HomeMy WebLinkAboutTitle V Inspection Report - 481 REA STREET 11/15/1996 ACTION-KING ENTERPRISES,INC.
6 LIVINGSTON STREET
LOWELLy M 01852
TEL: (51 417750
FAXs (500) 459-0770
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM °
PART A
CERTIFICATION
x'IIOPEI I"Y ADD : 4� M� 01845
DATE OF INSPECTION: 21-15-96
NAME OF INSPECTOR: WALTER,BREAULT,III.. ADDRESS OF OWNER:
(IF DIFFERENT)
CERTIFICATION STATEMENT
f CERTIFY THAT I HAVE PERSONALLY INSPECTED THE SEWAGE DISPOSAL SYS'T'EM AT THIS
ADDRESS AND THAT THE INFORMATION REPORTED BELOW IS TRUE,ACCURATE AND COMI'LETE
S OF THE TIME OF INSPECTION. THE INSPECTION WAS PERFORMED BASED ON MY TRAINING AND
r,'XPERIENCE IN THE PROPER FUNCTION AND MAINTENANCE OF ON-SITE SEWAGE DISPOSAL SYSTEMS. THE
SYSTEM.
X PASSES
CONDITIONALLY PASSES
NEEDS.FURTHER EVALUATION BY THE LOCAL APPROVING AUTHORITY
FAILS
�'I,.CTOR'S SIGNATURE: DATE:
11-15--9G
SYSTEM INSPECTOR SHALL SUBMIT A COP OF THIS INSPECTION REPORT TO THE APPROVING AUTHORITY
f'HIN THIRTY(30)DAYS OF COMPLETING THIS INSPECTION. IF THE SYSTEM IS A SHARED SYSTEM OR HAS A
SIGN FLOW OF 10,000 GPD OR GREATER,THE INSPECTOR AND THE SYSTEM OWNER SHALL SUBMIT THE
t'OIZT TO THE Al'PItC1l'RIATE REGIONAL OI FICE OF THE, DEPARTMENT OF ENVIRONM7E,NTAL PROTECTION.
t? ORIGINAL SHOULD BE SENT TO THE SYSTEM OWNER AND COPIES SENT TO THE BUYER,IF APPLICABLE
THE APPROVING AUTHORITY.
'ECTION SUMMARY:
CHECK A,B,C,OR D.
SYSTEM PASSES:
X I HAVE NOT FOUND ANY INFORMATION WHICH INDICATES THAT THE SYSTEM VIOLATES
ANY OF THE FAILURE CRITERIA AS DEFINED IN 310 CMR 15.303.
ANY FAILURE CRITERIA NOT EVALUATE ARE INDICATED BELOW,
SYSTEM CONDITIONALLY PASSES:
__ONE OR MORE SYSTEM COMPONENTS NEED TO BE RE PLACED OR REPAIRED. THE
SYSTEM UPON COMPLETION OF THE REPLACEMENT OR REPAIR PASSES IN PECI ION.
ATE YES,OR NO,OR NOT DETERM ,D(Y,n,OR ND). DESCRIBE BASIS OF DETERMINATION IN ALL
A NCES. IF"NOT DETERMINED EXPLAIN WHY NOT.
THE' SEPTIC TANK IS METAL,CRACKED,STRUCTURALLY UNSOUND,SHOWS SUBSTANTIAL
-TRATION OR EXITILTRATION,OR TANK FAILURE IS IMMINENT. THE SYSTEM WILL PASS INSPECTION IF
f?XISTING SEPTIC TANK IS REPLACED WITH A CONFORMING SEPTIC TANK AS APPROVED BY THE BOARD
FAI I'IL
1
PAGE I
ACTION-KING ENTERPRISES,INC.
