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HomeMy WebLinkAboutMiscellaneous - 154 DUNCAN DRIVE 4/30/2018 I _ 154 DUNCAN DRIVE 210/104.B-0180-0000.0 \ I � I I i i i r Commonwealth of Massachusetts i City/Town of OCT 0 2 2013 1 System Pumping Record M„v OF I.ORTH-P RO0VER Form 4 1 HEALTH DHPA,RTL-;EMT DEP has provided this form for us&by local Boards of Health. Other forms may be used, but the information must be substantially the same as that provided here. Before using.this form, check with your local Board of Health to determine the form they use.The System Pumping Record must be submitted to the local Board of Health or other approving authority. A. Facility_ Information 1. System Location: Left/Right front of Nous Le Rig a of , Left/right side of house, Left/ Right side of building, Left/Right front of building, Left/Right rear of building, Under deck Address ` /--� r Cityl-rown `� Djl�' State Zip Code 2. System Owner: Name Address(if different from location) City/Town State �V P7 "'`p Telephone Number i B. Pumping Record 1. Date of Pumping Date 2. Quantity Pumped: Gallons 3. Type of system: ❑ Cesspool(s) eptic Tank ❑ Tight Tank ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes No If yes, was it cleaned? ❑ Yes ❑ No, " 5. Condition of System: 6. System Pumped By.- Nell y:Neil Bateson F5821 Name Vehicle License Number Bateson Enterprises Inc- Company ncCompany 7. LocaboirLwhere contents were disposed: GLS. Lowell Waste Water C S — Sig a Haule Date t5fom4.doc•06/03 System Pumping Record•Page 1 of 1 i Commonwealth of Massachusetts RECE SIL City/Town of 009 System Pumping Record APR 2 9 2 Form 4 [HE OF Nr,��I-,ANLXWj �P ALTH Dt� 'y���N' �i DEP has provided this form for use by local Boards of Health. Other forms may be used, but the information must be substantially the same as that provided here. Before using this form, check with your local Board of Health to determine the form they use.The System Pumping Record must be submitted to the local Board of Health or other approving authority. A. Facility Information Important: When filling out 1. System Location: Left fro , left f ear left si of house Right front, right rear, right side of house. forms on the computer,use only the Y b key Address S /—/`! to move our. t. � Pl,/ cursor-do not use the return Cityffown State Zip Code key. _ 2 System Owner: �� - Name Address(if different from location) Citylrown State i Code Telephone Number B. Pumping Record 6-3 1. Date of Pumping Date 2. Quantity Pumped: Gallons 3. Type of system: Ll Cesspool(s) Septic Tank 0 Tight Tank Other(describe): 4. Effluent Tee Filter present? 8 Yes No If yes,was it cleaned? [ Yes Ll No 5. Conditi of S stem: V y 6. System Pumped By: Neil Bateson F 5821 Name Vehicle License Number Bateson Enterprises Inc Company 7. Locatio ere contents were disposed: S. Lowell Waste Water igna ure of H u r Date I i t5form4.doc•06/03 System Pumping Record•Page 1 of 1 Tow. -. North Andover Health Department Date: 7 ,� Location: (Indicate Address, /�if�Residential,or Name of Check#: �rx 1 / �� Type of Permit or License:(Circle) ➢ Animal $ ➢ Dumpster $ ➢ Food Service-Type: $ ➢ Funeral Directors $ ➢ Massage Establishment $ ➢ Massage Practice $ ➢ Offal(Septic)Hauler $ ➢ Recreational Camp $ ➢ SEPTIC PERMITS: ❑ Septic-Soil Testing $ ❑ Septic-Design Approval $ ❑ Septic Disposal Works Construction(DWC)$ ❑ Septic Disposal Works Installers(DWI) $ ➢ Sun tanning $ ➢ Swimming Pool $ ➢ Tobacco $ ➢ TrashlSolid Waste Hauler $ ➢ Well Construction $ ➢ OTHER:(Indicate) 1 484 Health Agent Initials White-Applicant Yellow-Health Pink-Treasurer NEW ENGLAND ENGINEERING SERVICES,INC. 8922 Town of North Andover 4/1/2006 154 Duncan Drive,Title 5 fee 50.00 f ED E ER Checking-Banknorth 50.00 /J/f�Lda V-3—J - -t NEw ENGLAND ENGINE]EMG S ERVI CES9 IdNC. 1600 Osgood Street Building 20 Suite 2-64 / North Andover, MA 01845 Til: (978) 686-1768 • Fax: (978) 327-6138 Benjamin C. Osgood, Jr., P.E. �����® President ApR 0 3 2006 March 31, 2006 TH OVER TOWN OF Np�pARTMANDENT H{EALTH Ms. Susan Sawyer North Andover Board of Health 400 Osgood Street North Andover, MA 01845 RE: TITLE V REPORT: 154 Duncan Drive, No.Andover, MA Dear Ms. Sawyer: Enclosed