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Home My WebLink AboutMiscellaneous - 165 FOREST STREET 4/30/2018 165 FOREST STREET 21D/106A-0180-0000.0 1 I n 4 f 1 O�'' 1 (� J Commonwealth of Massachusetts Title 5 01ficial Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 165 Forest Street OCT 19 2015 Property Address John O'Neill Owner Owner's Name information is required for North Andover MA 01845 8/26/2015 every page. Cityrrown State Zip Code Date of Inspection Inspection results must be submitted on this form.Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important: A. General Information When filling out forms on the computer,use 1. Inspector: only the tab key to move your Neil J. Bateson cursor-do not Name of Inspector use the return key. Bateson Enterprises Inc. Company Name ffi 111 Argilla Road Company Address Andover MA 01810 City/Town State Zip Code 978-475-4786 SI 15 Telephone Number License Number B. Certification 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: ® Passes ❑ Conditionally Passes ❑ Fails ❑ N edh Further Evaluation by the Local Approving Authority 8/26/2015 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****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. t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 165 Forest Street Property Address John O'Neill Owner Owners Name information is required for North Andover MA 01845 8/26/2015 every page. Cityrrown state Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I 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: After permit from B.O.H., install new outlet tee with gas baffle in septic tank&new d-box, inspection from B.O.H., septic system now passes Title 5 Inspection. 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. Check the box for"yes", "no"or"not determined" (Y, N, ND)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. ❑ Y ® N ❑ ND (Explain below): t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 • TLED • • i PUBLIC HEALTH DEPARTMENT Town of North Andover Community Development Division CERTIFICATE OF. COMPLIANCE As of: 8/25/15 This is to certify that the individual subsurface disposal system received a SATISFACTORY INSPECTION of the: Repair of D-box and Tee By: Todd Bateson At: 165 Forest Street Map 106.A Lot 0180 NorT Andover, MA 01845 The Issuan e of this certficahall not be.construed as a guarantee that the system will function satisfactorily. Michele Grant U Public Health Agent 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com I I S�Tn16r' . North Andover Health Department (ommunity and Economic Development Division ONSITE WASTEWATER SYSTEM CONSTRUCTION NOTES LOCATION INFORMATION ADDRESS: 165 Forest St. MAP:I�. A LOT: Igo INSTALLER: Todd Bateson DESIGNER: PLAN DATE: BOH APPROVAL DATE ON PLAN: INSPECTIONS D-box and Tee INSPECTION: 8/25/15 DATE OF BED BOTTOM INSPECTION: DATE OF FINAL CONSTRUCTION INSPECTION: DATE OF FINAL GRADE INSPECTION: SITE CONDITIONS ❑ Contractor reports any changes to design plan ❑ ;Existing septic tank properly abandoned ❑ Internal plumbing all to one building sewer ❑ Topography not appreciably altered Comments: SEPTIC TANK ❑ Building sewer in continuous grade, on compacted firm base ❑ Cleanouts per plan ❑ Bottom of tank hole has 6" stone base ❑ Weep hole plugged ❑ 1500 gallon tank has been installed H-10 loading ❑ Monolithic tank construction ❑ Water tightness of tank has been achieved by Vvisual testing Inlet tee installed, centered under access port ❑ Outlet tee installed, centered under access port (gas baffle/effluent filter) ❑ inch cover to within 6" of finish grade installed over one access port ❑ Hydraulic cement around inlet & outlet Comments: PUMP CHAMBER ❑ Bottom of tank hole has 6" stone base ❑ Weep hole plugged ❑ 1500 gallon Pump Chamber installed ❑ H-10 loading ❑ Monolithic tank construction ❑ Inlet tee installed, centered under access port ❑ Pump(s) installed on stable base ❑ Alarm float working ❑ Pump On/Off floats working ❑ Separate on/off floats ❑ Drain hole in pressure