26 LIVINGSTON STREET
LOWELL,MA 01852
TEL: (508)452-7750
FAX: (508)459-0770
IROPERTY ADDRESS: 481 RE STREET NORTH ANDOVER;MA 01845
)WNER: NICHOLAS BUMBACCO
)ATE OF INSPECTION: 11-15-96
CTION KING ENTERPRISES,INC.HAS BEEN RETAINED BY THE OWNER TO PROVIDE AN INSPECTION OF THE ON-
SITE SEWERAGE DISPOSAL SYSTEM AS DE l (D BY 310 CAIR 15.303.D.E.P.GUIDANCE INSTRUCTS THE
NSPECTOR TO MAKE AN EVALUATION OF THE SYSTEMS PERFORMANCE ON THE DAY OF THE INSPECTION.
THE TITLE 5 INSPECTION IS NOT DESIGNED TO PROVIDE INFORMATION TO DEMONSTRATE THAT THE SYSTEM
WILL ADEQUATELY SERVE THE USE TO BE PLACED UPON IT BY THE NEW OWNER AS STATED IN 15.302. THIS
ISPECTION IS NOT A WARRANTEE OR GUARANTEE OF THE SYSTEM FUTURE PERFORMANCE,AND DOES NOT
EITHER EXPRESS OR IMPLY TT.
PAGE i-A
ACTION-KING ENTEJ-7,PFdSE S,INC,
SUBSURFACE SEWAGE, DISAPOSt'llL S'UQ'l;EM VNTS-11�ECG lu, .1 EC -I %J'r-vl
PART A
CERTIFICATION (CONTINUED)
PROPERTY ADDRESS: 481 RE A STREET NOR71H ANDOYE&AIA±jM�
OWNER- NICHOLAS BUMBACCO
DATE,OF INSPECTION: 11-15-96
B) SYSTEM CONDITIONALLY PASSES (CONTINUED)
N/A SEWAGE( BACKUP OR.BRE Alk-C-OU'll OR HIGH STATI41-- WA'I'ER LEVEL OBSERVED PIT 1.11E
DISTRIBUTION BOX IS DUE TO BIROYaN OR OBSTRUCTED PIPE(S',OR DUE TO
SETTLED OR UNEVEN DISTRIBUTION BOX. THE, SYSTEM WILL PASS INSPECTION IF(WITH
APPROVAL OF THE BOARD OF HEALTH).
BROKEN PIPE(8,ARE RE rLA CIED
,OBSTRUCTION IS REMOVED
DISTRIBUTION BOX IS LEVELED OR REPLACED
I IIA -0- -T
THE SYSTEM RE QUIRE,D PU-lNlPIN`G MORE TA N FOUR TIME, YEAR DUE TO m%. _�,Ell 0kl
OBSTRUCTED PIPE(S). THE SYSTEM WILL PASS INSPECTION IF, (Wrl-H APPROVAL OF, THE
BOARD OF HEALTH.).
BROKEN PTIPF(S)ARE REPLACED
OBSTRUCTIOIAT ATSIZZ ,P,v'lw 0 V ED
C.) FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HE ALT H:
Y If n
x B I M-rd-0 z ill-,D Op't
N/A CO N'DIT 10 N 8 E FIST W III CI 1 TAE QU 1 RE, IFJ R TIMR EVALTUTA'11,10i'T T E 0 Il-VIA-L'filla
IN ORDER TO DETERMINE IF THE SYSTEM IS FAILING TO PROTECT THE PUBLIC DEAL
SAFETY AND THE EN ONMENT.
RD(),F III E A L TU D E.I`E R Avf 0YE,S I vL HA T Tly-1, S'7 ST-17%I I x
ox E(m%%llLLPAQSLWLESSBr
v v 210 lk-pz�k A.LXII,0 1 0 A A-VI-9 0 1 N�-1 A
FUNCTIONING IN A MANNER WHICH WILL PROTE CT THE PUBLIC HEALTH AND SAFEETY
AND THE, EN`71RONMENT:
CESSPOOL OR PRIVY IS WITHLN 50 FEET OF A SUR-FACE.WATER
CESSP 0 OL OR PRP.m.7 IS-'v'gvl I A kA ENT 50 FEET'OE A B ol-)RI,E RIN'%rff' 'V1l-,0s1',AvtklEl D A 1%'T luf-'
OR A SALT MARSH.
