HomeMy WebLinkAboutMiscellaneous - 198 DALE STREET 4/30/2018 T98 DALE STREET
f 210/037.B-0004-0000.0
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WDATEINVOICEAMOUNT
5-20/110
N KENNETT, INC. s6728
AU -.OBODY:AND INDUSTRIAL SUPPLIES395 BROADWAY .ENCE,MA 01841: .I 'U{PI illi{ ✓� 1„i
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DATE CHECK AMOUNT
DON KENNETT, INC.
SHAWMUT BANK Auth
BOSTON.MA 02211,
Sig
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Y �i!0067 28!i' 1:0 11000 2064 :_ 3 2 036806 611'
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—77
DATE DESCRIPTION
AMOUNT
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7/31/93 Pumped Septic Tank $145.00
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af�93
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+" {;M;>„. Bateson Enterprises, Inc. —Andover, MA 01810
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SEPTIC SYSTEM INSPECTION FORM
ADDRESS
DATE INSPECTED °
PROPERLY FUNCTIONING? N
WEATHER CONDITIONS
COMMENTS :
a
14A'3'E:R QUALITY TES r t-b `'
DYE TEST PERFORMED? Y N
DATE?
SKETCH:
WATERSHED RESIDENTS QUESTIONNAIRE
1. Name L Y) 1_e T2, ke.
2. Street Address J r IN,, I V
j 3. How many members are in your household? y
4. What type of sewage disposal system do you have?
❑ cesspool
2'septic tank and leaching area
❑ connection to municipal sewer
❑ other (describe)
❑ do not know
5. Are the plans (drawings) for rur sewage disposal system on file with the Board of Health?
❑ yes ❑ no 5? do not know
6. How old is your sewage disposal system? ❑ 0-5 years ❑ 6-10 years ❑ 11-20 years
over 20 years ❑ do not know
7. Has your sewage disposal system been rebuilt or repaired?
El yes Imo' no ❑ do not know
If yes, approximately how long ago? years. What was done?
8. How frequently is your sewage disposal system pumped out? Ldp annually
❑ every 2-4 years ❑ every 5-10 years ❑ over 10 years ❑ never
9. Have you had any problems with your sewage disposal system? ❑ yes ❑ no
If yes, what problems?
❑ repeated pump-outs needed
❑ system clogs, backs up, or drains slowly
❑ odors
❑ sewage surfaces through ground
10. How many of each applia a are connected to your swage disposal system?
washing machine dishwasher t/ garbage disposal
dehumidifier drain sump pump toilet
roof/pavement drains shower/bathtub
11. Please state the brand and type (liquid or powder) of detergent you use for:
dishwasher S i°n ) AFtt
clotheswasher —/
12. Does your property have a lawn? L+�' yes ❑ no
If yes, approximately what size? �-�//
❑ less than 1/4 acre El 1/4 acre I 1/z acre ❑ 3/4 acre ❑ 1 acre
❑ more than 1 acre (Specify) acres _
13. How often do you fertilize your lawn?
No. of applications per year =
Season(s) of the year
14. Please state the brand and type (liquid or granular) of lawn fertilizer you use:
❑ Check here if your lawn is maintained by a professional landscape contractor.
Address-
Title of File
Page of
Date f=ile Open:
a�t� ale dosed
Doc Document/Action Title Date of
action Refer to other purpose of 17ocuMent/Action and notes
Nun-1. Document/ document/ --
Action De artment
Board of Appeals - Board of Heal -..-I lanmm��g Board ; Cons
ervatiion Commission - Buil-ding Departnlen.t --'—
Commonwealth of Massachusetts
Massachusetts
System Pumping Record
System Owner System Location
T/f 1--( c- 9 ®fJ- (. G S?
Date of Pumping: D / Quantity Pumped: gallons
Cesspool: No ❑ Yes ❑ Septic Tank: No ❑ Yes.
Y
System Pumped by: br`4r¢d" 4i9&"Qdw License#
Contents transferrred to : Greater Lawrence Sanitary District
Date: Inspector:
t
NEW ENGLAND ENGINEERING SERVICES
INC
June 17, 2000
North Andover Board of Health
Town Hall Annex
27 Charles Street
North Andover, MA 01845
RE: TITLE V REPORT: 190 Dale Street,North Andover
Dear Sirs:
Enclosed is a copy of the Title V report for the above referenced property. The systemaP ssed our
inspection.
If there are any questions please call me at my office, 686-1768.
Sincerely
1314 rlin C. Osgoo2r., E.I.T.