is the Title 5 Report for the above referenced property. The system PASSES the inspection. If there are any questions please call me at my office, 686-1768. Sincerely, "'0' C' S) J Benjan1W C. Osgood Certified Title 5 Inspector i 1 of-Ii COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION TITLE 5 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENT SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 154 Duncan Drive No. Andover,MA 01845 Owner's Name: Scott&Mary Anne Lodde Owner's Address: 154 Duncan Drive No.Andover,MA 01845 RECEIVED Date of Inspection: March 31,2006 Name of Inspector:(please print) Benjamin C.Osgood,Jr.Certified Title 5 Inspector APR 0 3 2006 Company Name: New England Engineering Services Inc. Mailing Address: 60 Beechwood Drive North Andover,MA 01845 TOWN OF NORTH ANDOVER HEALTH DEPARTMENT Telephone Number: 978-686-1768 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 the on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15340 of Title 5(3 10 CMR 15.000).The system: X Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature: A < r Date:— 3/31/06 The system inspection 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 i i ****This report only describes conditions at the time of Y 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. i i 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 154 Duncan Drive No.Andover,MA 01845 Owner's Name: Scott&Mary Anne Lodde Date of Inspection: March 31,2006 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: YES 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: NO 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 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_ 3 of 1.1 . OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENT SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 154 Duncan Drive No.Andover,MA 01845 Owner's Name: Scott&Mary Anne Lodde Date of Inspection: March 31,2006 C. Further Evaluation is Required by the Board of Health: NO 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 (SAS)Soil Absorption System and the(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 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 organize 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 5ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other. 5of14 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENT SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 154 Duncan Drive No. Andover,MA 01845 Owner's Name: Scott&Mary Anne Lodde Date of Inspection: March 31,2006 Check if the following have been done. You must indicate"Yes"or"no"as to each of the following: Yes No x Pumping information was provided by the owner,occupant,or Board of Health X Were any of the system components pumped out in the previous two weeks_? x Has the system received normal flows in the previous two week period? X Have large volumes of water been introduced to the system recently or as part of an inspection? X Were as built plans of the system obtained and examined? (If they were not available note as N/A) x Was the facility or dwelling inspected for signs of sewage back up? x Was the site inspected for sign of break out? x Were all system components,excluding the SAS,located on site? x Were all 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? x Was the facility owner(and occupants if difference from owner)provided with information on the proper maintenance of the subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes No x Existing information.For example,a plan at the Board of Health x 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)] 6of11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENT SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 154 Duncan Drive No. Andover,MA 01845 Owner's Name: Scott&Mary Anne Lodde Date of Inspection: March 31,2006 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design)__L_Number of bedrooms(actual): 4 DESIGN flow based in 310 CMR 15.203(for example: 110 gpd x #of bedrooms)L 600 Number of current residents: 3 Does residence have a garbage grinder(yes or no): yes Is laundry on a separate sewage system(yes or no): no [if yes separate inspection required] Laundry