth of nine inches to a depth of six inches. If the rate is erratic in the opinion of the approving authority, the hole shall be refilled and soaked until the drop per increment of time is steady. Thetinte-for-th� ,cleve ,1 -to dfop-from a depth_of-nine-inches-to-a depth=of_siz.inches,_divided-by_threeTis=the Epercolation rate-imminntes-per-inch. (6) If the initial three-inch drop requires more than 30 minutes (rate equal to more than ten minutes per inch) the soil shall be saturated by filling the hole to the top and maintaining it full for at least four hours. The soil should then be permitted to swell a minimum of 12 hours so that the soil conditions will approach those which exist during the wettest season of the year. After the 12 hour swelling period, the test shall be made again by filling the hole to a 12 -inch depth and maintaining that level for 15 minutes, letting the level drop to nine inches, then timing the drop between nine inches and six inches. The time elapsed between nine inches and six inches, divided by three, shall be the percolation rate. (7) In certain soils, particularly coarse sands, the soil may be so pervious as to make a percolation test difficult, impractical, and meaningless. At the discretion of the Soil Evaluator and with the concurrence of the approving authority, the percolation test may be discontinued and a rate of two minutes per inch or less can be assumed provided that at least 24 gallons of water has been added to the percolation hole within 15 minutes and it is impossible to obtain a liquid depth of nine inches. 15.106: Landscape Position (1) The topography of the proposed disposal area shall be identified and recorded on the evaluation form. Particular attention shall be given to recording features which may adversely affect the functioning of an on-site system. These include: (a) bedrock outcrops or areas with many stones and/or boulders; (b) steep slopes (greater than 3:1, horizontal to vertical) exhibiting signs of unstable soil such as landslide scars, slump blocks, tree trunks or shrubs bending downslope; (c) highly disturbed ground as indicated by such features as remnants of foundations or pavements or buried construction debris; (d) low-lying coastal areas exhibiting signs of tidal inundation or tidal marsh vegetation; (e) low-lying inland areas exhibiting signs of influence of surface water runoff, ponding or freshwater wetland vegetation; and (1) flat low-lying areas adjacent to surface water bodies and streams. (2) The boundary of a velocity zone shall be determined by reference to the National Flood Insurance Program Flood Data and Flood Insurance Rate Maps for each community. 15.107: Hydroueoloeic Properties 12/27/96 (1) The hydrogeologic properties of the proposed disposal area shall be identified and recorded on the evaluation form with respect to the following: (a) estimated direction of ground -water flow; (b) ground -water table elevation (observed and adjusted by USGS water year data and/or soil mottling); - (c) estimated depth to bedrock if a factor in design of proposed system, or actual depth if encountered during deep observation hole tests; (d) depth of unsaturated zone, including any perched water tables. (e) drainage classification of dominant soil type as defined by SCS; (i) lateral distance to surface water and wetland delineation; (g) location of every water supply, public and private, 310 CMR - 507 310 CMR: DEPARTMENT OF ENVIRONMENTAL PROTECTION 15.107: continued I. within 400 feet of the proposed system location in the case of surface water supplies and gravel packed public water supply wells, 2. within 250 feet of the proposed system location in the case of tubular public water supply wells, and 3. within 150 feet of the proposed system location in the case of private water supply wells; (h) approximate safe yield or design capacity of every public water supply, if information is available; (i) identification of proposed disposal area in relation to the location of nitrogen sensitive areas designated pursuant to 310 CMR 15.215. (2) When observation wells are appropriate or necessary to determine the hydrogeologic properties of a site or region, such as direction of ground -water flow, perched ground -water tables and seasonal ground -water elevation fluctuations, the general guide for the proper use and installation of ground- water observation wells provided in Department guidance shall be followed. 