HomeMy WebLinkAboutMiscellaneous - 127 OLYMPIC LANE 4/30/2018 127 OLYMPIC LANE
210/106.6-0135-0000.0
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Commonwealth of Massachusetts
City/Town of North Andover RECE--_ VED
System Pumping RecordAUG 2 0 2009
Form 4
SV TOWN OF NORP RAN ENTER
DEP has provided this form for use by local Boards of Health. Other form m
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 within 14 days from the pumping date in
accordance with 310 CMR 15.351.
A. Facility Information
Important:
When filling out 1. System Location:
forms on the
computer,use 127 Olympic Lane
only the tab key Address
to move your North Andover MA 01845
cursor-do not
use the return City/Town State Zip Code
key. 2. System Owner:
" - Anthony Fester
Name
Address(if different from location)
City/Town State Zip Code
978-738-9899
Telephone Number
B. Pumping Record
1. Date of Pumping 7/15/09 2. Quantity Pumped: 1,000
Date Gallons
3. Type of system: ❑ Cesspool(s) ® Septic Tank ❑ Tight Tank ❑ Grease Trap
i
❑ Other(describe):
4. Effluent Tee Filter present? ❑ Yes ® No If yes,was it cleaned? ❑ Yes ® No
5. Condition of System:
Good working condition
6. System Pumped By:
Jason Elliott L90-471
Name Vehicle License Number
! Jason Elliott Septic Pumping
Company
7. Location where contents were disposed:
GLSD
12/20/09
na ure of Haule ate
Signature of Receiving Facility Date
t5form4.doc-03/06 System Pumping Record-Page 1 of 1
TOWN OF NORTH ANDOVER
SYSTEM PUMPING RECORD
DATE:
SYSTEM OWNER &ADDRESS SYSTEM LOCATION
(example: left front of house)
�a� L c L%
DATE OF PUMPING QUANTITY PUMPED L52---GALLONS
CESSPOOL: NO YES SEPTIC TANK: NO YES -'
NATURE OF SERVICE: ROUTINE EMERGENCY
,. , A
OBSERVATIONS:
�va�, of ,
GOOD CONDITION FULL TO COVrER -
HEAVY GREASE BAFFLES IN PLA,, E
ROOTS LEACHFIELD RUNBAC _
EXCESSIVE SOLIDS FLOODED
SOLIDS CARRYOVER OTHER (EXPLAIN)
c
SYSTEM PUMPED BY:
COMMENTS:
v
CONTENTS TRANSFERRED TO:
TOWN OF NORTH ANDOVER
SYSTEM PUMPING RECORD
DATE:
S1 STEM OWNER & ADDRESS SYSTEM LOCATION
o (example; left front of house)
7
�1
llA"I'E OF PUIYIPING, �v QUANTITY PUMPEDG A L L 0 �S
C'I:S51 UUL, NO YES SEPTIC TANK, NO YES
I
NATURE OF SERVICE: ROUTINE 1/ EMERGENCY
U[3.SERV.AT10NS:
GOOD CONDITION FULL TO COVER
HEAVY GREASE BAFFLES IN PLACE
ROOTS LEACHFIELD RUNBACK
EXCESSIVE SOLIDS FLOODED
SOLIDS CARRYOVER O' HER (EXPLAIN)
S)'sTCM PUMPED BY:
CUM.NlENTS:
c UN"I'ENTS TRANSFERRED TO:
0222016707 007MM
ane•awe \\
Commonwealth of Massachusetts Form 4--System Pumping Peld.
Massachusetts
System Pumping Record RECENL.
