HomeMy WebLinkAboutMiscellaneous - 191 HAY MEADOW ROAD 4/30/2018 191 HAY MEADOW ROAD---'
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COMMONWEALTH OF MASSACHUSETTS
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EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
DEPARTMENT OF ENVIRONMENTAL PROTECTION
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TITLE 5
OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
CERTIFICATION
Property Address: 191 Hay Meadow Road
Owner's Name: North Andover, MA 01845 Rd
Owner's Address: Kendall Spracklin
10/31/2006 NOV 17 2006
Date of Inspection: TOWN OF
HEALTH pj5PgRTMENTER
Name of Inspector: Richard C. Tangard
Company Name:_ 33 Pillings Pond Road
Mailing Address:_ Lynnfield, MA 01940
Telephone Number:_ 781 334-5049
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:
Passes
Conditionally Passes
Needs Further Evaluation by the Local Approving Authority
Fails
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.
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 adAress how the system will perform in the future under the same or different
conditions of use.
Page 2 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
191 Hay Meadow Road
Property Address:_ North Andover, MA 01845
Owner: — Kendall Spracklin
Date of Inspection:_ 10/31/2006
Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D
A. System Passes:
X 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.
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 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):
i
broken pipe(s)are replaced
obstruction is removed
ND explain:
Title 5 Inspection Form 6/15/2000 2
Page 3 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
l�11TTiTi!`1 s mi��� -hnued)
191 Hay Meadow Road
Property Address: North Andover, MA 01845
Owner:
Kendall Spracklin
Date of Inspection: 10/31/2006
wn
C. Further Evaluation is Y
Required b the Board of Health:
9
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 I 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 that no other
failure criteria are triggered.A copy of the analysis must be attached to this form.
I
3. Other:
Title 5 Inspection Form 6/15/2000 3
Page 4 of 11
OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
191 Hay Meadow Road
Property Address:_ North Andover, MA 01845
Owner: — Kendall Spracklin
Date of Inspection•_ 10/31/2006
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
X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or
cesspool
Ng Liquid depth in cesspool is less than 6"below invert or available volume is less than '/2 day flow
_X_ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number
of times pumped o
Any portion of the SAS,cesspool or privy is below high ground water elevation.
_ A d_ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface
water supply.
_ m A Any portion of a cesspool or privy is within a Zone I of a public well.
_ A�J_ Any portion of a cesspool or privy is within 50 feet of a private water supply well.
_ AAAA 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 labdratory,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.]
)VO (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:
To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000
gpd.
You must indicate either`yes"or`no"to each 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 II of a 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.
Page 5 of l l I
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address:_ 191 Hay Meadow Road
North Andover, MA 01845
Owner: Kendall Spracklin
Date of Inspection:_ 10/31/2006
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?
_ X, Have large volumes of water been introduced to the system recently or as part of this 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 signs of break out?
X _ Were all system components,excluding the SAS, located on site?
x _ 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?
X _ 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:
Yes no
_ Existing information.For example,a plan at the Board of Health.
_ Y 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)]
Page 6 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
191 Hay Meadow Road ION
North Andover, MA 01845
Property Address:_ Kendall Spracklin
Owner: — 10/31/2006
Date of Inspection:
FLOW CONDITIONS
RESIDENTIAL
Number of bedrooms(design): Number of bedrooms(actual):
DESIGN flow based on 310 C 15.203 (for example: 110 gpd x#of bedrooms):
Number of current residents: ;--
Does residence have a garbage grinder(yes or no) .
Is laundry on a separate sewage system(yes or no):,y6 [if yes separate inspection required]
Laundry system inspected(yes or no):=
Seasonal use:(yes or no): 6tp
Water meter readings, if available(last 2 years usage(gpd)): P,�4:;�;4 //,4
Sump pump(yes or no):&G
Last date of occupancy: 7`
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: LVZ:> mi— 7�-7(
Was system pumped as part of the inspection(yes or no): N o
If yes,volume pumped: r gallons—How was quantity pumped determined? '—
Reason for pumping:
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 currant operation and maintenance contract(to be
obtained from system owner)
_Tight tank _Attach a copy of the DEP approval
_Other(describe):
Approximate age of all components,onents date installed if known)
pP g p ( and source of information:
Were sewage odors detected when arriving at the site(yes or no):J�IO
Fage 7 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE:SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
j Property Address:_ 191 Hay Meadow Road
_. North Andover, MA 01845
Owner: Kendall Spracklin
Date of Inspection:_ 10/31/2006
BUILDING SEWER(locate on site plan)
Depth below grade:
P
Materials of construction: Lcast iron -
PVC_other(explain):
Distance from private water supply well suction line:
Comments(on condition of joints,venting,evidence of leakage,etc.):
sores
o luc.� �Z/G4
SEPTIC TANK:X (locate on sitelan
P )
IV
Depth below grade: /C
Material of construction: A 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:
j Sludge depth:
Distance from top of sludge to bottom of outlet tee or baffle: 3�
Scum thickness: '/
Distance from top of scum to top of outlet tee or baffle: ,5
Distance from bottom of scum to bottotp of outlet tee or baffle: /8
How were dimensions determined: --171t/c 404 .A
Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels
as related to out et invert,evidence of leakage,etc.):
24'e 77 0
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(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)
Property Address: 191 Hay Meadow Road
North Andover, MA 01845
Owner: Kendall Spracklin
Date of Inspection:_ 10/31/2006
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/day
Alarm present(yes 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:Y(if present must be opened)(locate on site plan)
Depth of liquid level above outlet invert: e/Al�i�
Comments(note if box is level and distribution t6 outlets equal,any evidence of solids carryover,any evidence bf
leakage into or out of box,etc.):
d�/! ��G l�J?1Z/Bt17TcnX/
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.):
i
I
Page 9 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address:_ 191 Hay Meadow Road
_ North Andover, MA 01845
Owner: Kendall Spracklin
Date of Inspection:_ 10/31/2006
SOIL ABSORPTION SYSTEM(SAS):-�L_(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: 1
leaching fields,number,dimensions: / ,Z 1 X 46
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.): �
Alen .�7 5 �� /`/V�c�(/G!� 754r/Lv1Zr= l� SAX/ No��69L
CESSPOOLS: (cesspool must be pumped as part of inspectionxlocate 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.):
i
Page 10 of 11
OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY O UNTARY ASSESSMENTS li
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address:_ 191 Hay Meadow Road
North Andover, MA 01845
Owner: Kendall Spracklin
Date of Inspection: 10/31/2006
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
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.Page 11 of l l
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 191 Hay Meadow Road
Owner: North Andover, MA 01845
Date of Inspection: Kendall Spracklin
10/31/2006
SITE EXAM
Slope
Surface water eta
Check cellar
Shallow wells A/C
Estimated depth to ground water S 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:
_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:
i
You must describe how you established the high grou d water elevation:
r
Title 5 Inspection Form 6/15/2000 I 1
i
Nov 02 06 11 : 57a P.
Summary Record Card generated on 11/2/2006 8:46:03 AM by Lisa Warren Page 1
4L Town of North Andover
Tax Map # 210-104.B-0089-0000.0
191 HAY MEADOW ROAD
SPRACKLIN, CAROL
• 191 HAY MEADOW ROAD
N. ANDOVER, MA
01845
Class 101 Singl amity Property Type 1 Residential
Size Total 1.01 Acres
IFY 2007
US Mailing Index
Name/Address Type Loan Number Activelinact. From Until
SPRACKLIN, CAROL Payor
191 HAY MEADOW ROAD
N.ANDOVER, MA
01845
US Account Maint.
Account No Cycle Occupant Name Active/Inactive
Bldg Id. 18104.0- 191 HAY MEADOW ROAD Last Billing Date 10/16/2006
3180132 03 Cycle 03 Active
US Services Maint. i
Service Code Rate Charge Muhiplier/Users
MISCFEE ADMIN FEE 0.635/8 7.82 1/
WTR WATER 01 ALL METER SIZE 21.91 /1
US Meter Maintenance
Serial No Status Location Brand Type Size YTD Cons
32707866 a Active ERT HH b Badger w Water 0.63 0.63
Date RtAding Code Consumption Posted Date Variance
9/19/2006 7 a Actual 7 10/20/2006 0%
7/6/2006 0 n New Meter 0 10/20/2006 0%
6/20/2006 2541 m Manual estimate 26 7/10/2006 -10%
MSG
3/20/2006 2516 m Manual estimate 25 4/17/2006 95%
ENC BLOCKED
12/27/2005 2491 m Manual estimate 15 1/17/2006 18%
MSG
9/21/2005 2476 m Manual estimate 13 10/14/2005 -3%
MSG
6/14/2005 2463 a Actual 13 7/1512005 5%
3/10/2006 2450 a Actual 11 4/5/2005 -8%
12/15/2004 .2439 a Actual 11 1/14/2005 33%
9/28/2004 2428 a Actual 11 10/8/2004 -5%
6/16/2004 2417 a Actual 6 7/30/2004 330%
4/23/2004 2411 a Actual 3 5/17/2004 0%
TOWN OF NORTH-ANDOVER
SYSTEM PUkPING RF-CORD
s1's"7'EM UWMER & ADDRESS d. SYS'T'EM LOCATION
5P������� ,- _ (example: left front of house)
191, �
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VATE OF PUMPING:„ �/� QUAKTITY PUMPED /5010(;ALL0»,
»TOOL: NO YES SEPTIC
TANK: N L�
�__._.. O Y E S
NATURE OFSERYICE; ROUTINE EMERGENCY
u 1I S r:R VATIONSr t"
0000 C011DITION. FULL TO COYER
HEAVY GREASE BAFFLES IN PLACE
ROOTS
l.EACHFIELD I;UIY13AC)(.,
EXCESSIVE
SOLIDS FLOODED
SOLIDS CARRYOVER DHFR (EXPLAJN)
i l'STE-AVI PUNT PCD
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Board of Health
q!)rtk Aodover,Mass
SUBSURFACE DISPOSAL DESICK CHECK LIST
LOT #
APPROVID DATE DISAPPROVED DATE„
Provideds Reasons:
Ti V FAIL CK _ -
Reg 2.5 The submitted plan must show as a minimums
a) the lot to be served-areasdimensions lot #,,abutters
location and log deep observation hoes-distance to ties -
52)
location and results percolation tests-distance to ties
design calculations & calculations showing regnired leaching'ar-
location and dimensions of system-including reserve area
existing and proposed contours
g) location any wet areas within 1001 of sewage disposal system or
disclaimer-check wetlands mapping
(h) surface and subsurface drains within 100' of sewage disposal
system or disclaimer
(i) location any drainage easements within 1001 of sewage disposal
system or disclaimer-Planning Board Piles
(3) known sources of water supply within 2001 of sewage disposal
system or disclaimer
k) location of any proposed well to serve lot-1001 from leaching facility
location of water Lines on property-3.01 from leaching facility
m) location of benchmark
driveways
71 garbage disposals
no PVC to be used in construction
q) profile of system-elevations of basement$ plumbs pipe, septic tanks
distribution box inlets and outlets, distribution field piping and
(other elevations
r) maximum ground water elevation in area sewage disposal system
plan must be prepared by a Professional Engineer or other
professional authorized by law to prepare such plans
Reg 6 Z Septic Tanks
(a) capac t es- 50% of flows water tables teess depth of tees,
access, pumping
cleanout
10 s from cellar wall or inground swimming pool
d) �5, from subsurface drains
Reg 10.2 Distribution Boxes
a) slope greater 0.08
Reg 10.1 b) sump
. o
Subsurface Design Check List Page 2'
M
' `AIL Og
Leachin Pits
Leaching is are preferred where the installation is possible
Reg 11.2 a) cal tions of leaching area-mdnimin 500 sq ft
17..4 b) spacing
11.10 c surface drainage 2%
11.71 d. cover material
e) i �z2'xliA splash Pad
f) tee at elbow
g) no bends in pipe from d-box to pipe
Leachin Fields
Reg 15.1 a ' no greater than 20 minutes/inch
� area-minimum 900 04 ft
15.4 construction of field
15.8 surface drainage 2 %
3.7 e) 201 from cellar wall or inground swuming pool
Leaching tenches 7
Reg 14.1a) =acg
s o eaching area-min 500 sq ft
14.3 b) - ft min 6 ft with reserve between
14.4 c) dimensi ns
14.6 d) constraation
14.7a stone,/
14.10 f� sarf�,ce drainage 2%
Dolope
a slopex = be shown
b) y/x X 50 - (to be shown
Pupps
Reg 9.1 a) ap
9.6 b) stand-by power
north Andoversymss
r M.ST?FAC& DY.,- OSkL DFMW C.HWK DIST
LOT #_j
AP PROVED DAT$ 9 f DIS6PFF4M DATE
Provided: 1 Reasons:
Title V FAIL C
Reg 2.5 The submitted plan rpt show ae a eir ua:
lot to be served-areasdimensions lot #,abutters
ocation and log deep, observation hoes-distance to tins
cation and rents percolation tests-distance to ties
sign calculations & calculations- showing requires leaching area
location and dimensions-of-system-including reverve area
existing and proposed contours- -
.� ( ) location any vat- areas vithin 100 of sewage disposal. system or
disclairar-check watlands mapping- _-
(h_) face and subsurface drains Athin I00+ of serge disposal--
system or disclaimer
(i location any drainage easements within 1.001 of ser ge disposal
systwa or disclaimer-Plan :g Board files
{ knov= sauces of pater supply within 2001 of serge disposal
system or disclaimer
location of proposed wt-11. to serve lot-1001 from leaebin facility
)- PAF g Y
location of eater lines -on property-101..2ror�-leaching facility
q(�fi)
location of benchmark
driveways
garbage disposals
no PVC -to- be used-in-construction
(q) profile of system-elevations of basement, plumb, pipe, septic tarfk,
distribution box inlets and outlets, distribution field piping and
utter elevations
of mii.=m ground water elevation in area sewage disposal system
(s) plan mist be prepared by a Professional weer or other
professional authorized by law to prepare such plans
Reg 6 She tic Tanks
( capae ties-750% of flow, water table, tees, doth of tees,
access, pumping
cleanout
c) 101 from cellar wall or ing and si4=Ang pool
(d) -250 from subsurface drains
Reg 10.2 Distribution Boxes
a) Rope greater than 0.08
Reg 10.4 V Kb) sunp
S
„jj(B $Pj,j1dVG iiiLVJ.FAIL
v.ave.as +.vv
FAIL OK y
r
Leaching Pits
4 Leaching pits are prof d where the installation is possible
Reg 11.2 a) calculations eaching area-minimae 50o sq ft
1.1.4 b) spacing
11.10 c) our drainage 2%
11.11 d) c r material
t�Ix4O splash pad
f) tee at elbow
g) no bends in pipe from d-box to pipe
Leaching Fields
Reg 15.1 'a) no greater than 20 minutes/inch
area-mini=x 900 aq ft
15.4 construction of field
15.8 d} surface drainage 2
3.7 e)_..201 Brom cellar wall or inground swung pool
- _ Leach3 rrCnTr�6cf
Reg 14.1 a)caul a anehing axaa-mfri 500 sq ft-14.3 b) spacing-4 t with reserve betkven
14dimm
.6 d) con action
14.7 e) aie
1h.10 f face drainage 2%
Downhill o e
a) slope x = to be shown) ---
b) ylx- 50 - (to be shown)
Reg 9.1 a) vel
9.6 b) s d-by power
Board of Beath BEMC $ISTEK
North Ano 2�ar�Haaa.
INSTALLATION LISP LOT . r�
APPRUM DATB DI PRC►PID
AVATICH 01 FAIL
I
Reasanst -
1. Distance Tot
a. Wetlands
b. Drains
c. Well
2. Water Line Location
3. No PPC Pipe
�. Septic Tank _
a. . _Tees -_Length & To Clean Ont 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
o b. Stone Depth
a - Capped Inds
d. Clean Double Washed Stone
7. Leach Pit
a. ions
b. a Depth
c. ash Pads
d, eas
e. Gwent Pipe to Pit - Both Sides.
. Clean Double Washed Stone
i -
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 with Regard-to Perc Test
d. Elevations
e. Water Table
SOIL PROFILE & PiERCO11TION TEST DATA
Nort1i Andove , No.&Street Lot No.
i Loc./Subdiv. Plan Owner Gx�/
Investigator �1 Observer_2�� -
— K
'i
SOIL PROFILES-DATE
4E17.e ?' Elev. 3' Elev. !-Elev.
i 0 � 0 0 0
s _
t 1 11 1 1
f
1
Ties to Test Pits
22 -2 2
r
3 3 3 3
i - -
4 4 - 4
r -
5 5 5 5'
6 6 6 6
7 7 _ 7 7
WO 8- 8 8
t
9 9 9 9
10 10 10 10
Benchmark Location
Elevation Datum
i
Percolation Tests-Date
} Pit Number 1 2 3 4 S
Start Saturation
i Soak-Mins.
p Start Test-Time
Drop of 3"-Time
Drop of 6"-Time
ASins . 1st . 3"Drop
Mins . 2nd 3"Drop — - —
Notes & Sketches on Back
SOIL PROFILE & PERCOLATION TEST DATA '
w-
ITorth AndoverNo.&Street � f No.� o _.L1___
Loc./Subdiv. AJn,,c+'6w Plan Owner—AL kl ,,, c
Investigator cr,ri M0 Observer dey) 'CC 't, n
SOIL PROFILES-DATE
3' Elev. 3Elev. 3. Elev. 'Elev.
0 0 0 0
I 1 1 1
2 2
Ties to Test Pits
2 2
3 3 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
,0 10 10 10
Benchmark Location _
Elevation Datum
Percolation Tests-Date �7
Yate----- !
Pit ?Number 1 2 3 4 S
Start Saturation ZZ
Soak-Mins. - r,,„'
Start Test-Time Z; 37
Drop of 3"-Time - L
Drop of 6"-Time
I•;ins . lst 3"Dro
mins . 2nd 3"Dro z „ -
Percolation Rate
Rotes & Sketches on Back
ti