system inspected(yes or no): Seasonal use:(yes or no): no Water meter readings,if available(last 2 years usage(gpd): well Sump Pump (yes or no): yes Last date of occupancy current COMMERCIALANDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sgk 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: 2_years per owner Was system pumped as part of the inspection(yes or no): no If yes,volume pumped: gallons—How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM X 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) hmovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) Tight tank Attached a copy of the DEP approval Other(describe): Approximate age of all components,date installed(if known)and source of information: As Built Dated 1.982 Were sewage odors detected wen arriving at the site(yes or no): no 7 of 1.1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENT SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 154 Duncan Drive No. Andover,MA 01845 Owner's Name: Scott&Mary Anne Lodde Date of Inspection: March 31,2006 BUILDING SEWER(locate on site plan) Depth below grade: 12"_ Materials of construction: x cast iron 40 PVC other(explain) Distance from private water supply well or suction line: 30' Comments(on condition of joints,venting,evidence of leakage,etc.): Pipe looks good in basement SEPTIC TANK: (locate on site plan) Depth below grade: 4" Material of construction: x concrete 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: 1500 gallons Sludge depth: <2 Distance from top of sludge to bottom of outlet tee or baffle: Scum thickness: <2 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: measure stick Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): *No outlet tee.Recommend installation of PVC outlet tee.Tank in good condition GREASE TRAP: N/A (locate on site plan) Depth below grade: Materials 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 sludge 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. r 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENT SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 154 Duncan Drive No. Andover,MA 01845 Owner's Name: Scott&Mary Anne Lodde Date of Inspection: March 31,2006 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. PO Re 0 15LJ D� osca� DRrv� t. ® Waw L)Al N Dt2l�1E" 11 ofil OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 154 Duncan Drive No.Andover,MA 01845 Owner's Name: Scott&Mary Anne Lodde Date of Inspection: March 31,2006 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water 4 feet 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: X Observed site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health—explain: Checked with local excavator,installers—(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: System is very close to ground surface.Water table is 4 feet based upon depth of previous flooding in basement and knowledge of the area. 6269 Date.....Z.`....3.....0� t - NORTF� TOWN OF NORTH ANDOVER p PERMIT FOR WIRING �,SSACMUS� This certifies that j .G "f�(f¢�1.�...©�L ........ ......... ............................ has permission to perform ........ ! -.....44'A4! C4.. .............................. wiring in the building of... C .f.. .......L. .. ............................. l /�-! h✓C!�'d ,�....p ................ .North Andover,Mass. at........................... .. ......... Q �..�... Lic.No..,�.-9-7.,.,x`...9..!9..............i- � ELECTRICAL INSPECTOR r The Ccmmonwealth of Massachusetts °r"" V" O Department o/ Public So/ety PW� No Z -- c - BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 oc"P&`cy + r.. 3/90 APPLICATIAON FOR PERMInT ce To PERFwith the nORM ELECTRICAL WORK Electrical-or. 10 oe 13-9(lormed in Code, 527 CMR 12 00 !N INK OR TYPE ALL INFORMATION) date_ f2 �(2 Ka e _rce!s,gneO applies for a permit to perform the electrical work desCrlbed below. To the Inspector of Wires f-z'Or Slre-el b Numoer) -—L;S� U N er Or Tenant 0-r- Q Ti L. Act,ess ,YY`vC' ' ,n con;vnclion witn a builo ng permit: Yes C] NO P.raose o B;id ng Lam' (Check Appropriate Box) _, s. ' �� tlllty Authorization No. Amps - / VOlts Overhead ❑ Undgrd ❑ No. of Meters Amps / Volts Overhead ❑ Undgrd ❑ N0 OI