line ❑ cover at final grade installed over pump access port ❑ Water tightness of tank has been achieved by testing ❑ Hydraulic cement around inlet & outlet Comments: CONTROLPANEL ❑ Alarm & Pump are on separate circuits ❑ Alarm sounds when float is tripped ❑ Location of control panel: basement ❑ Alarm signal located inside: basement Comments: DISTRIBUTION-BOX [� Installed on stable stone base [� H-20 D-Box [*]� Inlet tee (if pumped or >0.08'/foot) 0' Hydraulic cement around inlet & outlets [� Observed even distribution [� Speed levelers provided (not required) [� Schedule 40 PVC Pipe Comments: • `. D, Commonwealth of Massachusetts Map-Block-Lot -. • 106.A0180 BOARD OF HEALTH -P -- Permit -- No------------ North Andover -BHP-2015-0341-------- -------------- P.I. FEE F.I. $125.00 ----------------------- DISPOSAL WORKS CONSTRUCTION PERMIT Permission is hereby granted -Todd-B-a-te-son - -- ---------------------------------------------------------------------------------------------- to(Construct)an Individual Sewage Disposal System. at No 165 FOREST STREET ---------------------------------------------------------------------------------------------------------------------------------------------------------- as shown on the application for Disposal Works Construction Permit No. BHP-2015-034 Dated August-12,2915 ----------------------------------------------------------------- Issued On:_Aug-_1 2-2015 BOARD OF HEALTH • 4w "f ' . Commonwealth of Massachusetts Map-Block-Lot • 106.A0180 BOARD OF HEALTH ------- North Andover CERTIFICATE OF CO LIANCE THIS IS TO CERTIFY,T a divid ewage Disposal System (Construct) by Todd Bateson - - ----------- -------------------- ---- -- -- P------------ ------------ Installer at No 1-6-5-F-0-REST-STREET has been installed in accordance tth the provisions of TITLE 5 of the State Environment Code as described in the application for Disposal W s Construction Permit No. -BHP-2015-034 Dated August_12Z 20- 15 ---------------------- ------- --------- Printed On:Aug-12- 015 ---- - ------------------ ------------------------------------------- BOARD OF HEALTH k,... Application for Septic Disposal System 9-� 4;* Construction Permit - TOWN OF NORTHANDOVER MA01845 Important: Aaalication is hereby made for a permit to: When filling out ❑Construct a new on-site sewage disposal system` forms on the computer,use ❑Repair or replace an existing.on-site sewage disposalsystem only the tab key pair or replace an existing system component–What? to move your cursor-do note�rrI6�IPD use the return A. Facility Information key. �lt,I' Address or Lot# n TnIA14 It ,j.. c4CTNDER tpUv ER City/Town AUU '_ 2.-*TYPE OF SEP IC SYSTEM*: r�G �� , ❑Pump Gravity(choose one) Wg IT, iE if pump sy m,attach copy of electrical permit to application — > ETConventional System (pipe and stone system) ❑Infiltrator or Biodiffuser(Gravel-Less)(Attach a copy of your certification to install this type of system.) ➢ ❑Pressure Distribution S.A.S.(No D-Box) ➢ ❑Pressure Dosed(D-Box Present)S.A.S. ➢ ❑Does the system require an effluent filter? Yes No If yes, does plan specify make and model of filter? YES=(no further info. needed) NO=(installer must specify brand of filter before DWC issuance) What is the Make? What is the Mode#y 2. Owner Information Name "S1Address(if different from above) No A ,Q.v k rL , Y4 - 4!k y,6— Cityrrown State Zip Code dsTel1 ^7Y 6_45-7- Telephone ephone Number 3. Installer Information Name Name of Company BATMON ENTERPRI Address AD IV, nAt L ANDOVERL A OLA G18 0 . City/Town State Zip Code Telephone Number(Cell Phone#If possible please) 4. Desi.oner Information Name Name of Company Address City/Town State Zip Code Telephone Number(Best#to Reach) Application for Disposal System Construction Permit-Page 1 of 2 0 Appiicati-oh..for Septic Disposal System • I Construction Permit 'TOWN- -OF TODAY'S DATE ORTH_ANDOVER, MA 01845 $.250.00-Full Repair $725.00,-Component �Ss�c►a+ ' PAGE 2 OF 2 A. Facility.Information continued.... S. Type of Buildin-g esidential Dwelling or[]Commercial B. Agreement The undersigned agrees to ensure the construction and maintenance of the afore-described on-site sewage disposal system In accordance with the provisions of Title 5 of the Environmental Code, as well as the Local Subsurface Disposal Regulations for the Town of North Andover,and not to place the system in operation until a Certificate of Compliance has been Issued by this Board of Health. 