President
,7:1 2'G .-
60 BEECHWOOD DRIVE-NORTH ANDOVER,MA 01845-(978)686-1768-(888)359-7645-FAX(978)685-1099
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C&MONWEALTH OF MASSACHUSE'T'TS ,
EXECUTIVE'OFFICE OF ENVIRONMENTAL AFFAIRS 'l°=
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DEPARTMENT OF ENVIRONMENTAL PROTEMON
ONE WINTER STREET,BOSTON MA 02108 (617).29A500 , 2?d
.ay
ARGEO PAUL CELLtUCCI- DAVID 0:S7`&Ugg
Governor Cotttmiss�Qigei:'
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM - :,..:;._..•.
PART A
CERTIFICATION
Property Address:, /4vN. AAJ D Name of owner Gt-e&V o*Jjr u s W .
Address of Owner: 1410 0-ALiE sT1 ,t,9, fin!Q.
Date of Inspection:
Name of In.spector (Please Print) Beniatnin C. Osgood,Jr.
i am a DLP approved system Inspector pursuant to Section 15.340 of Title 5(310-CMR 15.000)
Company Name: New England -Engineering Services Inc.
Ma.'ingAddress: 60 Beechwood Drive. North Andover, MA
Telephone Number: 978-686-1768
CERTIRCAIION STATEMENT
1 certify that 1 have personally inspected the sewage disposal system at this address and that the Information•reported below is true.accurate
and complete as of the•time of inspection. The Inspection was performed based on my training and experience In the proper function and
maintenance of on=site sewage disposal systems. The system:
Passes •
_ Conditionally Passes
Needs FurtherEvaluation By the Local Approving Authority
Fags•
Inspector's Signature: Date: / 00
The System Inspector shall submit a copy zs inspection report to the Approving Authority(Board of Health or DEP)wMin thirty(301-days of
completing this inspection. If the system Is a shared system or has a design flow of 10,000 gpd or greater,the Inspector and the system owner
shall submit the report to the appropriate regional office of the Department aKinv)ronmental Protection. The original should')*sent tovw
system owpar•and copies sent to the buyer,if applicable,and the approving authority.
NOTES AND COMMENTS
j), s��fi'e 7�.�/e o..T1,�'i Te�tF /S (,.n,��; .(l E'w TES
a� /.a✓.v D R .Vee p r �U b e '�'t�c c.Y i., 76
revised 9/2/98 ' per Ior11
1 el IRFACE SEWAGE DISPOSAL SYSTEM INSPECTION-fORM
. PART'A
Property Address: 190 Dale Street CERTiRCAY7011(con itzmd) '.
^'- -North Andover.
^
Owner:Gregory Kanevski
Date of Inspection:6/17/00
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INSPECTION SUMMARY: Check A, •B, �, or D:
Ap SYSTEM PASSES: '
V 1 have not found any Information which indicates that any of the failure conditions described In 310 CMR 15:303 exist. Any:faQure'•'
criteria not evalyated 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 pf the replacement or repair,as approved by the Board of Health,will pals.
Indicate yes,no,or not determined(Y.N,or ND). Describe basis of determination in all Instances. If`not determined',explain why not.
_ The septic tank is metal,unless the owner or operator has provided the system inspector with a copy of a Certificate of
Compliance(attached)indicating that the tank was Installed within twenty(201 Years prior to the date of the inspectioh;or
the septic tank,whether or not metal,is cracked,stntcturaily,unsound,shows substantial infiltration or exfiluation,or tank
failure is imminent.. The system will pass inspection if the existing septic tank Is replaced with a complying septic tank as
approved by the Board of Health.
_ Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pips(s)
or due to a broken.settled or uneven distribution box. The system will pass Inspection if(with approval of the Board of
Health).
broken pipe(s)are replaced
obstruction is removed
distribution box is levelled or replaced
- _ - The system required pumpMMore thanfourlmes n year•due to broken or vtrstmcted plpe(si. The sys
inspection If(with approval of the Board of-Health):
broken pipes)are replaced
obstruction is removed
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w"VRFACE SEWAGE DISPO$AL SYSTEM INSPECTION FORM _ •, ;�s"/h+ . ri
PART A *:.x•:.,:��
Property Address: 190 Dale Street CERMFiCATION(continued)
North Andover
Owner:Gregory Kanevski _
Date of Inspection:6/17/00
C. FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH:
Co6ditiohs exist which require further evaluation by the Board of Health in order(o determine If the system Is taping to protedithe•:"-
public health,safety and the environment.
