HomeMy WebLinkAboutMiscellaneous - 111 CROSSBOW LANE 4/30/2018 Ill COSSBOW LANE
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TOWN OF NORTH ANDOVER
SYSTEM PUMPING RECORD_,
r_
�l STEM OWNER & ADDRESS SYSTEM LOCATION �
c,�r) , j (example: left front of house)
U:\T'E OF PUMPING: 'J // �i QUANTITY PUMPEDGALLONS
C. C:SSI'00L: NO YES SEPTIC TANK: NO YES
'�.ATURE OF SERVICE: ROUTINEy EMERGENCY
U13..SERV.=\TIONS:
GOOD CONDITION L/ FULL TO COVER
HEAVY GREASE BAFFLES IN PLACE
ROOTS LEACHFIELD RUNBACK
EXCESSIVE SOLIDS I— FLOODED
SOLIDS CARRYOVER OTHER (EXPLAIN)
i
j �l STEM PUMPED BY: ��� `�� �`Y?� � � '
C. U'1INIENTS:
� ONTLNTS TRANSFERRED 'T'0:
Address /CoDS-56a40 k'y Title of He
Page of
Date File Open:
----- Date file closed:
Doc Document/Action Title Date of T _
action 6tefer to other Purpose of Document/Action and notes
Document/ document/
Num. --
Action De artment
------------
Board of Appy ails — Board of Heal h Planmmng.Board _ Conservation commission — BUil.ding pepartrnen;t --
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FORM U - LOT RELEASE FORM
INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from
Boards and Departments having jurisdiction have been obtained. This does not relieve"
the applicant and/or landowner from compliance with any applicable or requirements.
**********************"*****APPLICANT FILLS OUT THIS SECTION*********** ***
APPLICANT —Trno�h�j Spr,n,� �ons�tunc crY� PHONE
LOCATION: Assessor's Map Number C/�� PARC`L_Zk
SUBDIVISION LOT (S)
STREET ST. NUMBER 11
OFFICIAL USE ONLY* ********************************
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RECOMMENDATIONS OF TOWN AGENTS: S>� C r^c +-� 5 b
CONSERVATION ADMINISTRATOR DATE APPROVED OZ
DATE REJECTED
COMMENTS
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TOWN PLANNER DATE APPROVED
DATE REJECTED
COMMENTS
i
I
FOOD INSPECTOR-HEALTH DATE APPROVED
DATE REJECTED
! _,,rSEP IC PECTOR-HEALTH DATE APPROVED
DATE REJECTED f
COMMENTS J/+�� ,"r ` rGsiP i 't•-� Imo.1 `7'11 �'c_�� Tim -a`l
PUBLIC WORKS -SEWERAIVATER CONNECTIONS
DRIVEWAY PERMIT
FIRE DEPARTMENT
RECEIVED BY BUILDING INSPECTOR DATE
Revised 9197 jm
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71
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TOL'tF'N OF NOR,H ANDOVER/
SOAP OF"-i'ti:f:IaTH
Commonwealth of Massachusetts AUG 5 -
Executive Office of Environmental Affairs 1997
Department of
Environmental Protection
William F.Weld
G"mor
Trudy Coxs
Saeretary,EDEA
David B. Struhs
Commissioner
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION y0
Property Address: rQ f�A�'C� ``/` /j-A/1Cd9resss oT Owner:
Date of Inspection: �� 7,,r- �� (If different)
Name of Inspector: ��� �`S�
Company Name, Address and Telephone Number:
jq PV'1-e 3/ `,0 4--t .►
CERTIFICATION STATEMENT
I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate
and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and
maintenance of on-site sewa a disposal systems. The system:
Passes
Conditionally Passes
Needs Further Evaluation By the Local Approving Authority
_ Fails
Inspector's Signature: Date:
The System Inf ctor shall submit a copy of this inspection report to the Approving Authority within thirty (30)days of completing does
inspection. >f the system is a shared system or has-a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit
the report to the appropriate -regional office of the Department of Environmental Protection.
The original should be sent to the system owner and copies sent to the buyer, if applicable and the approving authority.
INSPECTION SUMMARY:
Check A, B, C, or D:
A] YSTEM PASSES:, ,
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 evaluated are indicated below.
B] SYSTEM CONDITIONALLY PASSES:
�t
One or more system components neEd fo be replaced or repaired. The system, upon completion of the replacement or repair,
passes inspection.