15.201: Tvne of Svstem. Each on-site subsurface sewage disposal system approved pursuant to 310 CMR 15.000 shall consist of a septic tank which discharges liquid effluent through a gravity distribution or pressure dosing network to a soil absorption system as hereafter described. No modifications or alterations to the design criteria shall be allowed except pursuant to the alternative system and shared systems provisions of 310 CMR 15.280 through 15.293, or the local upgrade approval or variance procedures of 310 CMR 15.400. 15.202: Use of Recirculatine Sand Filters (1) A recirculating sand filter or equivalent alternative technology approved by the Department in accordance with 310 CMR 15.280 through 310 CMR 15.289 shall be a required design component of all systems with a design flow of 2,000 gpd or more to be located in Nitrogen Sensitive Areas, provided that such RSF shall not be required for a facility for which subdivision approval has been obtained to construct dwellings with a cumulative total design flow of 2,000 gpd or greater if a disposal system construction permit to construct a system with a total design flow of less than 2,000 gpd in full compliance with 310 CMR 15.000 on each of the subdivision lots to be served by a system is obtained and such separate subdivision lots are to be conveyed to independent owners. (2) A recirculating sand filter may be used to enhance nitrogen removal in systems with a design flow below 2,000 gpd in accordance with 310 CMR 15.217 (enhanced nitrogen removal). (3) Recirculating sand filters designed and approved in accordance with Department guidance are a certified alternative system for facilities or conditions as set forth at 310 CMR 15.289 (certification of alternative systems). (4) Recirculating sand filters or equivalent technology shall meet the following requirements: (a) effluent discharge concentrations shall meet or exceed secondary treatment standards of 30 mg/L BODS, 30 mg/L TSS and a minimum of 85% of the influent BOD, and TSS shall be removed. The effluent pH shall not vary more than 0.5 standard units from the influent water supply. (b) total nitrogen concentration in the effluent shall not exceed 25 mg/L and a minimum of 40% of the influent total nitrogen concentration shall be removed. (c) systems will be required to monitor influent and effluent quality on a quarterly basis. Effluent discharge limits shall be determined on a case by case basis as set forth in 310 CMR 15.202(4)(a) and (b) and shall require, at a minimum, effluent standards for pH, BOD„ TSS, TKN and NO, -N. 12/27/96 310 CMR - 508 4 310 CMR: DEPARTMENT OF ENVIRONMENTAL PROTECTION 15.202: continued (d) recirculating sand filter systems shall contain all components of a standard on-site system and be capable of functioning as a conventional system. Any departures from this provision require written approval from the Department. (e) the Department and the local approving authority shall be notified of any component or system failure within 24 hours of detection of such failure. (1) systems with design flows of 2,000 gpd or greater but less than 10,000 gpd shall not qualify for the credit for enhanced nitrogen removal allowed under 310 CMR 15.217. (g) pressure dosing is required for all systems with design flows of 2,000 gpd or greater but less than 10,000 gpd. Pressure dosing systems shall be designed in accordance. with Department guidance. (h) the four foot separation to high groundwater as required under 310 CMR 15.212 shall be calculated after adding the effect of groundwater mounding to the mean annual high groundwater elevation as determined pursuant to 310 CMR 15.103(3). (i) the system must be inspected annually by a Massachusetts Registered Professional Engineer and certification submitted to the local approving authority that the system and its components are functioning as designed. - 6) operation and maintenance manuals and procedures must be prepared by a Massachusetts Registered Professional Engineer and submitted as part of the application. (5) Prior to the use of any recirculating sand filter or equivalent alternative technology approved by the Department in accordance with 310 CMR 15.280 through 310 CMR 15.289, the applicant shall submit to the Department the written approval of the local approving authority together with a copy of the complete application submitted to the local approving authority. The application shall be deemed approved by the Department if, within 60 days of receipt of a complete application