1-16 Name Date Application Approved By: (Board of Health Representative) Name Date Application Disapproved,for the following reasons: For Office Use Only 1 Fee Attached, Yes No 2.. ProjectMafiager Obligation Form Attached, Yes No ' 3, &M LSXstem? Ifsoi Attach copy ofElectrical Permit'.' Xes_ No� 4. Foundation As Built,?(hew consfruct 0h-ronly); Yes (Same scale as a PP Y P w ro ed ANo ) . 5. F1oorMws?(hew construction only): 'es_ No Appifcatlon{or-D(sppsal ysterii: ond"etlon permit Page 2 of 2 SFyn Aa die.N Aadavrslic�etsezl3�cs.[a�It t frsr fit atc�t tqn fps••thesaeptia spetMA- t:thap Mp 9tty At (Ad4i6l oisdpdk-We=) -1709 Pun by Rehfive to the Qf smath Abd dated Dated s WM tevidm dated rmaed due) I the follawlag obligations fat a taageancut of 1wa D;*ct: i. Al thefasm]kr,I omoblipW tp obmm.aIIpe.=ib and'Boud offiealth ' oa fedomft anp:aorlt da R site uuet l d ay +aa tqpuwdpbmpft AftiL aim who .. 2. .I Batt any ad ' **Upemcn not��mp ��1 ectotmck:ar may h= F apatefa is noif:,eaciy,thCh ah,:ll.h�st�l�cabIc. . : . 3 Ae smftey x to have a 9Naa ;o .p to dmApplk" t • f - ' '�:• b � er�Iy,tib��k.�I"�t�P - at:�hex•3s�retain�.tg�, IOU 4ORwilet have tp be ptescau:-. - .6. _ • - -'-_�mmbat � f�ap far�t�s,cto. -" a OIfi'(at ell ttx him the ba ttibaiittied to Boni of Head,: t; for�ea ? t ect4m d=`I�smlkr iriust r baps fiatp +' p dtQtkat be mdy able trs C. eanae p�P� taller amst � •`'" � • ~ - , . ' �'� togtmaPecdon�rhepil$�xd#agapltte: Ipsmltcr does snot 4. As*e iasmlka'I um d that 9'I~t�sy►p the c'�i> r idea e ) I m ftqwed to a piece die of fte systctg ist#b sl'P�f fbt tatloa:j d dnt mark doaa tiv.etines �t ,r.IR,:iytF ..�. tea. 5.. Ab th`cinadllte�•I v�detstaaii I on.r�3 pe: a�gca of diicanit EVE a De alt thaf.&epajrer&vn&O aftL-ftftMdOO beep s+NC&A Ih Id9p0�crfttGoaadaadd�Ete07seaatoL 1'faslbrapean*a�byBowaf�st ffatoaasttht= d Fajen Waffouofimalr,D-. ang ,ataaae,vans PSP mawwgffaw otliar - 6. As tha mer M t Lma rbfihr Ido�w�lw*�:�p�� _ _� .. � rr==•,,s,s}��RR .. " •21X8{ {�Ab fe+hnn _ •• _ - - , Commonwealth of Massachusetts RECk V . Title 5 Official Inspection orm AUG 03 01 Subsurface Sewage Disposal System Form- Not for Voluntary Assessments TOWN OF NORTH ANDOVE r~ 165 Forest Street HEALTH DEPARTMENT Property Address John O'Neill Owner Owner's Name information is required for every North Andover MA 01845 7/29/2015 City/Towrr Mate Zip Code bate of Jrisp€ction Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When A. General Information filling out forms on the computer, use only the tab 1. Inspector: key to move your cursor-do not Neil J. Bateson .use t wzet en' Name of Inspector key. Bateson Enterprises Inc. ,y Company Name 111 Argilla Road Company Address Andover MA 01810 Cityrrown State Zip Code 978-475-4786 S 1 15 Telephone Number License Number B. Certification 1 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 5`192 approved system inspector pursuant to Section 15.346 of Title 5(310 CMR 15.000).The system: ❑ Passes ® Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 7/29/2015 Insp ct r s Sign re Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority., ****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. t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 • Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 165 Forest Street Property Address John O'Neill Owner owner's Name information is required for every North Andover MA 01845 7/29/2015 CWT.OWIT State Ztp Code Date,of inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ❑ I 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. Check the box for"yes", "no"or"not