Mglers 'C-Eters ane AmpaC,ry -X-8' arc Nalvre 01 Pr000sea Electrical Work No.01 Hot Tub3 No.of Transformers Total KVA In. ool "S ' '..res Swimming PAbove , rnd. ❑ md. ❑ Generalor3 KVA =' cfep,ac e O iieis No 01 Oil Burners No.of Emergency lighting Barts Units el5 NO of Gas burners FIRE ALARMS No of Zones 'e5 No OI Air COnd. TOIaI No.of Detection ano tons Initiating Device3 - --5— No of eal Total Total humps Tons KW No.of Sounding Deuces Space/Area Heating KW No.of Sell Contafneo Detection/Sounding Devtce3 -SES I Healing DevicesKW MuniCipaf I No of Low ❑ Connection ❑Other -- - �w S. ns No.of Low voltage Ballasts Wiring No of Motors Total HP t b - - RAGE Pvf5vanl IO the fe0viremenls Of M8 33aChU3et13 General Laws a= rs ranCe Po,cy ,nCfvo ng Completed on3 Coverage or its substantial equival eratient YES :'�Oo'OI SEme 10 Ings once YES � ❑ ES pease n0,cale the type of coverageby checking the appropriate box OT ER ❑ (please Specilyl (EApiraljon Dale, _ n Signature LIC NO LIC / ryyN �^ v/� � Bus. To( No.C7 CI?f — N All Tea No. a ' am a«are !nai Ine 1 censee does not have / _ �� the ' coverage or ns subslanl se^s^enera, Laws ano inai my signature on In. egvivaleni as — 3 permit aPPficalion waives inis tKu remeni ye Please cneC), one) �ti Telephone No. nei or Agenil PERMIT FEE S � R TO: NORTH ANDOVER, MASS OCT � 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 L'4 T /G/9 _"t)L4N(`A?IV J)/Q, North Andover, Mass. SITE LOCATION The grades and construction are as-specified in $$plans and specifications dated ni G i co M on�i Re 139. inear/ M anitarian 9Pj4A' ` IN Address _l��' _1���1G�� 1� Title of File Page 9 of Date File Open: Date file closed: Doc Document/Action Title Date of Refer to other Purpose of Document/Action and notes action Document/ document( Num. Action ®e artment Board of Appeals Board of Health — Planniing Board — Conservation Commission — Building Department � G. i Board of Health BEMC SZSTEK North An ger M"a- INSUI•LATICH CHSCK LIST LOT ��•� 17��/C��G�/ CNID DATg DISAPPROVED OVED AVATICBd OK FAIL yReagonsi— E'. APA I /!_1 I i FAIL OK 1. Distance Tot a. Wetlands b. Drains c. Well i 2. Water Line Location 3. No PVC Pipe �. Septic Tank a. _Tees --Length k To Clean Out Covers. too b. Cement Pipe to Tank On �� Sides of Tank -�' 7QE 'rte 5. Distribution Box riD�a�r n a. Covers & Box - No Cracks b. All Lines Flowing Bqual Amounts C. No Back Flow az..- 6. Leach Field or Trench / a. Dimensions / b. Stone Depth / c. Capped lads a d. Clem Double-Washed Stone' 7. Leach Pits ' a. Dimensio b. Stone epth C . Spl Pads z d. T s e. anent Pipe to Pit - Both Sides. f Clean Double Washed Stone 8. No Garbage Disposal e;2 9. -Final Grading Inspection 10. Barricading Covered System 11. As Built Submitted a. Lot Location - b. Dimensions of System c. Location -with Regard-to Pere Test d. Elevations e.' Water Table i i i - 1 r. , - r TOWN OF NORTH ANDOVER - SYSTEM PUMPING z 1I2ECORD SYS'I'm OWNER&ADDRESS _ SYSTEM I.,OCTI AON _ o, 0 �l G�"-2 __a.T ,� ��j Gia✓.e�� �� _..�..__-_____. CRATE OF P'CJMPING___�/,' 'o __.Y------QUANTITY PI PMPEJJ CESSPOOL NO_.,,,YES,_ SEPTIC TANK NO YT S n NATURE OF SERVICE; ROUTINE_�!/ EMERGENCY OBSERVATIONS: GOOD CONDITION FULL TO COVER HEAVY GREASE BAFFI ES IN LACE BOGEYS _ I EACHFJIELD RUNBACK -' EXCESSIVE SOLID: T FLOODED SOLID CARRYOVER-T (YI'I-IER EXPLAIN SYSTEM PUMPED BY COMMENTS. c,'()N`TFN,is,TRANSFERRED TO__,),�� S Y bf 'th Eh An,'c,� r," s s MBSURFACE DISPOSAL DF,'-XGN CHWK Uf?, t _.,.,..__ LOT APPROVED DATE DIS.""MCOED D,ATS_, Provided: Roasens: Title V FAIL Reg 2.5 a submitted plan must show as a minimum: a), the lot to be seared-area,dimensions lot #,abutters location and log deep observation hoes-distance to ties location and results percolation tests-distance to ties sign calculations & calculations showing required leaching area location and dimensions of system-including reserve area " V• existing and proposed contours location any wet areas vithin 1001 of sewage disposal system or disclaimer-check wetlands mapping (h),surface and subsurface drains within 100' of s,-ssage disposal system or disclaimer xi (i location any dx.riage e3sa: -its within 3.001 of see disposal system or disclaisr