AUG — 7 2007
Systm�Ow4nQrAnthon System Locatio
y e x,ii s y �fome TOWN OF NORTH ANDOVER
127 Olympic Lane 1.27 Olympic .i.,ano HEALTH DEPAR T i FE_'J'I
North Andover, MA, 01945 North Aiadaver, MA, 01845
(978)-738-9899 x (978)--738-9899 M
Festa
Type: Emergency Routine
Cesspool: No Yes Septic Tank: No = Yes
Date of Pumping: 30--O,:� Quantity Pumped: O(0 Gallons
System Pumped By: Wind River Environmental,LLC Permit#:
Contents Transferred to:
Contents Disposed at:
W w i ����a�• Kv
Date: Pumper Signature: w
Condition of System/Other Comments
,• Cf
Dep Approved Form-12/07/95
Form 4 System Pumping Record
Commonwealth of Massachusetss
Massachusetts
System Pumping Record
System Owner System
System Location
t
L 1,
Type: Emergency Routine
Cesspool: Nlo Yes Septic tank: iVo Yes
Daft of Pumping: 6-11-00, Quantity Pumped: Gallons
System Pumped By: Wind Wvw Enwhwww0al, UC Permit#:
Contents transferred to:
Contents Disposed at:
Date: NI-01V Pumper Signature:
Condition of System/Other Comments
AUGRECEIVE-ED
A0 4 2004
TOW,OF 7N(-)PTWAp,;;jqA r.-
L_LtALTH DEPARTM-EjN+-" I
-----------
Dep Approved Form - 12/07/95
-Board of Health
BF•PTIC SZSTEK
North Anc}overzMaaa. ..�.-..__
INSTALLATION CHECK LIST LOT � 30
APPROVED DATE IE SAPPHOPID DATE
AVATN'OKFAIL
------- eaepnst / .
_4z ;70
oS
1. Distance Tot
a. Wetlands
b. Drains
c. Well
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2. Water Line Location
3. No PPC Pipe
�S. Septic Tank
a. _Tees _Length & To Clean Oat Covers-
b. Cement Pipe to Tank On Both Sides of Tank
5.
Distribution 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
A c. Capped Ends ..
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d. Clean Double Washed Stone'
7. Leach Pits
' a. Dimensions
b. Stone Depth
c. Splash Pads
d. Tees
e. Cement Pipe to Pit - Both Sides
f. Clean Double Washed Stone
8. No Garbage Disposal
9. -Final Grading Inspection
10. Barricading Covered System
11. As Built Submitted
a. Lot Location
b. Dimensions of System
c. Location -.4th Regard-to Perc Test
d. Elevations
e; Water Table
4
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COMMONWEALTH OF MASSACHUSETTS
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
d DEPARTMENT OF ENVIRONMENTAL PROTECTION
goo
OFA®�� bv'
TITLE 5
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
CERTIFICATION
Property Address:/�/ / jT 'a-
Owner's Name
Owner's Address:
Date of Inspection:
Name of Inspector: ( lease print)3on6n L J
Company Name:
Mailing Address:r-AO-So. Sr •D/D�
Telephone Number: 5� l�
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 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:
t✓ Passes
Conditionally Passes
Needs Fyfther Evaluation by the Local Approving Authority
Fai
Inspector's Signature: \ Date: eO/—02.
The system inspector shad ubmit a copy of this inspection report the Approving Authority(Board of Health or
DEP)within 30 days of mpleting 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 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.
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:
OWner'Aa/, ? Xf V
Date of Inspection:
i
Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D
A. System Passes:
i
- 1 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.
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 pipes)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:
2
Page 3 of I 1
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OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL,SYSTEM INSPECTION FORM
PART A
/h CERTIFICATION(continued)
Property Address•/Gl'-7 D/` /7y /G
Owner: �1�,6 _
Date of Inspection: 42
t
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
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 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 bat no other
fiilure criteria are'triggered.A'copy of the analysis must be attached to this forin.
3. Other:
3
Page 4 of 1 I
" K OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address:l �
Owner:��
Date of Inspection: _
D. System Failure Criteria applicable to all systems:
You must indicate"yes"or"no"to each of the following for all inspections:
Yes No/�
t/ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool
_ 4ZDischarge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or
clogged SAS or cesspool, i
_ � Static liquid-level inAhe di§tributio `box aboove tlet inveft due too an overloaded or clogged SAS or
cesspool
_ _/Liquid.depth in cesspool is less than 6"below invert or available volume is less than '/2 day flow
_ TZRequired 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.