Indicate yes, no, or not determined (Y, N, or ND). Describe basis of determination in all instances. If"not determined", explain why not)
The septic tank is metal, cracked, structurally unsound, shows substantial infiltration or exfiitration, or tank failure is
imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as
approved by the Board of Health.
(revised 8/15/95) 1
One Winter Street a Boston,Massachusetts 02108 a FAX(617)556-1049 a Telephone(617)292-5500
%I Printed on Recycled Paper
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address:
Owner: 7",
Date of Inspection:
B] SYSTEM CONDITIONALLY PASSES (continued)
_ Sewage backup or breakout or high staltic water level observed in the distribution box is due to broken or obstructed
pipe(s) or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the
Board of Health):
broken pipe(s) are replaced
obstruction is removed
distribution box is levelled or replaced
The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass
inspection if(with approval of the Board of Health):
broken pipe(s) are replaced
obstruction is removed
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 the
public health, safety and the environment.
1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER
WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT:
Cesspool or 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 APPROPRIATE) DETERMINES THAT
THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE
ENVIRONMENT:
The system has a septic tank and soil absorption system and is within 100 feet to a surface water supply or tributary to a
--,surface water.suppler.:
The system has a septic tank and soil absorption`system and is within a Zone I of a public water supply well.
The system has a septic tank and soil absorption system and is within 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 water
supply well, unless a well water analysis 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.
D] SYSTEM FAILS:
I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis
for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct
the failure.
Backup of sewage into facility or system component due to an overloaded or dogged 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.
(revised 8/15/95) 2
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continuer!)
Property Address: ! !s S' ✓fi(; �� r/-T��
Owner:
Date of Inspection:
D]SYSTEM FAILS (continued): x
•
Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool.
Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/2 day flow.
Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).
Number of times pumped
Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation.
Any portion of a 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 I 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. If the well has been analyzed to be acceptable, attach copy of well water analysis for
coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen.
E] LARGE SYSTEM FAILS: rr
The following criteria apply to large systems in addition to the criteria above:
The design floe, of system is 10,000 gpd or greater (Large System) and the system is a significant threat to public health and safety
and the environment because one or more of the following conditions exist:
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
The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program
requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information.
(revised 8/15/95) 3
t^.
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: /� �/fu G W /"fir Al 11"
Owner:
Date of Inspection: r v
Check if the following have been done:
'Pumping information was requested of the owner, occupant, and BoardofHealth.
None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates
L.,,/during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection.
_As built plans have been obtained and examined. Note if they are not available with N/A.
�he facility or dwelling was inspected for signs of sewage back-up.
Z'The system does not receive non-sanitary or industrial waste flow
V The site was inspected for signs of breakout.
t'/'All system components, excluding the Soil Absorption System, have been located on the site.
The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or
tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum.
_ :he size and location of the Soil Absorption System on the site has been determined based on existing information or
approximated by non-intrusive methods.
_The facility o% ner (and occupants, if different from owner) were provided with information on the proper maintenance of Sub- ti
Surface Disposal System.
(revised 8/15/95) 4
4
l5.
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address:
Owned 174-5
Date of Inspection: //''��
9,7 FLOW CONDITIONS
RESIDENTIAL: (3. n
Design flow: N±Jgallony .
Number of bedrooms: t•i / t
Number of current residents: l•'�
Garbage grinder (yes or no):ArS
Laundry connected to system yes or no)* 4.
Seasonal use (yes or no): ' n �
Water meter readings, if available: A LA
Last date of occupancy:---- C
COMMERCIAUINDUSTRIAL:
Type of establishment:
Design flow: rtallons/day
Grease trap present: (yes or no)_
Industrial Waste Holding Tank present: (yes or no)_
Non-sanitary waste discharged to the Title 5 system: (yes or no)_
Water meter.readings, if available:
Last date of occupancy:
OTHER: (Describe)
Last date of occupancy:
GENERAL INFORMATION
PUMPING RECORDS and source of information: 2
Sysfem pumped as part of•inspection:,(yes orr no)Tp
If yes, volume pumpedTgalion
Reason for pumping: C14 e CIA- KArcG�-. 5' "s"TI*>"
TYPE OF STEM
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)
Other(explain)
APPROXIMATE AGE of all components, date installed (if known) and source of information: /� 1-3
Sewage odors detected when arriving at the site: (yes or no) _
(revised 8/15/95) S
4
. .. a .. ,
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: /�� C U /� Q W /yr O 'e n-
Owner: C
Date of Inspection:
SEPTIC TANK:_
(locate on site plan)
Depth below grade:
Material of construction: _concrete _metal _FRP—other(explain)
Dimensions: `� S f ;
Sludge depth: ,.