ar-P7 r n!mg Board files (3) kno= sources of k-atLr supply within 2001 of serape disposal n system Kr or disclaimer k) location of any proposed well to serve lot-1001 from leaching facility ,. ` (1) location of water lines on property-101 from leaching facility m) location of benchmark n) driveways `o garbage disposals i no PVC to be used in construction f (q) profile of system-elevations of basement, plumb, pipe, septic tank, distribution box inlets and outlets, distribution field piping and other elevations I W maximum ground water elevation in area sewage disposal system (s) plan must be prepared by a Professional Engineer or other professional authorized by law to prepare such plans Reg 6 c Tanks (a) capac t os=150% of flow, water table, tees, depth of tees, access, purging ` (b) cleanout ` (c) 101 from cellar wall or inground suimming pool - (d) 25+ from mbrurface drains Reg 10.2 Distribution Boxes a) slFpe greater ME 0.08 Reg 10.4 b) sump Subsurface DcaiFn Cheek List Par 2 s�_.........,_ ,a • FAIL OK Leach_iu Pits Leaching pits are preferred where the installation is possible Reg 11.2 a) calculations of leaching area-minimum 500 eq ft 11.4 b) spacing 11.10 c surface drainage 2% 11.11 d cover material le) V x21 a4" splash pad If) tee at elbow g) no bends in pipe from d-box to pipe ' Leaching Fields Reg 15.1 'I ) no greater than 20 minutes/inch b) area-minimum 900 sq ft 15.4 ) construction of field 15.8 V d) surface drainage 2 % 3.7 e) 201 from cellar wall or inground s dud ng pool Leaching Tvmches 3 Reg 14.1 a)Yne ons o eaching area-min 500 sq ft j 14.3 b ft min 6 ft with reserve between 71.4.4 c� s ]d1.6 d) ion 14.7 e)1 14.10 f) rainage 2% ` DomhAl Slop e a) mop xto be shown) = b) ;ajPp /xR '150 (to be shown) s Reg 9.1 ]a) val 9.6 b) d-by power i r.• '► OSS / IV =/2 cac.t/vU / �KlqnY or-7. ,Z FEND 4 nx �u. 7- Iry x_94_- r�o . ga -l,20•�o-- l�a • 90 _�;t,ea, s�® II� i i I I I i I S o G/a/ SF/' r/C . 7'r4 N r o - I \ � 1 EXIST Z%,,/,E E L L_ i i i �., '� t r;�r. . . + �' �.�l:�E.a..1 •afll'S1�t.+X+�,+�"t'E�4 +�..1RI1"r► . .S LIEU! 6J Lcsr I I A OT I O A LCT 9A, 43,5 97 S.F. r 00 EXIST, Dw ELL. GLIENT: PR,oPe2.TY LiWp-LLINE. �FFSi✓l'S' HALES �oJiJEY S► `�'N o�.l'rT-►isv�,v�1 Aim sP f:jT: bETE7ZN11►.!L�,T1o1�1 0�Zo�.t i►JC��GG3�]Ii�.fr_MEtJ« �N�-`(. L�.d.T10►J: Du►.ICAIJ DK►VE • c wOFA!gV ' �I►JCv LOT (�'� SIJ�. f�L.e,l.1 �`{ FR a NER£gv Ce�It/FyTH�rTr,r (iulc.oi�✓cs S►o�..w �. C_ F-L I t-j Assoc. L AS ON TNiS RqN/5 LoCATCO 0AInE rrnovkU 8-18-81 CJD SIJ ,p199 O AS S"OW 4/ ANoT/IAT IT Ebas . G � F G GNCRn ToTHF- ZON,uS B LAWOF �SS�X COUNTY A i2�IST2Y a>~ pE>=ps. SND SUR 1`10. At'iDOS/EQ MA. ��►G: r�� E: �1 !8 8i � �N6�L1�� . Commonwealth of Massachusetts City/Town of �- System Pumping Record _ n Form 4 ,� „ 'all DEP has provided this form for use by local Boards f HeVI be used but the information must be substantially the same as that � c,MULLM this form, check with your local Board of Health to determine the form they us umping Record must be submitted to the local Board of Health or other approving authority. A. Facility Information 1. System Location: Left f o house, right front of house, left side of house, right side of house, Left rear of hou , nght rear of house ft side of building, right rear of building, under deck. City/Town State Zip Code 2. System Owner: Name Address(if different from location) Citylrown State �� c rZIR Code Telephone Number �( B. Pumping Record 1. Date of Pumping Date 2. Quantity Pumped: Gallons 3. Type of system: ❑ Cesspool(s) Septic Tank ❑ Tight Tank ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes No If yes, was it cleaned? ❑ Yes No 5. Condition��IT( _ / V\- 6. System Pumped By: Neil J. Bateson 175821 Name Vehicle License Number Bateson Enterprises Inc. Company 7. L Ioncontents were disposed: G.L.S.D. Was t r Signature of le Date t5form4.doc•06/03 System Pumping Record•Page 1 of 1 WELL DATABASE ADDRESS: !J �� l e 0 = AGE OF WELL. WELL DRILLER: ?` WELL PER:tiIIT.T: WELL LOCATION: U WELL PERMIT DATE: 7 DEPTH OF WELL. '-TYPE.OF WELL: a.. DRILLED ? b. DUG c. UNKN01 , , . TYPE OF WATER BEARING ROCK:. ? `� t — WATER ANALYSIS DATE= 2 HIGH IMANGANESE: Y N HIGH IRON: Y N OT=CONAl. S• y N