_LI/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 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.]
(Yes/No)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:
ire To be considered a large,system"tHe system must,serve facility with a 4design flow of 10,000 gpd to 15,000
gpd•
You must indicate either"yes"or"no"to tach 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 11 of 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.
4
Page 5 of I 1
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address�� / 1 /�
Zxv
Owner• fr
Date of I pection:
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 ofAthe system componentspumped out the previous t>e weeks'?
a Has the system received normal flows in the previous two week period?
_jZHave 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?
L.� 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:
# }, ,1`
r Yes no 4 . : Y:
L,,,,- Existing information. For example,a plan afthe Board of Health.
v 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)]
- 5
Page 6 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address:
Owner•
Date of Inspection:
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):/(/d
Is laundry on a separate sewage system(yes or no),/I/
P[if yes separate inspection required]
Laundry system inspected(yes or no):—
Seasonal use: (yes or no):� q ,
Water meter r11
eadings, if available(last 2 years usage(gpd)):
Sump pump(yes or no):/V d
Last date of occupancy:Ocla4ot CC?
COMMERCIAL/INDUSTRIAL
Type of establishment:
Design flow(based on 310 CMR 15.203): gpd
Basis of design flow(seats/persons/sgft,etc.):
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/use: _
OTHER(describe):
GENERAL INFORMATION
Pumping Records
Source of information:
Was system pumped as part of the inspection(yes or no).
If yes, volume pumped/o�gallons--How was quad ity pumped determined?
Reason for pumping:
TYPE F SYSTEM a + I r
eptic tank,distribution box,soil absorption system 't
_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):
n�
App roaima e age a l com onents,date installed(if known)and source of information:
Were sewage odors detected when arriving at the site(yes or no):AA6
6
~- F
Page 7 of 11
• ~' �' OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address:
Owner: 1
Date of Inspection: �G
BUILDING SEWER(locate on site plan)
t�
Depth below grade:
Materials of construction: ast iron _40 PVC_other(explain):
Distance from private water supply well or suction line:
Comments(on condition of joints,venting,evidence of leakage,etc.):
SEPTIC TANK: V' (locate on site plan)
h
Depth below grade:
Material of construction: L oncrete_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: )C X 1p�reC
Sludge depth: ry'
Distance from top of slue to bottom of outlet tee or baffler 5 !
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:
How were dimensions determined: ,/71ZQ S Y-L
Comments(on pumping recommendatiiniet and outlet tee or bafflecondition,structural integrity,liquid levels
as relate o outlet invert,evidence f leak e,etc.):
j gZa xo-e,
GREASE TRAP:_(locate on site plan)
r Depth below grade:
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:
Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels
as related to outlet invert,evidence of leakage,etc.):
7 `.
Page 8 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
/SYSTEM INFORMATION(continued)
Prop Address:
G lli':
- arty
Owner:142lwl
Date of In§pection:
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: gall€iis
Design Flow: gallons/day
Alarm present(�es 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: (if present must be opened)(locate on site plan)
Depth of liquid levelabove out invert: _
Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of
lege into or out of box, etc.):o
r
v416
A20 cc� c
PUMP CHAMBER: (locate on site plan)
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.): y
.. c
41,
t
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Page 9 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INF/ORMATION(continued)
l
Property Address:_/r
Owner:
Date of Ins ct1 n:
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-
eaching fields,number,dimensions: tra
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,
etcj:D
47/L4
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 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.):
i1
a
9
Page 10 of 1 l
Ile
OFFICIAL INSPECTION FORINT—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM'INFORMATION(continued)
Property Address:
Owner• ?�,�
Date of Inspection:
f
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. Locate where public water supply enters the building.