Distance from top of sludge to bottom of outlet tee or baffle:_
Scum thickness: v P �.
Distance from top of scum to top of outlet tee or baffle: G
Distance from bottom of scum to bottom of outlet tee or baffle: /y~
Comments:
(recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural
integrity, evidence of leakage, etc.)
y
GREASETRAP:_ J�
(locate on site plan)
Depth below grade:
Material of construction: _concrete _metal _FRP—other(explain)
Dimensions:
Scum thickness.
Distance from top of scum to top of outlet tee or baffle:
Distance from bottom of Brum tn bottom of outlet tee or baffle:
Comments: k --t f s y:' -s r f i- r S 't f i
(recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to`outlet invert, structural
integrity, evidence of leakage, etc.)
(revised 8/15/95) 6
F
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: ��� i0 SS' g'f44 /�/ ��•r�U�"``
Owner:
Date of Inspection: �1 7r/S
TIGHT OR HOLDING TANK:
(locate on site plan)
Depth below grade:
Material of construction: _concrete _metal _FRP—other(explain)
Dimensions:
Capacity: gallons
Design flow: gallons/day
Alarm level:
Comments:
(condition of inlet tee, condition of alarm and float switches, etc.)
DISTRIBUTION BO �
(locate on site plan)
Depth of liquid level above outlet invert:
Comments:
(note if level and distribut',or is equa!, evidence of solids carryover, evidence of leakage into or out of box, etc.)
r • . 4 t.'F .. ! f 71 fl �. ,� , t 1 ( Y "fi!. ?, Y ,y. .' r- . 'F " % n Y f.; -3 r S
a
PUMP CHAMBER:_
(locate on site plan) /(/
)4-
Pumps in working order:(yes or no)
Comments:
(note condition of pump chamber, condition of pumps and appurtenances, etc.)
(revised 8/15/95) 7
s
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: I�� ('��j Sd fj
Owner:
Date of Inspection:'-
SOIL
nspection:'SOIL ABSORPTION SYSTEM (SASjz( it
►
(locate on site plan, if possible; exrequired, but may be approximated by non-intrusive methods)
If not determined to be present, explain:
Type:
{ leaching pits, number:_
leaching chambers, number:_ -
leaching galleries, number:
leaching trenches, number,length:
leaching fields, number, dimensions: O
overflow cesspool, number:
Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,etc.)
CESSPOOLS: _
(locate on site plan) pt ,4 .
Number and configuration:
Depth-top of liquid to inlet invert:
Depth of solids layer:
Depth of scum layer:
Dimensions of cesspool:
Materials of construction:
Indication of groundwater:
inflow (cesspool must be pumped as part of inspection)
f
r c. .t
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.)
(revised 8/15/95) 8
a
t
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: Clef,S'S 13 CXW
Owner:
Date of Inspections 7-t v S 7, -\- 7 ?
SKETCH OF SEWAGE DISPOSAL SYSTEM:
include ties to at least two permanent references landmarks or benchmarks
locate all wells within 100'
y,
133,
DEPTH TO GROUNDWATER
Depth to groundwater: U f+ feet
method of determination or approximation:
DUG Dow u L, 44i1TN Ria 1z Ay D
(revised 8/15/95) 9
,10RTN
O� c°° °,NO
3? °` BOARD OF HEALTH
� A
i y
• -s _ + s
` 120 MAIN STREET TEL. 682-6483
�9SS^GMUSEs�y NORTH ANDOVER, MASS. 01845 Ext. 32
MEMORANDUM
TO: Bob Nicetta, Building Inspector
FROM: Board of Health ���
RE: 111 Crossbow Lane
DATE: March
31 1992
i
After reviewing the proposed construction at ill Crossbow
Lane, I ask that you please disregard the memo dated, March 24,
1992 .
If you have any questions, please do not hesitate to call
me. Thanks.