2) SYSTEM WILL FAIL UNLESS THE.BOARD OF HEALTH(AND- PUBLIC WATER SlUPPLIT-JR,lF
AT
APP R(--)PRIMIT)D E TE RM MT E 8 T]IAA"T1 1E,SYSTEM III F UN C T 10 NTIN%G 0T�k MA E R THAT
T
PROTECT 'THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT.
THE SYSTEM HAS A SEPTIC TANK AND SOJI—TABSOF-PTIONSYSTEM AND IS WXTB3N
100 141(ET l0 A SURACE""t,0ERSUPP
T,W
ORAl I A Rl " A S URFACE"V' 'T V I
SUPPLY.
THE SYSTEM HAS A SEPTIC TANK AND SOIL ABSORPTION SYSTEM AND IS WITULN
A ZONE I OF A PUBLIC WATER SUPPLY WELL-
0 -. 'b- Its
THE SNA"oTil"M HAS A SEPTIL'C"ALIANIK AND t"xwBS'%-j%RPTl0NT 00 1"031 EIVA 213,11M)AS'IV 11-1-EN
50 FEET OF A PRIVATE WATER SUPPLY WELL.
THE SYSTEM HAS A SEPTIC TANK AND SOIL ABSORPTION SYSTEM AND IS LESS
THAN 100 FEET BUT 50 FEET OR MORE FROM A PRIVATE WATF.R SUPPLY WET J,
IN
IT Y L 89
E A ANU V'GALtAh," I]"
ORGANIC COMPOUNDS INDICATES THAT THE WELL IS ER E E FROM POLLU-11ON
FROM THAT FACILITY AND THE PRE SENCE OF AMMONLk NITROGEN AND
NITRATE.NIT ROGE-N IS EQUAL TO OR LESS TUE.5PPM.
PAGE, 2
D) SYSTEM FALLS.
N/A I HAVE DETERMITNED THAT THE..SYS'STEAMI VIOLA'T'ES ONE,OR MORE.O THE.I'O¢-,LOWPNIG
FAa�a�iTaaF a' L'iIILPOI< AS DEFINED IN 310';M R 15.303. Tama,BASIS FOR THIS DE FE,��18.lu-111 ��
IS IDENTIFIED BELOW. THE BOARD OF HEALTH SHOULD BE CONTACTED TO DE:TEBUYIENF
WHAT WILL BE NECESSARY TO CORRECT THE FAILUM
BACKUP OF SEWAGE INTO FACILITY OR SYSTEM CO1N;PONE N T IdUE TO A��'
OVERLOADED OR CLOGGED SAS OR CESSPOOL.
DISCHARGE OR PONDING OF EFFLUENT TO THE SURFACE OLD HE GROUNID OR
SUR-FACE,WATERS DUE.TO AN ONrFRT.OADE:D OIL CLOGGED SAS OIL CT SSPOOL:,
STATIC LILQUID LEVE11�'THE DISTRIBUTION D( ���.�Y� �d V'va�a D�'I
AN OVERLOADED OR CLOGGED SAS OR CESSPOOL.
LIQUID DEPTH IN CESSPOOL IS LESS THAN 6"BELOW INVERT OR AVAILABLE
VOLUME 1S r__ESS THAN 1/2 DAY FLOW-
RE QU ED UTYaP.ING MORE TRAM 4 TPIES I T�, LAST e'er A NOT DU
CLOGGED OR OBSTRUCTED PIPE(S).
NUMBER OF TIMES PUMPED
ANY PORTION OF THE SOS:ABSORPTION SYSTEM,CESSPOOL.OR PINNY IS BELOW
THE IbIGLg GR OUND�Z'x T E R ELE"v'A T IO�'.
ANY PORTION OF A CESSPOOL OR PRIVY IS WITIlFflq 100 FEET OF A SURFACE.