a ,
47,
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...- -••----..... .. -.� -v�:�..-r--.-..._v,.,-`... ti r.. ..w- .tiv--•+.rA..r.rr- -tv�-v..-.....- •....--- -�..-� _-`.•yr---w+-.=�b-•r-+✓..�--�+--ti--..+.-...-.��-� `..------r"-
Page 11 of 11
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OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C,
SYSTEM INFORMATION(continued)
Property Address: — r
Owner
Date of Inspection:
SITE EXAM
Slope
Surface water
Check cellar
Shallow wells
Estimated depth to ground water feet
'
Please indicate(deck)all methods used to dete ine tht high, ound wafer elevation:
Obtained from system design plans on record-If checked,date of design plan reviewed:
Observed site(abutting property/observation hole within 150 feet of SAS)
Checked with local Board of Health-explain:
Checked.with local excavators,installers-(attach documentation)
Accessed USGS database-explain:
Yo must desc 'be how you established the high ground water elevation:
#V 617vwl�a o ti► r^4:
e"^ 3��5r �o z j , bo u.0- Duct t-er
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11
COMMONWEALTH OF MASSACHUSETTS
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
o DEPARTMENT OF ENVIRONMENTAL PROTECTION
ONE WINTER STREET,BOSTON,MA 02109 617-292-5500
t
r
WILLIAM F.WELD TRUDY CORE
Governor Secretary
ARGEO PAUL CELLUCCI DAVID B.STRUHS
Lt.Governor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Commissioner
PART A
CERTIFICATION
Property Address: 127 Olympic Lane, North Andover Owner: John C. & Mary A. McLaughlin
Date of Inspection: 10/2/97 Address of Owner:Same
Name of Inspector:Richard A. Briscoe (if different)
I am a DEP approved system inspector pursuant to Section 15.340 of Tide 5(310 CMR 15.000)
Company Name: R. A. Briscoe. Inc.
Mailing Address: 61 Garrison St., Groveland, MA 01834
Telephone Number:(508] 372-2200
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
training and experience in the proper function and
and complete as of the time of inspection.The inspection was performed based on my g p p p
maintenance of on-site sewage disposal systems.The system:
_asses
_Conditionally Passes
=Needs Further aluation By the Local Approving Authority f
Fails `k
Inspector's Signature: Date: /U • Z • 7
The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty(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 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]S711.
PASSES:
ave 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.
COMMENTS:
B]SYSTEM CONDITIONALLY PASSES:
One or more system components as described in the"Conditional Pass"section needs to be replaced or repaired. The system,upon
completion of the replacement or repair,as approved by the Board of Health,will pass.
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,unless the owner or operator has provided the system inspector with a copy of a Certificate of
Compliance(attached)indicating that the tank was installed within twenty(20)years prior to the date of inspection;or
the septic tank,whether or not metal,is cracked,structurally unsound,shows substantial infiltration or exfiitration,or tank
failure is imminent. The system will pass inspection if the septic tank is replaced with a conforming septic tank
as approved by the Board of Health.
(revised 04/25/97)
Page 1 of I 1
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address:127 Olympic Lane, North Andover
Owner: John C. &Mary A. McLaughlin
Date of Inspection: 10/2/97
B]SYSTEM CONDITIONALLY PASSES(continued)
Sewage backup or breakout or high static 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). Describe observations:
broken pipe(s)are replaced
obstruction is removed
distribution box Is leveled 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(SAS)and the SAS is within 100 feet to a surface water supply or
tributary to a surface water supply.
The system has a septic tank and soil absorption system and the SAS is within a Zone I of a public water supply well.
The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well.
The system has a septic tank and soil absorption system and the SAS 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. Method used to determine distance (approximation not valid)
3) OTHER
(revised 04/25/97)
Page 2 of 11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 127 Olympic Lane, North Andover
owner: John C. &Mary A. McLaughlin
Date of Inspection: 10/2/97
D]SYSTEM FAILS:
You must indicate"Yes"or"No"as to each of the following:
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.