MJR/cjp
enclosure
I
,SORT►,
3?04"140
BOARD OF HEALTH
120 MAIN STREET TEL. 682-6483
'SSACHUSNORTH ANDOVER, MASS. 01845 Ext. 32
MEMORANDUM
TO: Building Office
FROM: Board of Health
RE: 111 Crossbow Lane
DATE: March 24, 1992
It was portrayed to this department that this dwelling was
connected to Town sewer. Since it is not and does have a septic
system, the Form U signed March 23, 1992 by the Board of Health
should be disregarded. The applicant should resubmit their
proposal to this department.
MJR/cj p
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FORM U
TOWN OF NORTH ANDOVER
LOT RELEASE FORM
SUBDIVISION
ASSESSORS MAP
I
SUBDIVISION LOT(S)
PERMANENT ADDRESS (ASSIGNED BY D.P.W.
STREET
l31 4 A/
APPLICANT Of %l %JS j (} ��y'i PHONE
-76)
DATE OF APPLICATION
TOWN USE BELOW THIS LINE
PLANNING BOARD
DATE APPROVED
TOWN PLANNER DATE REJECTED
CONSERVATION COMMISSION
CONSERVATION ADMIN. DATE APPROVEDDATE REJECTED
BOARD OF HEALT,Fi
V '` DATE APPROVED �iJ
HEALTH SANITARIAN ` / DATE REJECTED ✓
DEPARTMENT OF PUBLIC WORKS
DRIVEWAY PERMIT
SEWER/WATER CONNECTIONS
FIRE DEPT.
RECEIVED BY BUILDING INSPECTION
DATE
This form shall be signed by the agents of the Planning and Ilealti Boards,
the Conservation Commission prior to the issuance of any building permits
' for the subject lot. This form shall not releive the applicant from the
compliance of any applicable Town requirement or Bylaw.
Board- of He.altq " aTEK, _
North Arnda•ver Q• :,fi1 $ LI3T LOT
1.
~ XCAVATI M g L
ISI SA.PFH��
FAIL OK
Distance Toi
a. Wetlands �-
b. Drains
c• Wel]' f -L
2. Water Line Location
No PPC Pipe
4e -Septic Tank = -
a. _Tess -_Length do To Clean that Covers -
b. Cement Pipe to Tank On Both Sides of Tank
5. Di s tribtation Box -
- a. Covers & Box - No Cracks
b. - All Lines Flowing Equal Amounts
c. No Back Flow
6. - Leach Field or Trench
a. Dimensions
b. Stone Depth vDS
c. Capped 'Ends -�
d. .Clean Double Washed Stone
7. Leach Pits
a. Diman ons
b. Sto Depth
C* sh Pads
d. ens _
e. Covent Pipe to Pit - Both Sides
f. Clean Double Washed Stone
8. No Garbage Disposal
9. -Final Gradin; Inapectioa r° 5e
10. Barricading Covered System
11. As Built Submitted
BE Dd��
_ a. Lot Location
b. Dimensions of System
c. Location with Regard-to -Pere Test
d. Elevations
e.' Water Table
Board of Health
u�,r.}1; :,ndoQer,Masa
SUBSURFACE DISPOSAL DESIGN CHECK LIST
LOT # �o GpvsSBo�
APPROVED DATE / DISAPPROVED DATE
Reasonss
' cF Cacti wµ
Provided:
G
Title V FAIL CK
Reg 2.5 41b
e submitted plan must show as a mini MUM*-
the lot to be served-area,dime�nsions lot #,abutters
location and log deep observation holes-distance to ties
location and results percolation tests-distance to ties
design calculations & calculations showing required leaching area
location and dimensions of system-including reserve area
f) existing and proposed contours
(g) location any wet areas -ithin. 1001 of sewage disposal system or
disclaimer-check wetlands mapping
(h) surface and subsurface drains within 1001 of sewage disposal
system or disclaimer
(i) location any drainage easements vithin 10301 of serge disposal
/ system or disclairer-Pl nning Board files
✓ (3) kno= sources of water supply witMn 2001 of sewage disposal e
system or di.sclainer
k) location of any proposed well to serve lot-1001 from leaching facilit;
location of water lines on propexty-101 from leaching facility
m) location of benchmark
) drivew,dys
o) garbage disposals
no PVC to be used in construction
(q) profile of system-elevations of basement, plumb, pipe, septic tank,
distribution box inlets and outlets, distribution field piping and
Other elevations
r) maxSuum ground cater elevation in area sejage disposal system
(s) plan must be prepared by a Professional Eagineer or other
professional authorized by lair to prepare such plans
Reg 6 . Septic Tanks. ,4o ,
(a) capacities-�j9;6 of flow, kater table, tees, depth of tees,
access, pumping
(b) cleanout
(c) 101 from cellar wall or inground sz.*ima--ng Pool
(d) 251 from subsurface drains
Reg 10.2 Distribution Foxes
Aa) slope greater than 0.08
Reg 10.1 b) sump
O(THE 110 CoNTcVi_ M%9laT 7e>,6 E'p4e CIF wE•r�tiDS — C1-EEC.K ��Croti1 C' -1
Su-r A ppE,4e,�;. -m 'F3c- 4es,&m e
S\IS�FN l.��S 'TiLd� %co.