MATER SUPPLY OR TRrEBUTARV TO A SURFACE MATER SUPPLY.
ANY PORTION OF A CESSPOOL OR PRIVY IS WITHIN A ZOO 1 OF A PUBLIC WELL.
AN gT PORTION OIL A CESSPOOL OR PRIVY IS oY'I I ZiJ N 50 F E E T^Y, A a g�v'i-k a i
WATER SUPPLY WELT,.
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 ACc EPTA L
WATER QUALITY ANALYSIS. IF THE WELL HUAAS BEEN D'
ACCEPTABLE, ATTACH COPY OF WELL WATER ANALYSIS FOR COLff O RM
BACTERIA, VOLATILE ORGANIC COMPOUNDS,AMMONIA_NITROGEN AND
NITRATE,NITROGEN.
E) LARGE SYSTEM F ILS:
THE FOLLOWING CRITERIA APPLY TO L AIzGE.SYSTE-,._S T ADTIITIMNT TO TTTF CRTTF tl
tAk> Vu.
N/A THE DESIGN FLOW OF SYSTEM IS 10,000 GPD OR GREATER(LARGE SYSTEM)AND THE
SYSTEM IS A SIGNIFICANT THRF T TO PUBLIC HEALTH ANTS SAFETY AND THE
EP:I RONMENT DE CAUSE ONE OR lka^IIE OF'1`1111E EOLLG:Y'�iG C)N ITIO STS E-AST:
THE SYSTEM IS WITHIN 400 FEET OF A SURF ACE DRINKING WATER SUPPLY
THE SYSTEM IS WITHIN200 FEET OF A TRIBUTARY RY TO A SURFACE.DR-INKING
:P'A'LER SUPPLY.
THE SYSTEM IS LOCATED Iii A NITROGEN SENSITIVE AREA(INTERIM WELLHEAD
PROTECTION AREA( PA) OR A MAPPED ZONE II OF A PUBLIC WATER SUPPLY
WELL,
THE OWNER OR OPERATOR OF ANY SUCHSYSTEM SHALL BRING THE SYSTEM AND rACiL 1 Y INTO FULL,
COMPLIANCE WITH THE GROUNDWATER AT T PROGRAM REQUIREMENTS OF 314 CMR 5.00 AND 6.00,
PLEASE CONSULT LOCAL REGIONAL OFFICE OF THE DEPARTMENT FOR FURTUER WT+'OR?�:1
PAGE 3
ACTION-KING ENTERPRISES,NC.
PART B +�
CHECKLIST
PROPERTY ADDRESS:481 REA STREET NORTH ANDOVER MA 01845
`?WNER: NICHOLAS BUMBACCO
)ATE OF INSPECTION: 11-15-96
'HE,CK IF THE FOLLOWING HAVE BEEN DONE.
X PUMPING INFORMATION WAS REQUESTED OF THE OWNER,OCCUPANT,AND BOARD OF
HEALTH.
X NONE OF THE SYSTEM COMPONENTS HHAVE BEEN PUMPED FOR AT LEAST TWO WEEKS AND
THE SYSTEM HAS BEEN RECEIVING NORMAL FLOW RATES DURING THAT PERIOD. LARGE
VOLUMES OF WATER HAVE NOT BEEN INTRODUCED INTO THE SYSTEM RECENTLY OR AS
PART OF THIS INSPECTION.
X _AS BUILT PLANS HAVE BEEN OBTAINED AND EXAMINED. NOTE IF THEY ARE NOT
AVAILABLE WITH N/A.
X THE FACILITY OR DWELLING WAS INSPECTED FOR SIGNS OF SEWAGE BACK-UP.
X THE SYSTEM DOES NOT RECEIVE,NON-SANITARY OR INDUSTRIAL WASTE FLOW.
X THE SITE WAS INSPECTED FOR SIGNS OF BREAKOUT.