Yes No
Backup of sewage into facility or system component due to an 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 dogg5ed 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 dogged 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:
You must indicate"Yes"or"No"as to each of the following:
The following criteria apply to large systems In addition to the criteria above:
The design flow 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:
Yes No
the system Is within 400 feet of a surface drinking water supply
r
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 04n5/97)
Page 3 of 11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: 127 Olympic Lane, North Andover
owner: John C. &Mary A. McLaughlin
Date of Inspection: 10/2/97
Check if the following have been done: You must indicate either"Yes"or"No"as to each of the following:
Yes No
fL _ Pumping information was requested of the owner,occupant,and Board of Health.
None of the system components have 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.
As built plans have been obtained and examined.Note if they are not available with N/A.
The facility or dwelling was inspected for signs of sewage back-up.
The system does not receive non-sanitary or industrial waste flow
The site was inspected for signs of breakout.
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.
The size and location of the Soil Absorption System on the site has been determined based on:
P Y
_ The facility owner and occupants,(if different from owner)were provided with information on the proper maintenance of
Sub-Surface Disposal System.
Existing Information. Ex.Plan at B.O.H.
Determined In the field(if any of the failure criteria related to Part C Is at issue,approximation of distance is
unacceptable) [15.302(3)(b))
i
(revised 04/25/97)
Page 4 of 11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 127 Olympic Lane, North Andover
Owner: John C. &Mary A. McLaughlin
Date of Inspection: 10/2/97
FLOW CONDITIONS
RESIDENTIAL:
Design flow: p.d./bedroom for S.A.S.
Number of bedrooms:
Number of current residents:-
Garbage grinder(yes or no):--AW
Laundry connected to system(yes or no): °s
Seasonal use(yes or no):—AIO
Water meter readings,if available(last two(2)year usage(gpd): /?/,0 G
Sump Pump(yes or no)�lJ�
Last date of occupancy.--baup1 ir-D
COMMERCIAL/INDUSTRIAL.-
Type
OMMERCIAL/INDUSTRIAL:Type of establishment:
Design flow: oallons/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 vailable:
Last date of occupancy
OTHER:(Describe)
Last date of occupancy:_
GENERAL INFORMATION
PUMPING RECORDS and source of information:
V t7Z A r'
System pumped as part of inspection:(yes or no) le
If yes,volume pumped /" gallons /
Reason for pumping: �0.�' v eT/ ,r/ ��t��( �y �¢��50 Q�y1`•
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)
I/A Technology etc. Copy of up to date contract?
Other
APPROXIMATE AGE of all components,date installed(if known)and source of information: Lf./
Sewage odors detected when arriving at the site:(yes or no)
(revised 04/25/97)
Page 5 of 11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 127 Olympic Lane, North Andover
owner: John C. &Mary A. McLaughlin
Date of Inspection: 10/2/97
BUILDING SEWER:
(Locate on site plan)
Depth below grade: Z
Material of construction: Gust iron_40 PVC_other(explain)
Distance from private water supply well or suction line
Diameter_d -
Comments: (condition of joints,venting,evidence of leakage,etc.)
SEPTIC TANK:
(locate on site plan)
Depth below grader
Material of construction:— ncrete_metal_Fiberglass_Polyethylene_other(explain)
If tank is metal,list age_Is age certified by Certificate of Compliance_(Yes/No)
Dimensions: TV
Sludge depth:
Distance from top of sludge to bottom of outlet tee or baffle:
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:
How dimensions were determined: �" y
Comments: lel oy e �inlq
� �G(recommendation for pumping,cto s or baffles,depth 9f liquilive
l in relation,to outlet invert,structural
integrity,evidence of leakage,etc.) 1+ �c?S i4`1 G�
GREASE TRAP:
(locate on site plan)
Depth below grade:
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:
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.)