IOIC-6Nt) — F%NX� TbND
. �JFIGIr.� F',H\S4a (.A%th•DC ON We:. Cos,,TbvR2
FC.. C.,ow.,but.s Dovr� "A.Tt + cyN L r 41 C, to F04-
Svbmax face DssiEgCh€ck List Pa g6 2
FI, OK
Leaching Pits
Leaching pits are preferred where the installation is possible
Reg 11.2 a) calculations of leac area-mi ni atm 500 eq ft
11.4 b) spacing
11.10 c) surface 2%
11.11 d) cover mate
e) k'x2 f x4v lash pad
f) tee a elbow
g) ends in of
from d-box to pipe
Leaching Fields
Reg 15.1 ) no greater than 20 minutes/inch
) area-tui ni atm 900 Bq ft
15.4d,c) construction of field
15.8 ) surface drainage 2 %
3.7 e) 201 from cellar vall or inground sw nndng pool
Lea7acedrainage
s
Reg 3.14.1 a) calculationso eachi.ng area-rdn 500 sq ft
14.3 b) spamin ,6 ft with reserve between
14.4 c) di�rc
14.6 d) con
114.? s) Sto
1.11.10 f) sur 2%
Downhill Slope
a) slope y x to be shows)
CSD b) y/x Z 150 = (to be shown)
EMS
Reg 9.1 a)
9.6 b) -,Pd-by powrer
SOIL PROFILE &. .'ERCOLATJON TEST DATA
North Andover, Mass. Street No G'e��sC-3ocJ Lot No /O
' . Loc/Subdiv. -�"✓4q/ls• _�- Pland Owner B,�2B , %' OS¢ba0
Investigator �%. B��13�41 //v ��"/S bserver
�rSOIL PROFILE DATES
17/,f/ ///T/B/
1_81ev 2.Elev 3.Elev 4.Elev
a
0 --5 //
J
Bp 0 0 4�w 103 O
`T
Ti-es Test
PAS
2 2 2 2
3 3 v 3 v
M
5 5 3 5 5
� NEEOE�
6 X7 6 6 6
7 7 7 7
.8 8 8 8 CLp-
9 9 9 9
10- 10 10 10
Benchmark Location
Elevation Datum
Vtf�F PERCO;,ATION TESTS
l,«ru-tow►`
DATES //17 1, / S�11193
Pit Number 1 2 3 4
Start Saturation
Soak-Minutes
Start Test=Tlmemss ,• S
Drop of 3"-Time 2
Drop of 6"-Time
Mr:s.lst 3" drop �3
Mins.2nd " Drop 17 W e P -5+6AI
Percolation &P S
i
t .•t Mac
TO: NORTH ANDOVER, MASS ��,p7` L 19
BOARD OF HEALTH
FROM: DESIGN ENGINEER Re: Soil Absorption Sewage
System Inspection
This is to certify that I have inspected the construction of the said disposal system at
Zc� /C 012,0,S-S-4
North Andover, Mass.
LV /��
SITE LOCATION
The grades and construction are as specifiedjormy plans and specifications dated
MAY .1c 6y NE 114F 14
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p is form for usa by local Boards of Health• The System Pumping Racotc .T_,
be :ubmltted to the.local'Soard of Health or other approving authority,
A; FacJ IIty ,lnforr tion
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only Ne tib key,
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te!of Pumpin9'I:j
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