X ALL SYSTEM COMPONENTS,EXCLUDING THE SOIL ABSORPTION SYSTEM,HAVE BEEN
LOCATE,ED ON THE, SITE.
X THE SEPTIC TANK MANHOLES WERE UNCOVERED,OPENED,AND THE INTERIOR OF THE
SEPTIC TANK WAS INSPECTED FOR CONDITION OF BAFFLES OR TEE,MATERIAL OF
CONSTRUCTION,DIMENSIONS,DEPTH OF LIQUID,DEPTH OF SLUDGE,DEPRTH OF SCLTNi.
X THE SIZE AND LOCATION OF THE SOIL ABSORPTION SYSTEM ON THE SITE HAS BEEN
DETERMINED BASED ON EXISTING INFORMATION OR APPROZLYIATED BY NON-INTRUSIVE
METHODS.
X THE FACILITY OWNER AND OCCUPANTS,IF DIFFERENT FROM OWNERS WERE PROVIDED
WITH INFORMATION ON THE PROPER MAINTENANCE OF SUB-SURFACE DISPOSAL SYSTEM.
PAGE 4
ACTION-KING JNG ENTE PRIG ea;S,TNC,
SUBSURFACE SEWAGE DISPOSAL INSPECTION F01 YI
D/S 0 1F f-
SVS'TEM INFORMAUON
PROPERTY ADDRESS: 481 REA STREET NORT ANIDO vE&ETA 01845
OWNER, NICHOLAS BUMBACCO
DATE.OF INSPECTION- 11-15_96
P.g 13 NiIAI'
(DESIGN FLOW:— 440 GALLONS.
NUMBER OF BEDROOMS: 4
NUMBER OF CURR�E.NT RESIDENTS. 2
GARBAGE G dUER t'El v OR NO)' `.-"S ___ _ __
SEASONAL USE(YES OR NO) NO LAITrq DPC Z;€.31�i1�ia:t_;TED O S S EPyl
WATER METER READINGS,IF AVAILABLE: 100 f FEET AWAY
LAST DALE OF OCCUPANCY: O N eci
COMMERC ANDUS'TRIAI,:
TYPE OIr ES'TABL,ISHIME T: [A
DESIGN FLOW: GALLONS/DAY
GREASE TRAP PRE,SENT,(YES OR NO
DUSTRI L WASTE HOL DLNG TANK P FSE',NT: (VL'.S OR NO.)
NON-SANTTARa'WAagE UISCIIARGED bO 1 HE TITLE S SVSbEM: (YES O9E NO)
W ER.METER READINGS3,IF AVAILABLE:
LAST DAY OF OCCUPANCY:
OTHER: (DESK I E)
LAST DAY OF OCCUPANCY:
GENERAL,01FOB IN1A A ION
PUMPING RE CORDS AND SOURCE OF INFORMATION.
5-96 fflO MOWN- F.1a
S('STEM P UMPED AS PART OF 0-OP EC'TION C.ES OR NO)
IF YES, VOLUME PUMPED 2000 GALLONS.
REASON FOR PUMPING INSPECT TANK AND RAFFLES
rx)I AYIE 101F SYSTEM
x SEPTIC TANK/DISTRIBUTION BOX/SOIL ABSORPTION SYSTEM
EM
SINGLE CESSPOOL
OVERFLOW CE.SSPOOi.
® PJ""Y
SHARED SYSTEM(YES OR NO)(IF YES,ATTACH PRIVIOUS INSPEC i ION RECORDS, IT, AIN V)
OT HE R.