(revised M5/97)
Page 6 of i l
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 127 Olympic Lane, North Andover
Owner: John C. & Mary A. McLaughlin
Date of Inspection: 10/2/97
TIGHT OR HOLDING TANK: �00(Tank must be pumped prior to,or at time of,inspection)
(locate on site plan)
Depth below grade:
Material of construction:_concrete_metal_Fiberglass_Polyethylene other(explain)
Dimensions:
Capacity: oallons
Design flow: aallons/day
Alarm level: Alarm In working order_Yes;_No
Date ofum in revious :
P pumping:
9
Comments:
(condition of inlet tee,condition of alarm and float switches,etc.)
DISTRIBUTION BOX:�pS
(locate on site plan)
Depth of liquid level above outlet invert:_(
Comments:
(note if level and distribution is equal,evidence of solids carryover,evidence of leakane into or out of box etc.)
i64cIC u
PUMP CHAMBER-_&#
(locate on site plan)
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.)
(revised 04/25/97)
Page 7 of 11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 127 Olympic Lane, North Andover
owner: John C. &Mary A. McLaughlin
Date of Inspection: 10/2/97
SOIL ABSORPTION SYSTEM(SAS):
(locate on site plan,if possible;excavation not required,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:
overflow cesspool,number:
Alternative system:
Name of Technology:
Comments:(note condition of soil,signs of h draulic fai ure,level of ponding,condition of vegetation,etc.)
r
CESSPOOLS:_�Jd
(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(cesspool must be pumped as part of inspection)
i
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.)
i
i
(revised 04/25/97
Page 8 of 11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 127 Olympic Lane, North Andover
Owner: John C. &Mary A. McLaughlin
Date of Inspection: 10/2/97
SKETCH OF SEWAGE DISPOSAL SYSTEM:
Include ties to at least two permanent references landmarks or benchmarks
locate all wells within 100'(locate where public water supply comes into house)
Q
� p
0
i► II '
g _p r �S�•O
D � 112t C
(revised 04/25/97)
Page 9 of 11
I
V
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 127 Olympic Lane, North Andover
Owner: John C. &Mary A. McLaughlin
Date of Inspection: 10/2/97
Depth to Groundwater_'Feet
Please indicate all the methods used to determine High Groundwater Elevation:
Obtained from Design Plans on record
v Observation of Site(Abutting property,observation hole,basement sump etc.)
Determine it from local conditions
Check with local Board of Health
Check FEMA Maps _
Check pumping records
Check local excavators,Installers
Use USGS Data
Describe in your own words how you established the High Groundwater Elevation. (Must be completed)
(revised 04/25/97)
Page 10 of 11
R. A. BRISCOE, INC.
61 GARRISON ST.
GROVELAND,MA 01834
TEL.(508)372-2200 FAX(508)372-2450
SEPTIC SYSTEMS:DESIGNED,BUILT, REPAIRED AND PUMPED
Title V Inspections
Title V Inspection Report
10/2/97
Property Address: 127 Olympic Lane, North Andover
Owner. John C. & Mary A. McLaughlin
Date of Inspection: 10/2/97
My report contained herein does not constitute a guarantee of future usage and the functionality of the
existing septic system. Such report issued herewith is merely based upon my observations, and I hereby
disclaim any further operation of your current septic system.