determined" (Y, N, ND)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. ❑ Y ® N ❑ ND(Explain below): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Pape 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 165 Forest Street Property Address John O'Neill Owner Owner's Name information is required for every North Andover MA 01845 7/29/2015 Oat. Dttyffown State Zip�Cade Date oftnspectiorr B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes(cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ® broken pipe(,)are replaced ❑ Y ® N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ® N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ® N ❑ ND (Explain below): ❑ 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 ❑ Y ® N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ® N ❑ ND (Explain below): 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 t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 N Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 165 Forest Street Property Address John O'Neill Owner Owner's Name requinform r on is North Andover MA 01845 7/29/2015 requiredd for every �'• citytTown -State Zip Gude Dateof Inspection B. Certification (cont.) 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 supplywelt ❑ 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 wafer analysis, performed at a [SEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other. Outlet tee in septic tank&d-box needs to be replaced. D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6"below invert or available volume is less than 1h day flow 15ins•3/13 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts _ - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 165 Forest Street Property Address John O'Neill Owner Owner's Name information is North Andover MA 01845 7/29/2015 required for every y e, EitylTam State Zp Code Date-of Inspection- B. nspectionB. Certification (cont.) Yes No ❑ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times primped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® 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 fecal coliform bacteria indicates absent 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 and chain of custody must be attached to this form.] ❑ The system is a cesspool serving a facility with a design flow of 2000gpd- ?'Q;Q00gpd: ❑ ® 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] targe Systems: To be considered a targe system the system must serve a facility With a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. 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—IWPAj or a mapped Zone ff of a pubic water supply weft 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. t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments r 165 Forest Street Property Address John O'Neill Owner Owner's Name information is required for every North Andover MA 01845 7/29/2015 ,page, Cdy/Town State Zip.Code Date,.of Jnspection C. Checklist 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 of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) 0 ❑, Was the facility or dwelling_inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? Were the septic tank manholes uncovered., opened,, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® El information 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: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of.bedrooms,desi 4 4 ( gn): Number of bedrooms,(actual). DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 600 i t5ins•3113 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 165 Forest Street Property Address John O'Neill Owner Owner's Name information is required for every North Andover MA 01845 7/29/2015 page. GityfFowvrr State Ziptode Date,of 4nspectlorr D. System Information Description: Number of current residents: 3 Does residence have a garbage grinder? ❑ Yes No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ❑ No Seasonat use? Yes 0 No Water meter readings, if available(last 2 years usage(gpd)): On well water Detail: Sump pump? ❑ Yes ® No Last date of occupancy: Current Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑. Yes ❑ .No Water meter readings, if available: t5ins•3113 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Pape 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments r 165 Forest Street Property Address John O'Neill Owner Owner's Name information is required for every North Andover MA 01845 7/29/2015 0W. City'rrown' State Zip Code Date•of frtspectiorr D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Pumped two years ago, owner Was system pumped as part of the inspection? ® Yes ❑ No If yes, volume pumped: 1500 gallons How was quantity pumped determined? Measured tank Reason for pumping: Inspect tank&tees Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no)(if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins•313 Tide 5 official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts (Ifff U Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 165 Forest Street Property Address John O'Neill Owner Owner's Name information is required for every North Andover MA 01845 7/29/2015 Page, CW-own state Zip Code Date-of-Inspection, D. System Information (cont.) Approximate age of all components, date installed(if known)and source of information: 27 years old, 5/2/1988, as built plan Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 2.6 feet Material of construction: ® cast iron ® 40 PVC ❑other(explain): Distance from private water supply well or suction line: feet Comments(on condition of joints, venting, evidence of leakage, etc.): 4"Cast Iron through wall, 3" PVC in house, no leaks visible Septic Tank(locate on site plan): Depth below grade: _ 1.6 feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: y_ea>:s. Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 10' x 5'x4' Sludge depth: 4" t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 165 Forest Street Property Address John O'Neill Owner Owner's Name information is required for every North Andover MA 01845 7/29/2015 d• Wown Mate Zip Code Date of tnspectiory D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 29" Scum thickness 4" Distance from top of scum to top of outlet tee or baffle 8" Distance from bottom of scum to bottom of outlet tee or baffle 11" How were dimensions determined? Tape measure Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Purrrped sapfictank. h'ttet tee ok.Outtet tee Madly ccrrodedt, needs to be replaced.geptft of liquid at outlet invert. No evidence of leakage. Inlet cover has riser 6"deep. Grease Trap(locate on site plan): Depth below grade: feet 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: Date t5ins•3113 Title 5 Official Ins pection Form:Subsurface Sewage Disposal System•Page 10 of 17 c Commonwealth of Massachusetts I�W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 165 Forest Street Property Address John O'Neill Owner Owner's Name information is required for every North Andover MA 01845 7/29/2015 096. City/Town State Zip£ode Date&Inspectkm D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 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: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal poral System•Pape 11 of 17 Commonwealth of Massachusetts _ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 165 Forest Street Property Address John O'Neill Owner Owner's Name information is required for every North Andover MA 01845 7/29/2015 �. QWTowrr state Zip Code fate of Inspection D. System Information (cont.) Distribution Box(if present must be opened)(locate on site plan): Depth of liquid level above outlet invert 0 Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): D-box level &distribution equal. Evidence of carryover, pumped d-box to clean. D-box has bad corrosion, needs to be replaced. D-Box cover broken, replaced it. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No" Alarms in working order: ❑ Yes ❑ No* Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): *If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System(SAS) (locate on site plan., excavation not required): If SAS not located, explain why: t5ins•3113 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form • Not for Voluntary Assessments 165 Forest Street Property Address John O'Neill Owner Owner's Name information is required for every North Andover MA 01845 7/29/2015 I g • fit T`Gwir state Zip•Code DateofInspection D. System Information (cont.) Type: 0 leaching.pits number: ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: leaching fields number, dimensions: 1 field 41'x 57' ❑ 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, etc.): Soil ok. Vegetati6a 6k: No slo ti of j9ioMliT11tto igUftea. Cesspools(cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of i-quid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 165 Forest Street Property Address John O'Neill Owner information is Owner's Name required for every North Andover MA 01845 t CityJFowrr 7/29/2015 ii D. System Information (cont.) Oateof� Comments(note condition of soil, signs of hydraulic failure, level of ponding, etc.): condition of vegetation, 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.): t5ins•3/13 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 165 Forest Street Property Address John O'Neill Owner information is Owner's Name required for every North Andover MA page. Cityfrown state 1 01 01 845 Code 7/29/2015 r1SpeCt1AR D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view 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. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately o waw �Q„ A {PGS o� - t 3d`iou 4 t5ins•3N3 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 165 Forest Street Property Address John O'Neill Owner Owner's Name information is required for North Andover MA 01845 7/29/2015 "96- City/Town Mate Zip Zode Date,of Inspection D. System Information (cont.) Site Exam: Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: 4 feet Please indicate all methods used to determine the high ground water elevation: Obtained from system design plans on record If checked, date of design plan reviewed: 4/16/1985 Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health-explain: Design plan ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed WSGS database-explain: You must describe how you established the high ground water elevation: Test pit data on design plan Before filing this Inspection Report, please see Report Completeness Checklist on next page. tSlns-3/13 Title 5 Offlclal Inspection Form:Subsurface Sewage Disposal System•Pape 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 165 Forest Street Property Address John O'Neill Owner Owner's Name information is required for every North Andover MA 01845 7/29/2015 page. DitylF Mate Tp Code Dateof inspection- E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked Inspection Summary D (System Failure Criteria Applicable to All Systems)completed ® System Information Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 :- Commonwealth of Massachusetts Y City/Town of . System Pumping.Record Form 4 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 1. System Location: Left/ ic ihtfrontofhouse eft/Right rear of house, Left/right side of house, Left/ Right side of building, Left/Right front of building, Left/Right rear of building, Under deck . Address / /:5' Cityrrown State Zip Code 2. System Owner. Name* Address(if different from location) Citylrown ' State Zip Code Telephone Number a J _ %. B. Pumping Record 1. Date of PumpingDate 2. Quantity Pumped: ('s Gallons 3. Type-of system: ❑ Cesspool(s) Q-6-e-ptic Tank ❑ Tight Tank ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yeas D-90 If yes,was it cleaned? ❑ Yes ❑ No, 5. Condition of System:C> A. ^ ' /-eu ek 6. System Pumped By.- Nell y:Neil.Bateson F5821 Name Vehicle License Number Bateson Enterprises Inc- Company 7. Location where contents were disposed: S Lowell Waste Water signitufe 4HOUWU Date t5formtdoc•06/03 System Pumping Record•Page 1 of 1 eoa?h REC*lYE:1 Any appeal shall be filed - '� DANIEL LING -3'��`� '9t TOWN ,!_L tK within (20) days after the 'to: AMwt^ ;�' NORTH date of iiiing of this Notice �'s�•,18 'E in the Office of the Town ti SUN Z55 Ali g� Clerk. TOWN OF NORTH ANDOVER MASSACHUSETTS BOARD OF APPEALS;._ NOTICE OF DECISION Date . ..JuTm 20, . 1994. . . . . . . . . . . . Petition No.. . 02.5794. . . . . . . . . . . . . Date of Hearing. .June. Petition of . . .Timothy. M., .Illingworth. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Premises affected . 165. .Forest. .Street. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Referring to the above petition for a variation from the requirements of XM . .S e c t ion .7, . . . . Paragraph .7.3. and .Table. 2. .of .the. Zoning. Bylaw . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . so as to permit continued. existence. of. porch. which.encroaches. three .(3). feet .into. .the. rear .setback.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . After a public hearing given on the above date, the Board of Appeals voted to . . GRANT. . . . the variance as requested and hereby authorize the Building Inspector to issue a permit to Timothy M. illin.gworth. The Board finds that the petitioner has satisfied the provisions of Section 10, Paragraph 10.4 of the Zoning Bylaw and that the granting of this variance will not adversely affect the neighborhood or derogate from the intent and purpose of the Zoning Bylaw. Signed �� .�y�� C ra�er.. . Jr. , Chan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . William Sullivan, .Vice-chairman . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Walter Soule, Clerk . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Ramond Vivenzio . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Robert. Ford . . . . . . . . . . . . . . Board of Appeals 4 RECFIVE9 Any appeal shall be filed pHl�, within (20) days after the �7/�TG'� ; NORTH {RUR ER date of iiiing cif this Notice in the Office of the Town Clerk. .iUH L� 8 59 AM 9 �9SSAC M05 h TOWN OF NORTH ANDOVER MASSACHUSETTS BOARD OF APPEALS **************************** * Timothy M. Illingworth * DECISION 165 Forest Street North Andover, MA 01845 * Petition #025-94 * **************************** The Board of Appeals held a regular meeting on Tuesday evening, June 14 , 1994 upon the application of Timothy M. Illingworth requesting a variation of Section 7, Paragraph 7.3 and Table 2 of the Zoning Bylaw so ' as to permit continued existence of porch which encroaches three (3) feet into rear setback on the premises located at 165 Forest Street. The following members were present and voting: Frank Serio, Jr. , Chairman, William Sullivan, Vice- chairman, Walter Soule, Clerk, Raymond Vivenzio and Robert Ford. The hearing was advertised in the North Andover Citizen on May 25 and June 1, 1994 and all abutters were notified by regular mail. Upon a motion by Mr. Soule and seconded by Mr. Vivenzio, the Board voted unanimously to GRANT the variance as requested. The Board finds that the petitioner has satisfied the provisions of Section 10, Paragraph 10.4 of the Zoning Bylaw and that the granting of this variance will not adversely affect the neighborhood or derogate from the intent and purpose of the Zoning Bylaw. Dated this 20th day of June 1994 . BOARD OF APPEALS Frank Serio, J . Chairman Z$ Fbr�EST 57" NoI�TM 4 j pnvc-)- , MA, l�Jvp�N� wgTcr{ ��P>�y Q wECL TaUAJ �- �� - ��°� SES-tic SY STEM UES►C� �PPi�C�vCL D,4rt' I--3o-g� Apmovw6 Aurhol'?,ry MEED IGY>' We-r�N� p�Fs�j. ND 13f'G J'H(,uG - �I�QPPR�VEu C �� 2�%6• � - R�45oNS D�� I� StPrt SYSTEM IJS-VOU-,dTiOAJ C-YCAV4T(e•,-fJ )tiSPE6►iOtiJ PJu>-LTY El 1?/ISS Q- F:41L �{ -Z- ) d-k - —re gmol ro f'g of I l�1N,QL l iJ�pEGj"IOI� ,�c�Pi�OVED Qi3TC APPi�)vJNG 4U'F tf �rry DISA PPROv6D DarC ROS N FwAL APPINDVAL - �' do APP13WVJG M DRINKING WATER LABORATORY — CERTIFIED Quick_Results, Sample Pick-Up 36 Pelham Rd. (603) 898-2504 Salem, NH 03079 (603) 898-6526 Laboratory Number: 486 Sample Date: Submitted B -24_.87 By: Saracino CoCnst . Sample Source: Lot # 28 Foeest Street North Andover , Mass . Analysis: According to Standard Methods of Water & Wastewater Analysis, 15Th Ed. Total Coliform . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 per 100 ml Chlorides . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 . 5 mg/L PH . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 . 51 Hardness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 mg/L Manganese . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 . 05 mg/L Sodium . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30. 4 mg/L Iron . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 . 065mg/L Nitrate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 . 1 mg/L Nitrite . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0. 1 mg/L Arsenic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 002 P.P.B. Comment: This sample meets EPA recommended limits . alyst BOARD OF HEALTH Town of North Andover ,Mass . Permit # Date 19 '� APPLICATION FOR WELL & PUMP PERMIT Application isherebb ade for permit to drill a well (e--: Application is made to instala p ump system. Q�l Location: Address_ �� . .Lot # ZG' 7 Ownery2��e2xo ��<<�-�- �. Address �S / -�,,��.�c �� c5/�_ 62e 1 T e 1 2Z Well Contractor Address //i# wr/d� A Tel . Pump Contractor �G?�2.0 Address Tel . WELL CONTRACTOR (To be completed at time of pump test ) Type of Well Well used for Diameter of Well Size of. Casing r Depth of Bed Rock Depth casing into Bed Rock Was Seal Tested? Yes ( ) No ( ) Date of Testing Depth •-o1—.:e4- — - Well Ended in W.ha-t- Material j Depth to Water_ Delivers Gals .Per Min . for 4 hours Drawdown feet after pumping _hours- at Date of Completion Signature Well Contractor PUMP INSTALLER (To be• f-i.11ed in- before installation) Size & Name Pump — __'_Pump Type Used Water Pump Delivers GPM Size of .Tank _ Pipe Material Used in Well : Cast Iron (_) Galvanized (_) Plastic (_i Well Pit ( ) or Pitless .Adapter (_) Was sleeve used to' protect pipe? Yes (_) NO(_) 'Type or Name Well Seal Date -�c�k►t*iM�r��it 9c��r;4�r tit t�C t4�4 tit ti�t'r eM tiM�'t►4 ti'c�r ti4;4�r�t 31r�4r�4 s4�t;4;�;'t;4;4;'r;4 ti4;4;': :is-.:::- . ., � ��ti4��r der sM tk Date Water analysis repor-t 'submitted to Board of Neal-th Date release given tD owner of record & Bldg. Insp Health Inspector i L� as A N i i /sa I �o � Y .� � 4 ;�:i'i�•�, Mme„•. C.%,/ ' Z- 2 -7 r� } SCOPE /Z�QU//��it./E/V T r Y tN OF DES/6N 6-1-FI,41-/0N 4T.. .. ... . .(FOR OF STONE) _ ._. . . ... . EX/STING ELE147-10N .4T. . . .. . . . . 2EQU/2&9 'CALL = . .. .. . . . . . . .. ..... . +�o. z�LEI�.QT/ONS � - Al ops/�N 4s aUr�T ,4S BU/� T /NV P/PE 0&/7- OF y0U,5E L� INVRIPE /NTO T4NK INV PIPE OUT OF TQUVK /5 7, 8 .3 161=b 3 SYSTE/r/ INV. PIPE INTO D. BOX 5 7. c/3 /6 0, 73 INVRIPE OUT OF D. BOX / 5 7. 26 /G a. $y /N INV END OF PIPE / 5 7 Od i s q: 6 Z vis8- ss FO2 GVATF2 EL EV,4 TION .4VE1046E STONE Yo D4TE.• DEPr/1 ,4T P,eo3E G11E/ST/.4NSEN 6N- 61 �e//1/ //�/�' NOTE.- TW1,5 //4 KENOZ,4 .4 VE. &41/Ee;y/L L,i-U. PZ-,4N /S NOT ,4 GV,4�£'.e.4NTY � OF TWE SYSTEM BUT 4 I1E2/FIC,47-/ON OF T11E LOCATION OF TWE EY13 TING ST�eUCTU2ES. G oT , � G ----� nx ,s T L o =7- 1 • -rte \ a J�j �- 2- -7 A SLOPE IZ6:04111eE ENT �LZN OF / X (/50 /50 - - DES/6N CI-EV47'ION AT. . .. ... . .(TOP OF STONES - .. . . . ... . . .. .. . .. . . .. .... .. .. � EXISTING a007-10N qT. . . .. . . . . 2EQU/i2E0 6ZIFY..QT/ONS DE5/6N .4S!3U/LT ,4S [JUIZ 7- /M/P/PE OUT Of/-/OUSE- Q ,J C /Nl/P/PE 11V7-0T4NK /5 S.D /6'�, 3 g SUB —SU/C Fi�-/CL DI-51,00 L /NV P/PE OUT OF TANK /S 7, 8 3 161.'d 3 SYSTE/r/ /NV PIPE 11V7_0 o. eOX / S 7. y 3 /6 . '7 3 /NV PIPE OUT OF D. BOX / S 7. 26 /�p. -ay /N /NV END OF PIPE 5 pU o. � /V / 7 is9_ 6Z iss, ss57 FO2 141,4TE2 EL E Y,l TION �r J .4VE2.46E STONE 5C.4LE D4TE-• DEPT/ ,4r P,eoaE of&,e1,5T/.4NSEN , INC. NOTE.- T1//S PZ-4N /S NOT ,4 A 4,je,4NTY //4 KENOZ-4 ,4VE., A4VEPl//4L, h-U. OF TqE SYSTEM BUT -4 1/E2/F/C,47-10N Of TqE LOC.4T/ON OF TAS E E,1'/S T/NC ST,eUCTU/zES.