(€.XPLAIl
APPROXIMATE AGE OF ALL COMPONENT'S,DATE INSTALLED(IF OWN)AND SOURCE OF
INFORMATION.
a'EARS \s.aOI"VdElJ YYT1gTL+2'a)
SEWAGE ODORS DETECTED WHEN ARRIVING AT THE SITE,. (YES OR NO) NO
P AG E J
ACTILON-KING
PART C
SYSTEM INFORMATION(CONTINUED)
PROPERTY AID RE SS: 481 RE,A STRI ClET NORTH ANDOYA!ll�AIA 0'110845-
OWNER. NICHOLAS BUMBACCO
DATE OF INSPECTION: 11-15-96
SEPTIC T ANI K-. II-E3
olu Qly�i v
(LOCATE
DEPTH BELOW GRADE- 6"
ILT RETE 'TREll A
MAT ERIAL OF CON'OTR'j C.TION. X CONCI METAL—IT"mr tk-1 I
kEXPLAM)
DMIENSIONS: 10' X 6' X 4.5'
SLUDGE D E-P T IT!
DISTANCE FROM Top OF SLUDGE TO BOTTOM CSI:'0"UTLE OR BAFFLE:— v
SCUM THICKNESS: 0
DISTANCE FROM TOP OF SCUM TO TOP OF OUTLET TEE OR BAFFLE: 7"
DISTANCE FROM BOTTOM OF SCUM TO BOTTOM OF OUTLET TEE OR BAFFLE!
CO MME N TUS:
(RECOMMENDATION FOR PUMPING,CONDITION OF INLET AND OUTLET TEES OR BAFFLES,-DEPTH OF LIOUlD
LEVEE L IN RELATION TO OUTLET IN A A - -,T
,VERT-STRUCTUR-A-1 TINTEGRITY,EVEDENW-F
NO SIGNS OF BACKUP IN TANK
GREASE TIZAP• NIA
(LOCATE ON SITE PLAN)
DEPTH BELOW GRADE,
DIMENSIONS:
SCUM THICKN-ESS!
DISTAN' ]vKHROM' ki B if K,
CE 1OP"F SCUM "r OTUTTILIE'11-1111ZE()"it A1411LE.—
DISTANCE FROM BOTTOM OFSCUM TO BOTTOM OF OUTLET TEE OR BAFFLE.
COMMENT9!
(RECOMIMIE,N DAT TON FOR P-T IT IF -1 OF VILET .111D-TT-y E A'v ES OR B'111FLESS,D.11"ll 01"1 T"ll"A
1% L ING,COND-1-1-k011 A Ilk , Vy U A A, A� 0 "A�� til A A A-1 k-1 AlAy -JL"
J, x uPv'jA., ET
LEVEL IN RELATION TO OUTLET INVERT,STRUCTURAL INTEGRITY,EVIDENCE OF LEAKAGE.
ETC.)
PAGIE,6
ACTION-KING ENTERPRISES,INC.
SUBSURFACE SEWAGE.DISPOSAL SYSTEM INSPECTION FO R kf
PART C
SYSTEM INFORMATION(CONTENUED)
PROPERTY ADDRESS: 481 REA STREET NORTHANDOVE&MA 01845
OWNER: NICHOLAS BUNJIBACCO
DATE OF INSPECTION: 11-15-96
TIGHT OR HOLDING TANK. N/A
(LOCATE ON SITE PLANT
DEPTH BELOW GRADE:
MATERIAL OF CONSTRUCTION: CONCRETE METAL FR P OTHER(.EXPLAIN)
D NSIONS:
CAPACITY- C-ATLONS
DE So IT G IN"F L 0 G A or,L 0 T&4T 8 1""Ail
ALARM LEVEL
COMMENT.-
(%--.ONJ"JmON OF'0LETTEE,CON DITIOINOFALARIM AND FLOAT 0 AA CHES,E
f 9_lC
DISTREBUTION BOX:— YES
(L
F
, OCATEN SITE PLAN)
DEPTH OF LIQUID LEVEL ABOVE OUTLET INVERT: 054
COMMENTS-
v
(NO TAE IF LE'ATEA-1,40ND DISTRIMUTAOiNISEQUAL,E VA P q'C_E OF SOLIDS CA"l-l-R-1 OA�jlv, EVPDEN'C_h OF
I�NTO OR OUT OF BOX,
ETC.)