R. A. Briscoe
Page 11 of 11
I
Board-of ealth
North Andtiver,Mas s
SUBSURFACE DISPOSAL DESIGN CHECK LIST
LOT �o
APPROVED DATE DISAPPROVED DATE
Provided: Reasons:
Tit14 FAIL 0fe,
Reg 2.5 ubmitted plan must show as a minimum:
e lot to be served-area,dimensions lot # abutters
cation and log deep observation hoes-distance to ties
411, cation and results percolation tests-distance to ties
sign calculations & calculations sho�wi.ng required leaching area
VL cation and dimsensions of system-including reserve area
isting and proposed contours
cation any wet areas Athin 1001 of sewage disposal system or
isclaimer-check wetlands mapping
(h) surface and subsurface drains within 1001 of sewage disposal
system or disclaimer
(i) cation any drainage easements thin IAO of serge disposal
system or disclaimer-Planning Board files
�) Baa sources of water supply witbin 200, of sewage disposal
system or disclaimer
location of any proposed well to serve lot-1001 from leaching facility
location of water lines on property-10+ from leaching facility
("location of benchmark
driveways
( arbage 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
btner elevations
maximum ground water elevation in area sewage disposal systems
(s) plan must be prepared by a Professional Engineer or other
T,_
fessional authorized by law to prepare such plans
Reg 6 tic Tanks
(a) apac t es- 50% of flow, water table, tees, depth of tees,
access, pumping
-cleanout
10l from cellar wall or ingrouad swimming pool
(d) .25I from subsurface drains
Reg 10.2 Distribution Boxes
Reg 10.4b} ape greater 0.08 '
Subsurface celesi Check List Page 2
FAIL OR
Leaching Pits
Leaching pit are preferred where the installation is possible
Reg 11.2 a) calculat s of leaching area-ndnimaam 500 eq ft
11.4 b) spacing/
11.10 c) surf ede drainage 2%
11.11 d) cov material
e) Ay t t x4" splash pad
f) eat elbow
g) no bands in pipe from d-box to pipe
L
eaching Fields
Reg 15.1 o greater than 20 minutes/inch
rea-miMIMIM g00 eq ft
15.4 onstruction of field
15.8 urface drainage 2 %
3.7 0 i from cellar Wall or inground mdm dng pool
Leachin Trepefies
Reg 14.1 a) c c o leaching area-m n 500 aq ft
14.3 b) spacing- ft mi.n 6 ft with reserve between
14.4 c) dimes ons
14.6 d) cons ction
14.7 e) s e
14.10 f) sgrface drainage 2%
Downhill Slop e
a) s ope y x=o be shown)
tl b) y/x X 150 = (to be shown)
r
i
Reg 9.1 a) app vel
9.6 b) s d-by power
SOIL PROFILE & PERCOLATION TEST DATA
1dort5 Andover,I:�ss. No.&Street s Lot No. 30
Loc./Subdiv. Plan OwnerAC
Investigator Observer
SOIL PROFILES-DATE
1' Elev. ?' Elev. 3.
Elev. 4'Elev.
0 0 0 0
1 1 1 1
Ties to Test flits
2 2 2 2
3 03 3 3 ------—
4 _ _ -- 4 -_ - 4 - -- 4 = ._
5 5 5 5
6 6 6 . 6
7 7 7 7
8 8' 8 8
9 -- 9 9 9
10 10 10 110
Benchmark Location t-
Elevation Datum
Percolation Tests-Date-
Date-----
7
Pit Number 1 2 3 4 5
Start Saturation
Soak-Mins. j
Start Test-Time
Drop of 3"-Time -
Drop
"-Time -Dro of 6"-Time 1
Mins . lst . 3—"Drop
Mins . 2nd 3"Dr9p
Percolation Rate
Notes & Sketches on Back
c„l;U•�",.:i1 t�L� llliJ1=V.:�!1L v.Ul :.i,, v,a:,,..,. .,
NORTH ANDOVER BOARD OF HEALTH F ��
APPROVED DATE PROVIDED DISAPPROVED DATE TIME REASON -
�---� —
3
Title 5
Reg. 2. 5 Fail OK Th --submitted plan must- show as a minumum:
(a)- the lot to be served (area,dimensions ,l.ot //,abutters)
(.Planning Board files)
(b e--location and log of deep observation holes-distance
to,ties
(c) location and results of percolation tests-distance
to ties
(d) design calculations & calculations showing required
leaching area
(e) _:location and dimensions sf system (including reserve
area)
r' ,existing and proposed contours
location of any wet areas within 100' of the sewage
disposal system ot-" disclaimer (check wetlands mapping)
(h) surface and subsurface drains within 100' of sewage
disposal system or disclaimer
L (i) location of any drainage 'easements within 100' of
sewage disposal system or disclaimer (planning board
files)
( ' ) knownsou- ces_ of__:water supply within-- 200' - of sewage
disposal system or disclaimer
(k), ; location of any proposed well to serve the lot (100'
from leaching facility)
location of water lines on property (10' from. leachin�
facilities)
6 location of benchmark
n) driveways
,o) garbage disposers
,p') no PVC is to be used in construction
(q) a profile of the system (elevations of basement , plum"
pipe septic tank, distribution box inlets and outle:-sI
distribution. -field piping and any other elevations)
(r) faximum ground water elevation in area of sewage dispj
system
s) plan must be prepared by a Professional Engineer or
other professional authorized by law to prepare such
plans
S tic Tanks
Reg. 6 (aa Capacities - 150° of flow, water table , tees , depth
of tees , access , pumping,
Cleanout
10' from cellar wall or inground swimming pool
d) 25' from subsurface drains
1•L I7 ��lluU J 41 aJ LA JrJ l41 1 ll4v �a.i y .: ..J v v... i 11V VLl 1J v 1 t..Iy
Tail OK Distribution Boxes
g.10,2 ('a Slope greater than 0.08
eg.10.4 (b) Sump
Leaching Pits �.
L eaching,,Kts are preferred where the installation is
possible
.eg.11 . 2 ('a Calculations of leaching area (minimum 500 S.F. )
eg.11 .4 b Spacing
.eg,11 .1 c Surface drainage 2%
eg.11 .11 d Covermaterial
e 2 �2 4, pfas(� ,A /
4� �2 c Cr C-1 ho 0
Leaching Fields J I bb
eg.15,1 'j h,oGreater than 20 minutes/inch
'eg.15.1 ( �jArea' (minimum-.900 S.F. )
'eg.15.4 ,c��, Coristruction of field
eg.15.8 dr Surface drainage 2%
'.eg. 3,7 e 20' from• cellar wall or inground swimming pool
Leaching Trenches
eg.14.1 (a) Calculati.afis of leaching area (min. 500 S.F.)
.eg.14. 3 (b Spaci.ng' (4 ft. min. 6 ft. with reserve between) .
eg.14.4 (c Dimensions
14.5 =
'eg.14.6` (d onstructiori = t.
:eg.14.7 (e Storie
'eg.14:10 Surface drainage 2% f
Downhill Slope
�a� Slope y/x o be shownby/x X 15,0 = �to be shown
Pumps
leg. 9.1 (a) Approval
leg. 9.6 - (b) Stand-b power
I
i
f
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i
I
i
SOIL PROFILE & PERCOLATION TEST DATA
Town/City I*N)Q , ��, No.&Street O L� M Pt C_ LA t--) E Lot No. 3�
Loc./Subdiv.[ IVGALLS Cf-DSS((l)Plan Owner
Investigator SP�• -13AGA-L(.�Q Observer �� C��S�-4 i SIC— l GIF L_ tQA,Z
SOIL PROFILES-DATE �/� a)-7.7 g I y (-7 S
1. lev. Elev. 3'
. Elev. 4'Elev.
0 0 �' �� 0 0
To uta
1 A'7E 1 1 1
7,413 L C
' 2 D OZ Y 2 2 2
.ion""EMIROMMOI^
3 PZp3 3 s LYMp1c.
4 4 — 4 4
5 5 5 5 �v r
OXIDE ED LA,/E
6 6 6 6 30
'Iioc�t�y
7 7 t-L 7 7
+ T E.ST P Ct"
8 8 z 8 8
9 9 9 9
10 10 10 10
Benchmark Location
Elevation Datum
Percolation Tests-Date
Pit Number 1 2 3 4 S
.Start Saturation
Soak-Mins. S-
Start Test-Time
Drop of 3"-Time
Drop of 611-Time
Mins.lst 3"Dro
" S
Notes & Sketches on Back Frank C. elinas & Associates, North And.
L -r zo. .
47F
147
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INX 02t QMrj2E Wag 105 13+
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ills
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