the Department fails, in writing: (a) to request additional information from the applicant; or (b) grant a written approval, which may include any special conditions the Department believes appropriate to protect public health, safety, or welfare or the environment; or (c) to deny the approval of the recirculating sand filter or equivalent alternative technology. In the event the Department requests additional information from the applicant, the 60 day period for Department review shall commence upon receipt of such additional information. In the event the Department denies the approval of the recirculating sand filter or equivalent alternative technology, that determination may be appealed in accordance with 310 CMR 15.422. 15.203: System Sewaee Flow Desian Criteria 12/27/96 (1) Each component of an on-site subsurface sewage disposal system shall be designed to treat sanitary sewage discharged from all buildings to be served by the system using the System Sewage Flow Design flows set forth at 310 CMR 15.203(2) through (5). Actual water meter data shall not be substituted for the design flow criteria for the activities listed below unless pursuant to 310 CMR 15.416. Design flow is equivalent to estimated generated flow for the proposed use plus a factor representing flow variations. 310 CMR - 509 COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION TITLE 5 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: iA% atra a. Owner's Name: L V / u Owner's Address: ft; Q 4 Date of Inspection: Z 17, 2 -mm 3 ( BOARD , Name of Inspector: (please print) 9'946-'Ar41040N­FHE�4`L /S - �_„ !'! Company Name: SurvSPACE IN4P,6C77oN SEk!//cE Mailing Address: / tytd4g4;+ A� St X33 Cw no oi9sa Telephone Number: CERTIFICATION STATEMENT I certify that I have personally inspected the'i&kage 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: XPasses _ Conditionally Passes _ Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature: �Date:3/� LcW3 The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP) within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Notes and Comments ****This report only describes conditions at the time of inTpection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 page I Page 2 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: Z a --.- Owner: �,— Date of Inspection: 7gYD Inspection Summary: Check A,B,C,D or E / ALWAYS complete all of Section D A. System Passes: XI 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: AIA _ One or more system components as described in the "Conditional Pass",section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Answer yes, no or not determined (Y,N,ND) in the _ for the following statements. If "not determined" please explain. _ The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a'Certificate of Compliance indicating that the tank is less than 20 years old is available.. . , ND explain: _ Observation of sewage Backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if (with approval of Board of Health): broken pipe(s) are replaced _ obstruction is removed distribution box is leveled or replaced' ND explain: _ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if (with approval of the Board of Health): _ broken pipe(s) are replaced obstruction is removed ND explain: Ili Page 3 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: fit%Li-MA., alae_ rna Owner: Date of Inspection: 7 419 6:? C. Further Evaluation is Required by the Board of Health: 1144 _ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b) that the system is not functioning in a manner which will protect public health, safety and the environment: _ Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: _ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. .The system has a septic tank and SAS and the SAS is within a Zone I of a public water supply. The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance "This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: Page 4 of I 1 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: Owner: Date of Inspection: 7 1 O 2-3 D. System Failure Criteria applicable to all systems: You must indicate "yes" or "no" to each of the following for all inspections: Yes N 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. 