PUMP CHAMBER:
(LOCATE ON SITE.PLAN)
PUMPS IN WORKING ORDER(YES OR NO) N/A
COMMENTS:
(NOTE C 0 IN""i Ix 10 N OE P1 U M P CHAMBER,C 0 INDIT 10 1-4 0 F P UIN I PA-0 AND 14-02".U RTE I-IT z It'i'i U,S,E'A
PAGE7
ACTION-KING E \YERP5.'CA'JE S,INC.
PROPERTY ADORES g: 481 IKEA STREET N'ORTH ALNDOV E&NSA 01845
OWNER: NICHOLAS BUMBACCO
DA'I'S OF INSPECTION-. II-I5_96
SOLI.ABSORPTION SYSTEM(SAS): X
(LOCATE ON SITE PLAN,IF POSSIBLE,EXCAVATION NOT REQUIRE ID,BUT MAY BE APPRO MIATED BY NOIV-
UR—SIVE METHODS).
ODS).
F NOT DETERMINED TO BE PRESENT,EXPLAIN:
TYPE:
LIFFA:HIND PITS, ,!99�l33!!p ,i� BER- �gyq ��ij
LEAC �G C-1I -ff- BYES R,1�U IBER:
LEACHING GALLERIES,NUMBER:
LEACIIING TRE NCRES,NUMBER LENGTII:
gL�;E7•yAC L/NGy FIELDS, UMBE,Ir,�yTg+�_g�.. _ENSIONSa {I}569 X 30} SE.E.PLANS
V v L1FLO Vtl�C_ESSd OOL."',L)W1B R:
COMMENTS: (NOTE CONDITION OF SOIL,SIGNS OF HYDRAULIC FAILURE,,LE 17LL OF PONDING,CONDITION OF
�'VE.�'E'L'A'T'ION; '..
L
C E 8 8 P 0 LS: ?aA
(LOCATE OIL SITE PLAN)
NUMBER AND CONFIGURATION!
DEPTH-TOP Oar LI'uTID TO III LET�T'A'E o A:
DEPTH OF SOLIDS LAYER:
DEPTH OF SCUM LAYER:
P._E,NSIO S OF CESSPOOL.:
OP CO 4 I IC I IO MATE LS dui
INDICATION OF GROUNDWATER.
LOW(CESSPOOL MUST BE PUMPED AS PANT OF INSPECTION:
COMMENT S: (NOTE CONDITION OF SOIL,SIGNS OF HYDRAULICA FAILURE,i RE,L DEL OF I O1"I)Pq ,CONDIT ION 01,
VEGETATION,ETC.)
P 7': N/A
(LOCATE ON SITE ILL_NI
Mt IEe:IA3 s OF CONS'IRU%ClTION: DIMENSIONS:
DEPTH OF SOLIDS:
COM-MW.N`I Sa (NOTE,CONDITION OF SOH,SIGNS OF HYDRAULIC FAILURE,,L.E.'*T_L OF PONDLNG,CONDITION OF
6'�GL Al l ION,L'TC.'9
A AGE d
ACTION—KEN Ejpa'TERIPR SES; INC
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FOR
PART C
SYSTEM �2� ldtH YF-1 (l.V\r 1 ILVr V iF)7
PROPERTY AI DRY SS: 481 REA STREET NORTH ANDOY'EIR
OWlTl R. ITIC✓IIOLA8 BU.BAC:C;O
DATE OF INSPECTION: 11-15-96
SKETCH 0 F SE tI,GE LISI'OSAIT,S 1'S T EM:
INCLUDE'TIES TO AT LEAST TWO PERMANENT REFERE NC:ES LANI)KARIKS OR BENCHMAIUKS
COAT ALL WELLS WITHIN 100 '
SEE ATTACHED PLANS
DEPTH TO GROUNDWATER
DEPTH TO GROIiND ATER: 6 TO 7 FEET
METHOD OF DETERMINATION OR
APPIZO ATION:
�]ES�
gas a x r�
PAGE 9