1) SYSTEM WiLL PASS UNLESS BOARD OF HEALTH DETFRMWES IN ACCORDANCE WiTH 310 CMR 16.303(1)(b)•THATTHESYSTE
IS NOT FUNCTIONING IN A MANNER WH.ICH_WILLPRQgCT,THE PUBLIC HEALTH_AND SAFETY AND THE E3f.KIHONME2,Lt
Cesspool or privy is within 50 feet of surface water
Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh.
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21 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 AND SAFETY AND THE 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 soil absorption system and the SAS is within a Zone I of a public water supply wap:
_ The system has a septic tank and soil absorption system and the SAS is within 60 feet of a private water supply wall.
The system has a septic tank and soil absorption system and the SAS Is less than 100 feet but 60 feet or more from a
private water supply well;unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the
well Is free from pollution from that facility and the presence of ammonia nitrogen and nitrate niuogen is etluaito or less
than 5 ppm., Method used to determine distance (approximation not valid).•
31 OTHER
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SUBSURF�CESEWAGE DISPOSAL SYSTEM INSPECTION FORM
i PART A + ';
CERTIRCATiON(continued) _
Property Address: 190 Dale Street 4
North Andover '
Owner:Gregory Kanevski - - -
Date of Inspection:6/17/00 ^ 1
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D.• SYSTEM FAILS: l
You must indicate either"Yes"or"No' to each.of the following; 1 r
1 have determined that one or more of the following failure conditions exist as described in 310 CMR 16.303. The basis for this
determination is identified below. The B and of Health should be contacted to determine what will be necessary to correct the failure.
Yes No
Backup of- a lage lato facility-or- -tom component•due%to an ovedoeded or•ciaggedSASor•cesspooi.' • jr►——:�-_,
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 112 day flow.
Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).
Number of times pumped_.
Any portion of the Soll'Absorption System,cesspool or privy is below the high groundwater elevation.
Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply.
Any portion of a•cesspool or privy is-within a Zone 1 of a public well.
Any portion of a:cesspool or privy is within 60 feet of a private water supply well.
Any portion of a'eesspooi or privy is less-than 100 feet but greater than 60 feet from a private water supply well with no
acceptable water quality analysis. If the well has been analyzed to be acceptable,attach copy of well water analysis for
—coliform bacteria,volatile organic compounds,ammonia nitrogen-and nitrate nitrogen.
E. LARGE SYSTEM FAiLS:
You must indicate either"Yes'or"No" to each of the following:
The following criteria apply to large systems in addition to the criteria above:
The system serves a facility with a design fiow'of 1:0.000 gpd or greater(Large System)and the system Is a significant throat to public
health and safety and the environment because one or more of the following conditions exist:
Yes No
the`system is within 400 feelt of a surface drinking water supply l
the syctem4a-wIWn200 feet ofa t�ibuEarY lsa�urt�oe�dnkiwy waNr w�}iY• --
the system Is located in a nitrogen sensitive area(Interim Wellhead Protection Area=iWPA)or a napped Zone 0 of a public
water supply wen) {
The owner or operator of any such system shall upgrade the System in accordance with 310 CMR 16.304(2). Please consult the local regional
office of the Department for further(nfortnation.
revised 9/2/98 Page 4oftt
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SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPEC710 FORM L
PART B "x,£
~' CHECKLIST
Property Address: 190 Dale Street - I
North Andover -
Owner:Gregory Kanevski
Date of Inspection: 6/17/00 ', y
' Check if the following have been dorie:You must Indicate either"Yes"or"No"as to each of the following:
Yes No
Pu.L ping information was provided by the owner,occupant,or Board of Health.
-None of the syctemcompoaanu.hstw bean pnatiPadxfor atlaast two•aueakc sru the•syctam hasbaaa=calssipg-saiiKal-low
rates during that period. Large volumes of water have not been introduced into the system recently oras part of-this
inspection.
_ As built plans have been obtained and examined. Note if they are not available with N/A.
_ The facility or dwelling was inspected for sighs of sewage back-up.
_ The system does not receive non-sanitary or industrial waste flow.
Ae _ The site was inspected for signs of breakout.
_ All system components.excluding the Soil Absorption System,have been located on the site.
_ The septic tank manholes were uncovered,opened,and the interior of the septic tank was Inspected for condition of baffles
or tees,material of construction,dimenslons,depth of liquid,depth of sludgb,depth of scum.
/ The size and location of the Soil Absorption System on-the site has been deormined based on:-
✓ Existing information.For example.Plan at B.O.H.
✓ Determined In the field(if any of the failure criteria related to Part C is at issue,approximation of distance Is unacceptable)
(16.302(3)(6)1 -
The facility owner(and.occupaats,H different rormati monsla pto ••^gar uasna"f
SubSurface Disposal Systems.
is
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revised 9/2/98 Page sertt
SUBSURFACE SEWAGE OISPOSAI;SYSTEM INSPECTION FORM
....ti PART
SYSTEM INFORMATION
Property Address: 190 Dale Street
F'
North Andover i. ' '•I
Owner:Gregory Kanevski
�,.:.
Date of Inspection: 6/17/00
FLOW CONDITIONS
RESIDENTIAL:
t �•ih.
Design flow: i g.p.d./bedroom.
Number of bedrooms{design): Number of dedrooms(actual) t
Total DESIGN flow
NY'mber of current residents.-?—
Ghrba9e grinder(yes or no)-,LO
Laundry(separate system) (yes or no):jej If yes,separate.i{upection•required
Laundry system Inspected (yes or no) rS 1�fTw
Seasonal use(yes or no):,A/—U
Water meter readings,if available(last two ear's usage( d)::
9 Y 9 9P
Sump Pump(yes or no)-."
Last date of occupancy: Gc9r/e Alr'r
i
C6MMERf3AL/iNDUSTRIAL•
Type of establishment:
Design flow: 9pd (Based on 15.203)
Basis of design flow
Grease trap present:(yes or nol_
Industrial Waste Holding Tank present:(yes or no)_
Non-sanitary waste discharged to the Title b system:(yes or no)_
Water meter readings,if available:
t .
Last date of occupancy:
Oj HER:(Describe)
Last date of occupancy:
GENERAL WFORMATION.
PUMPING RECORDS and source of information:
w K t lefty O4e t>w*wf-
System pumped as part of inspection:(yes or no).44V
If yes,volume pumped: gallons
Reason for pumping:
TYPE OF SYSTEM
Y Septic tank/distribution box/soll absorption system
T Single cesspool
Overflow cesspool :.
Privy
f Shaved system(yes or no) Of yes,attach previous Inspection recprds,if any)
I/A Technology etc.Attach copy of up to date operation and maintenance contract
Tight Tank Copy of DEP Approval s s
Other R
APPROXIMATE AGE of ail components,date lnstalle"f icnown)•end source oMnformation: -•--• lJl'l'? rg43
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Sewage odors detected whewarriving at the she:(yes or no).&V f `
revised 9/2/98 Put 6Oftt
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cr mcI NFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
Property Address: 190 Dale Street SYSTrrm INFORMATION(condnuedl
North Andover .'~
Owner:Gregory Kanevski
Date of Inspection:6/17/00 ty-
! BUILDING SEWER:
(Locate on site pian)
Depth below grade-& t
Material of construction: /cast iron 40 PVC other(explain)
Distance from private.water supply well or su tion line
Diameter
r•
_ ,.�:... .
Comments: condition t foints.ve tin ,evidence of toe a-etc.1 7
SEPTIC TANK•_
(locate on site•ptan)
Depth below grade:
Material of construction:oncrete—metal_Fiberglass _Polyethylene_other(explain)
If tank is(netal,fist age_ 1s.age.confirmed by Certificate of Compliance_(Yes/No)
Dimensions: /,ta 6W^-.0✓'>
Sludge
N
•S u g _
Distance from top of sludge to bottom of outlet tee ortiaffle:166L4'
N
Scum thickness: t9
Distance from top of scum to top of outlet tee or baffle:;eV*
Distance from bottom of scum to bottom of outlet tee or baffle:A,*
How dimensions were determined: srYltrsryw tt1GIG
Comments:
(recommendation for pumping.condition of inlet and outlet tees or-baffles,depth of fiquid level In relation to outlet Invert.-structuraHMerlr(ty,
evidence of leakage,etc.) 1,AJ r r 4L ✓VY.
Ns w Is if"an&FWo> rV s N
e" ZU l N IN 4r3
O�'N ly✓Cr�3
GREASE TRAP:,i./�.
(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 df outlet tee or baffle: s
Date of last pumping:
Comments:
(recommendation for pumping,condition of Inlet and outlet tees or baffles,depth of fiquid.level in relation to outlet Invert,structural integrity,
evidence of leakage,etc.)
r
revised 9/2/98 Pate 7ofit
�e
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FOAM• �
S PART C r,t
SYSTEM INFORMATION(condelued) :c..
Property Address: 190 Dale Street r
4 North Andover 1: • ' �'• ;
Owner:Gregory Kanevski t •
Date of Inspection: 6/17/00
TIGHT OR HOLDING TANK"tTank must bo pumped prior to,or at time of,Inspection)
(locate on site plan) ^i S
t r Y`rAi
Depth below grade:_
Material of construction: c'ncrete_metal Fber foss_Polyethylene—other(explain)
Dimensions: -
Capacity: gallons .
Design flow: gallons/day
Alarm present
Alarm level: Alarm In working order:Yes_ No
Datd of previous pumping:
Comments:
(condition of inlet tee,condition of alarm and float switches,etc.)
DISTRIBUTION 130X:_
(locate on site plan)
Depth of liquid level above outlet invert: 0_
Comments:
(note If level and distribution Is equal,evidence of solids carryover,evidence of leakd$$a Into or out of box,etc.) — —
Bez iN 6-VOP [oNOr716Ar, No FurQG�tlGC' O/` �a�ivc c,m,rttJavr,L
y.tJ E4dk3 Al_ �r s T Mt tl,w A
PUMP CHAMBER.&A
(locate on site plan)
Pumps In working order:(Yes or No)
Alarms In working order(Yes of No)
Comments: 1. 1
(note condition of pump chamber,condition of pumps and appurtenances,etc.) -
i _
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revised 9/2/98 Pate I of 11
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-FACE SEWAGE DISPOSAL YSTEMiNSPECTiO.k FORM -�
PART C
Property Address: 190 Dale Street SYSTEM INFORMATION(cor>tinued)
North Andover :t'M
Owner:Gregory Kanevski
Date of Inspection:6/17/00
SOIL ABSORPTION SYSTEM(SAS):_
(locate on site,plan,if possible;excavation not required,location may be approximated by non4ntruslve methods)
If not located,explain;
Ty e:
leaching pits;number:_
leaching chambers,number:_
leaching galleries,number:_
leaching trenches,number,length: Z r cµtrf.
leaching fields,number,dimensions:
overflow cesspool,number:_
Alternative system:
Name of Technology:
Comments:
(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,etc.) f np
/S'fLE'Pa- SYsTVA4 f-06 IL,S NO 1 A4&. NO iiNO/t 4 h a� s3r ►7dNt34�1q
QwwP 5614 blZ 1-5A) Cols&f 77P77d M
CESSPOOLS:
(locate on site plan)
Number and configuration: ;
Depth-top of liquid to inlet invert:
Depth of solids layer:
Depth of scum layer:
Dimensiot*of cesspool:
Materials of construction:
Indication of groundwater:
Inflow(cesspool must be pumped as part of inspection)
Comments:
(note condition of soil,signs of hydraulic faituraAevel of ponding,condition of.vegetation,etc.l
i
PRIYY:1y_.a - `
l:
(locate on she plan)
s t s
Materiels of construction: Dimensions! =
Depth of solids•
Comments:
(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation.etc.)
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2 9/ /98 Pile 9 of It
• i
SUBSURFACE 9ErGE DISPOSAL SYSTEM INSPECTION FORM i
PART C
SYSTEM INFORMATION(continued)
Property Address: 190 Dale Street
North Andover r r n -
Owner:Gregory Kanevski
Date of Inspection:6/17/00 `
:SKETCH OF SEWAGE DISPOSAL SYSTEM: ,
Include ties to at least t*o permanent reference landmarks or benchmarks I
locate all wells within 100'(Locate where public water supply comes into house) '
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SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION TIM
PART C
SYST_EPA INFORMATION(con6nueA
Property Address: 190 Dale Street
North Andover
Owner:Gregory Kanevski
Date of Inspection: 6/17/00
NRCS Report nems god-Y ELS EK Cc%✓T•y MrFxs No fzTHtXw M d7
Soil Type_ .5 V S ` IS TTaaJ
Typical depth to groundwater j► S' 7t� 3..5� -`
USGS Date website visited
Observation Weill checked
Groundwater depth: Shallow Moderate Deep
SITE EXAM Slope
Surface water
Check cellar
Shallow wells
Estimated Depth to Groundwater_Feet
Please Indicate all the methods used to determine High Groundwater Elevation:
Obtained from Design Plans on record
_Y Observed.Site(Abutting property,observation hole,basement sump etc.) -
Determined from local conditions
Checked with local Board of health
Checked FEMA.Maps
Checked pumping records
Checked local excavators,installers
Used USGS Data
Describe how you established the High Groundwater Elevation.(Must be completed)
t1,oPorw Tb- gAClc bc,RO, %V C7- AREA• lJ e" TO 8�
OA of IYL' c C
•- VS(s s ,P&—IA
drf- be fie.... (�-��,�o.
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revised 9/2/98 : Pact tt or it