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. Y Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria and volatile organiccompounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.] (ila oo) 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: 9A, To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. You must indicate either `yes" or "no" to each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no _ the system is within 400 feet of a surface drinking water supply _ the system is within 200 feet of a tributary to a surface drinking water supply _ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area— IWPA) or a mapped Zone II of a public water supply well If you have answered "yes" to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. Page 5 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 2 t ou Owner . 4 t +a "-✓- Date of Inspection: 7 a D Check if the following have been done. You must indicate `des" or "no" as to each of the following: Yes No Pumping information was provided by the owner, occupant, or Board of Health _ Were any of the system components pumped out in the previous two weeks _ Has the system received normal flows in the previous two week period ? Have large volumes of water been introduced to the system recently or as part of this inspection ? Were as built plans of the system obtained and examined? (If they were not available note as N/A) Was the facility or dwelling inspected for signs of sewage back up ? Was the site inspected for signs of break out ? _ Were all system components, excluding the SAS, located on site ? _ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum ? _ Was the facility owner (and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems ? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: Yes no _ >� Existing information. For example, a plan at the Board of Health. A— Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [3 10 CMR 15.302(3)(b)] Page 6 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: Z �/s kM Clot 1_Ma Owner: 4i4,a oKr Date of Inspection: 7 v3 FLOW CONDITIONS RESIDENTIAL Number of bedrooms (design): _:�_ Number of bedrooms (actual): DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x # of bedrooms): Number of current residents: Does residence have a garbage grinder (yes or no): 0 Is laundry on a separate sewage system_ (yes or no): 0 [if yes separate inspection required] Laundry system inspected (yes Seasonal use: (yes or no): Water meter readings, if available (last 2 years usage (gpd)): At k Sump pump (yes or no): 00 Last date of occupancy: rwvL� COMMERCIAL/INDUSTRIAL N 14 Type of establishment: Design flow (based on 310 CMR 15.203): gpd Basis of design flow (seats/persons/sgft,etc.): Grease trap present (yesor no): _ Industrial waste holding tank present (yes or no): — Non -sanitary waste discharged to the Title 5 system (yes or.no): Water meter readings, if available: Last date of occupancy/use: OTHER (describe): GENERAL INFORMATION Pumping Records 9 I P &t N, 4 /O Source of information: A"�" Was system pumped as partof the inspection (yes or no) If yes, volume pumped: _gallons — How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM Septic tank, distribution box, soil absorption system _ Single cesspool Overflow cesspool —_ Privy _ Shared system (yes or no) (if yes, attach previous inspection records, if any) _ Innovative/Altemative technology. Attach a copy of the current operation and maintenance contract (to be obtained from system owner) Tight tank Attach a copy of the DEP approval — Other (describe): age of all components, date installed (if known) and source of information: Were sewage odors detected when arriving at the site (yes or no): �� Page 7 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: z W HRat I sr�C Owner7J3Aa,--k&i,-ftu— Date of Inspection: 71-z-9/03 BUILDING SEWER (locate on site plan) Depth below grade: Materials of construction: _cast iron X40 PVC _other (explain): Distance from privatewater supply well or suction line: /OD I (— Comments (on condition of joints, venting, evidence of leakage, etc.): SEPTIC TANK: ]C (locate on site plan) Depth below grade: Material of construction: Xconcrete _metal _fiberglass polyethylene _other(explain) If tank is metal list age: _ Is age confirmed by a Certificate of Compliance (yes or no): _ (attach a copy of certificate) Dimensions: /0 �e5 6 �X S Sludge depth: Z� ,t Distance from top of sludge to bottom of outlet tee or baffle: 3D Scum thickness: / i/ Distance from top of scum to top of outlet tee or baffle: Z 0 `� Distance from bottom of scum to bottom of outlet tee or battle: How were dimensions determined: V�w4 a.Q " ej'�P�J*� Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): , , GREASE TRAP: _(locate on site plan) Depth below grade: Material of construction: _concrete _metal _fiberglass _polyethylene._other Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Page 8 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: a"e, Owner, Date of Inspection: 703 TIGHT or HOLDING TANK-_ (tank must be pumped at time of inspection)(locate on site plan) AM Depth below grade: Material of construction: _concrete _metal _fiberglass polyethylene _other(explain): Capacity: Rallons Design Flow: Rallons/day Alarm present (yes or no): Alarm level: Alarm in working order (yes or no): Date of last pumping: Comments (condition of alarm and float switches, etc.): DISTRIBUTION BOX: X (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: 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.): 0 PUMP CHAMBER: _ (]orate on site plan) /M' Pumps in working order (yes or no): _ Alarms in working order (yes or no): _ Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): 1 Page 9 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: Ha Owner: "o..r Date of Inspection: SOIL ABSORPTION SYSTEM (SAS): (locate on site plan, excavation not required) If SAS not located explain why: Type _ leaching pits, number. _ _ leaching chambers, number: _ leaching galleries, number: _ leaching trenches, number, length: leaching fields, number, dimensions: is _ overflow cesspool, number: _ _ innovative/altemative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): p CESSPOOLS: _ (cesspool must be pumped as part of inspection)(locate on site plan) /VA Number and configuration: Depth — top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow (yes or no): _ Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): PRIVY: _ (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation; etc.): Page 10 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: at�t aLe` Owner: tCi�1 Date of Inspection: %D3 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. �ocate where public water supply enters the building. �t N� ?7 fit M t r '— N©T ro c3-1 --"A E n { Page 11 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: t1Ak&t, w MA_ Owner iA��n✓ Date of Inspection: 24ao SITE EXAM Slope Surface water Check cellar Shallow wells rr Estimated depth to ground water•>96twt- Please indicate (check) all methods used to determine the high ground water elevation: _ Obtained from system design plans on record - If checked, date of design plan reviewed: Observed site (abutting property/observation hole rxithy 1500 feet ofSAS) Checked with local Board of Health -explain: t �RCi� fu _ Checked with local excavators, installers- (attach documentation Accessed USGS database -explain: 11 IV System Owner ERAEX SRACRg4QW 14 ASHHOM7 DRIVE WRTH READIl4G, MA 01984 (978) 375.4390 PRAM Type: Emergency Cesspool: No Date of Pumping: 101 a, JI Commonvea" of Mossachusetss : Massachusetts System Pumoino Rewrd Routine Yes System Pumped By: Wind River Environmental, LLC I Contents transferred to: Contents Disposed at: Date: k>1 a/ I D( Pun, Si'..: Condition of System/Other Comments System location FRANK Z Wyman Street Sa16m, t4k 01970 (978) 375-4390 Dep Approved from - 12/07/95 Farm 4 -- System Pumping Record Septic tank: Na Owe Quantity Pumped: 6 $ a t� Gallon* Permit #: air 107 Forest St. Middleton, MA 01949 (508)774.2772 WA . FORM 4 - SYSTEM PU,VIPLNG RECORD 5�Q gSAV`G5 WEDCo onwealth of Massachusetts sachusetts NOV t 3 lylb Massachusetts Gr C,' —,� ",ALEM Hf -:11115H DEPT. t `�t "�C./��/1C11.c✓ Salem r Date of Pumping: p Quantity Pumped:�G�allons Cesspool: No Yes ❑ Septic Tank: No ❑ Yes S)'stem Pumped by: lr�� Contents transferred to: License #: S Sf� Date 0 THE PROFESSIONAL EXPERTS IN THE SEPTIC AND DRAIN INDUSTRY 0 nc)&() FORM 4 - SYSTEM PUMPING RECORD i of Massachusetts , Massachusetts System Pumping Record Date of Pumping: �i' Quantity Pumped�C/gallons Cesspool: No LTJ/ Yes ❑ Septic Tank: No ❑ Yes LAY Svstem Pumped by:r/11/✓�' .. License 4: ......... ......... Contents transferred to: Date Inspector FORM 4 - SYSTEM PUMPING RD' CURRIER SEPTIC & DRAIN SERVICE 107 FOREST STREET; MIDDLETON, MA 01949 (978)774-2772 CO�MNIONWEALTH OF MASSACHUSETTS s MASSACHUSETTS SYSTEMPUMPING RECORD CITY OF SALEM HEALTH DEPT. SYSTEM OWNER: SYSTEM LOCATION: bra/ DATE OF PUMPING: QUANTITY PUMPED: GALLONS CESSPOOL: NO El YES F-� SEPTIC TANK: NO E] YES Ea,. SYSTEM PUMPED BY: CURRIER SEPTIC & DRAIN SERVICE CONTENTS TRANSFERRED TO: DATE: �� INSPECTOR: