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Home My WebLink AboutMiscellaneous - 2240 TURNPIKE STREET 4/30/2018 (2)0 Lot & Street Map/Parcel CONSTRUCTION APPROVAL Has plan review fee been paid: NO Permit# Plan Approval: Date: /// / Approved by: Q17, Designer: -Plan Date: Conditions -- Water SuppIy< Well Permit: Well Tests: Chemical Bacteria I Bacteria H Plumbing Sign -Off: Comments: _..Driller: Date Approved Aa `9 Date -Approved a Date Approved q y _ Wiring Sign -Off. Form "U" Approval: Approval to -Issue: Date Issued By: Conditions: NO Final Approval: All Permits Paid? _ NO Well Construction Approval? S NO Septic System Construction Approval? NO Certification? NO Other YES NO Any Variance Needed? YES CN FINAL BOARD OF HEALTH APPROVAL: DATE: APPROVED BV: r SEPTIC SYSTEM INSTALLATION s Is the installer licensed? NO - Type of Construction: NEW REp,aJ SEPTIC SYSTEM INSTALLATION s Is the installer licensed? NO - Type of Construction: NEW REp,aJ New Construction: --Certified Plot Plan Review YES 1 -Floor Plan Review YES NO _— Conditions of Approval from Form U YES NO _Issuance of DWC permit: - YES NO _DWC Permit Paid? -- YES NO . ---DWC-Permit # _ Installer:�� --_---Begun-Inspection:_ _ NO _ __. -Excavation Inspection: Needed - .—Passed: ._-Construction Inspection: Needed: , uilt-P an Satisfactory: ME - Approval of Backfill: Date: / By: � v -Final Grading Approval: Date:S b& ) Q y Final Construction Approval: Date: 44.1_' By: Certificate of Compliance: Approval:// Date: Commonwealth of Massachusetts North Andover, Massachusetts System Pumping Record Jessica Abreu 2240 Turnpike Street North Andover. 01845 Location of system: Front Date of Pumping: August 15, 2012 Type of system: Septic Tank Gallons Pumped: 1500 gallons System pumped by: Service Pumping & Drain Co., Inc. S Hallberg Park North Reading, Ma License #: BHP -2011-0413,0412,0411,0410,0409,0408 i ` L., l TO',VN OF NORTH ANDOVER HEALTH H DEPART�VIE Contents transferred to: Greater Lawrence Sanitary District Date: August 15, 2012 Pumping Technician: BL This is PROPRIETARY and CONFIDENTIAL information that may be used only by the Board of Health for regulatory purposes Commonwealth of Massachusetts North Andover, Massachusetts System Pumping Record System Owner & Address: Jessica Abrew 2240 Turnpike St North Andover, Ma 01845 Location of system: Front Date of Pumping: December 23, 2011 Type of system: Septic Tank Gallons Pumped: 1500 gallons System pumped by: Service Pumping & Drain Co., Inc. 5 Hallberg Park North Reading, Ma AN `1N TOWN OF NORTH ANDOVER HEALTH DEPARTMENT License #: BHP -2011-0413,0412,0411,0410,0409,0408 Contents transferred to: Greater Lawrence Sanitary District Date: December 23, 2011 Pumping Technician: AS This is PROPRIETARY and CONFIDENTIAL information that may be used only by the Board of Health for regulatory purposes Commonwealth of Massachusetts P City/Town of NO. ANDOVER y System Pumping Record 1 3 2008 Form 4 r ;v©ovER M TQv ' v1ENT Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. reaan DEP has provided this form for use by local Boards of Health. Ot she 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: 2240 TURNPIKE ST. Address NO. ANDOVER MA 01845 City/Town State Zip Code 2. System Owner: GRUMJOO RA Name Address (if different from location) City/Town B. Pumping Record 1. Date of Pumping 10/6/08 Date 3. Type of system: ❑ Cesspool(s) ❑ Other (describe): 4. Effluent Tee Filter present? ❑ Yes No 5. Condition of System: 6. System Pumped By: Benjamin Shute Name J's Septic & Drain Company 7. Location where contents were disposed: GLSD _ /> State Zip Code Telephone Number — 2 Quantic Pd* 1500 Y Umpe . Gallons R/S'eptic Tank ❑ Tight Tank If yes, was it cleaned? ❑ Yes ❑ No H79 406 Vehicle License Number 10/6/08 Date t5form4.doc• 06/03 System Pumping Record • Page 1 of 1 Commonwealth of MassachusettsI�1Pp City/Town of NO. ANDOVER System Pumping Record NOV - 9 2co5 Form 4 ,M TO{WN OF NORTH ANL)OVE jEALTH DEPART. MENT R DEP has provided this form for use by local Boards of Health. Other e ut 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. Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. VQ waen A. Facility Information 1. System Location: 2240 TURNPIKE ST. Address NO. ANDOVER MA 01845 City/Town State Zip Code 2. System Owner: GEUMJOO RA Name Address (if different from location) City/Town B. Pumping Record 1. Date of Pumping 10/15/05 Date 3. Type of system: ❑ Cesspool(s) B Other (describe): a470 4. Effluent Tee Filter present? ❑ Yes N' No 5. Condition of System: 6. System Pumped By: -�Lm —a �— V `4--s - L.urYre_r Name J's Septic & Drain Company 7. Location where contents were disposed: GLSD _ of State Telephone Number 2. Quantity Pumped Septic Tank Zip Code 2000 Gallons ❑ Tight Tank If yes, was it cleaned? ❑ Yes ❑ No H79 406 Vehicle License Number 10/15/05 Date t5form4.doc- 06/03 System Pumping Record - Page 1 of 1 System Owner Commonwealth of Massachusetts N `AA -A,-". Massachusetts System Pumping Record System Location Bu-- � Ae)�s '), D S� Date of Pumping: 3 '7 —D(5t5�J Quantity Pumped: gallons �j V,, -Hz-,A Cesspool: No � - Yes Ll Septic Tank: No `Yes L System Pumped by: Fat`edda Ere&M,64aa License # Contents transferrred to : Greater Lawrence Sanitary District Date: _ Inspector- Owner information is required for every page. Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. _1A Commonwealth of Massachusetts Tale 5 Official Inspection Form A:A-u -5 Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 2240 Turnpike St. Property Address Geumjoo Ra Owner's Name North Andover Ma. 01845 4-2-11 Citylrown 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. RECEIVED A. General Information 1. Inspector: APR 11 ZQ11 TOWN OF NORTH ANDOVER rOCAL I M UftFAKTMENT N. Timothy White ..�.,..,,..,,.,..��.�,.,, Name of Inspector Homepro Northshore Company Name 75 Glen St. ( P.O. box 101) Company Address Rowley Cityrrown ( 978-948-8428) Telephone Number B. Certification Ma. State S12015 License Number 01969 Zip Code 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 ❑ Needs Further Evaluation by the Local Approving Authority M_ 1 r--�-� %� --U- 4-2-11 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 the future under the same or different conditions of use. t5ins • 09/08 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 1 of 17 Owner information is required for every page. l Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 2240 Turnpike St. Property Address Geumjoo Ra Owner's Name North Andover Ma. 01845 4-2-11 City/Town 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: 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): na t5ins • 09/08 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 2 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ;M 2240 Turnpike St. Property Address Geumjoo Ra Owner Owner's Name information is required for North Andover Ma. 01845 4-2-11 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 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(s) 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): na ❑ 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): na 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 • 09/08 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 3 of 17 Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 2240 Turnpike St. Property Address Geumjoo Ra Owner's Name North Andover Ma. 01845 4-2-11 Cityrrown State Zip Code Date of 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 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 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: na 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 Y2 day flow t5ins • 09/08 Title 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 M 2240 Turnpike St. Property Address Geumjoo Ra Owner Owner's Name information is required for North Andover Ma. 01845 4-2-11 every page. Citylrown State Zip Code Date of Inspection B. 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 pumped: El® Any portion of the SAS, cesspool or privy is below high ground water elevation. El® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. El® Any portion of a cesspool or privy is within a Zone 1 of a public well. E]® Any portion of a cesspool or privy is within 50 feet of a private water supply well. E]® 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- 10,000gpd. ❑ ® 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. 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 — 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. t5ins • 09/08 Title 5 Official Inspection Forth: Subsurface Sewage Disposal System • Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 2240 Turnpike St. Property Address Geumjoo Ra Owner Owner's Name information is required for North Andover Ma. 01845 4-2-11 every page. Cityfrown State Zip Code Date of Inspection 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) ® ❑ 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? ® ❑ 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: ® ❑ 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 (design): 4 Number of bedrooms (actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x # of bedrooms): 110-440 gpd t5ins - 09/06 Title 5 Official Inspection Form: 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 2240 Turnpike St. Property Address Geumjoo Ra Owner Owner's Name information is required for North Andover Ma. 01845 4-2-11 every page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 4 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage d 9 ( Y 9 (gP ))= well Detail: Sump pump? ❑ Yes ® No Last date of occupancy: still occupiedDate 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.• 09108 Title 5 Official Inspection Forth: Subsurface Sewage Disposal System • Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 2240 Turnpike St. Last date of occupancy/use: Other (describe below): na General Information Pumping Records: Source of information: Was system pumped as part of the inspection? If yes, volume pumped: How was quantity pumped determined? Reason for pumping: Date 4-2-11 Date of Inspection last pumped 1 year information from owner gallons 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 • 09/08 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 8 of 17 Property Address Geumjoo Ra Owner Owners Name information is required for North Andover Ma. 01845 every page. Cityfrown State Zip Code D. System Information (cont.) Last date of occupancy/use: Other (describe below): na General Information Pumping Records: Source of information: Was system pumped as part of the inspection? If yes, volume pumped: How was quantity pumped determined? Reason for pumping: Date 4-2-11 Date of Inspection last pumped 1 year information from owner gallons 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 • 09/08 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 8 of 17 Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 2240 Turnpike St. Property Address Geumjoo Ra Owner's Name North Andover City/Town D. System Information (cont.) Ma. 01845 4-2-11 Date of Inspection Approximate age of all components, date installed (if known) and source of information: 7 years old Information from plans Were sewage odors detected when arriving at the site? Building Sewer (locate on site plan): Depth below grade: Material of construction: ❑ cast iron ® 40 PVC ❑ other (explain): 15 in feet ❑ Yes ® No Distance from private water supply well or suction line: 30 ft from incoming water line to outgoing sewer line Comments (on condition of joints, venting, evidence of leakage, etc.): joints & venting good condition - no evidence of leakage Septic Tank (locate on site plan): Depth below grade: 6 in with riser &cover at grade feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other (explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 10 long - 5ft wide 5 ft deep 1500 gal Sludge depth: 2in t5ins • 09/08 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 M 2240 Turnpike St. Owner information is required for every page. t5ins • 09/08 Property Address Geumjoo Ra Owner's Name North Andover Ma. 01845 4-2-11 Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank (cont.) Distance from top of sludge to bottom of outlet tee or baffle 33 in Scum thickness lin Distance from top of scum to top of outlet tee or baffle lin Distance from bottom of scum to bottom of outlet tee or baffle 15in How were dimensions determined? rulers & measuring rod Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank does not need to be pumped - inlet & outlet tees in very good condition liquid at bottom of outlet invert - no sign of leakage in or out of tank- tank in good condition Grease Trap (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass 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: feet ❑ polyethylene ❑ other (explain): Date Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 10 of 17 ' Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 2240 Turnpike St. Property Address Geumjoo Ra Owner Owner's Name information is required for North Andover Ma. 01845 4-2-11 every page. City/Town State Zip Code Date of Inspection 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.): na 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.): na * Attach copy of current pumping contract (required). Is copy attached? ❑ Yes ❑ No t5ins • 09/08 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 11 of 17 Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 2240 Turnpike St. Property Address Geumjoo Ra Owner's Name North Andover City/Town D. System Information (cont.) Ma. 01845 4-2-11 State Zip Code Date of Inspection 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 was level - distribution was equal - no solids carryover - no leakage in or out of d- box - size of d- box 16x16 in 16in deep 5in below qrade 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.): pump & alarm in good working order - pump chamber 10 in below grade with riser & cover at grade - 10 ft long - 5ft deep - 5ft wide - 1500 gal Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins - 09/08 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 2240 Turnpike St. Property Address Geumjoo Ra Owner Owner's Name information is required for North Andover Ma. 01845 4-2-11 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ® leaching trenches number, length: ❑ leaching fields number, dimensions: 3 trenches 70 ft long each - ❑ 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.): dry sand soil - no hydrulic failure - no ponding system was under upper front lawn Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth — top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ® No t5ins • 09/08 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 M 2240 Turnpike St. Owner information is required for every page. Property Address Geumjoo Ra Owner's Name North Andover Ma. 01845 4-2-11 Citylrown State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): na 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 • 09/08 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 14 of 17 A Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 2240 Turnpike St. Owner information is required for every page. Property Address Geumjoo Ra Owner's Name North Andover Ma. 01845 4-2-11 Cityrrown State Zip Code Date of Inspection 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 Ct li 5f t5ins • 09/06 Title 5 Official Inspection Forth: Subsurface Sewage Disposal System • Page 15 of 17 T Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 2240 Turnpike St. Property Address Geumjoo Ra Owner's Name North Andover City(rown D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Ma. 01845 State Zip Code 4-2-11 Date of Inspection Estimated depth to high ground water: from original grade groundwater 8 ft - system is raised 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: Date 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: You must describe how you established the high ground water elevation: from plans eshgw at 30 in groundwater at 100 in raised bed Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins • 09/08 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 16 of 17 ' Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 2240 Turnpike St. Owner information is required for every page. Property Address Geumjoo Ra Owner's Name North Andover Ma. 01845 4-2-11 City/Town State Zip Code Date of 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 - 09/08 Title 5 Official Inspection Forth: Subsurface Sewage Disposal System • Page 17 of 17 V Commonwealth of Mas 0 us _ tts Ir Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 2240 Turrnpike St Property Address Guen Aoo Ra Owner information is required for every page. Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. — I— ISI Owner's Name North Andover City/Town Ma. 01845 State Zip Code 5-17-08 Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. A. General Information 1. Inspector: N. Timothy White Name of Inspector HomePro Northshore Company Name 75 Glen Street Company Address Rowley City/Town (978)948-8428 Telephone Number B. Certification MAY 2 2 2008 TOWN OF NORTH ANDOVER HEALTH DEPARTMENT MA State S12015 License Number 01969 Zip Code 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 ❑ Needs Further Evaluation by the Local Approving Authority Inspector's Signature 5-17-08 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. Title V Form • 12/07 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 1 of 15 INCommonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 2240 Turrnpike St Property Address Guen Aoo Ra Owner Owner's Name information is North Andover Ma. 01845 required for every page. Cityrrown State Zip Code B. Certification (cont.) 5-17-08 Date of Inspection 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. 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: na ❑ 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 Title V Form • 12/07 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 2 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 2240 Turrnpike St Property Address Guen Aoo Ra Owner Owner's Name information is required for North Andover Ma. 01845 every page. Citylfown State Zip Code B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ distribution box is leveled or replaced ND Explain: 5-17-08 Date of Inspection ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if (with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ obstruction is removed ND Explain: na C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b) that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. Title V Form • 12107 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 3 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M �< 2240 Turrnpike St Property Address Guen Aoo Ra Owner Owner's Name information is required for North Andover Ma. 01845 every page. Citylrown State Zip Code B. Certification (cont.) C) Further Evaluation is Required by the Board of Health (cont.): 5-17-08 Date of Inspection ❑ 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 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: na 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 % 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 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. Title V Form • 12/07 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 4 of 15 Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 2240 Turrnpike St Property Address Guen Aoo Ra Owner's Name North Andover Ma. 01845 Cityrrown State Zip Code B. Certification (cont.) D) System Failure Criteria Applicable to All Systems (cont.): 5-17-08 Date of Inspection Yes No No ❑ ® 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 the system is within 200 feet of a tributary to a surface drinking water supply 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 Area — IWPA) or a mapped Zone II of a public water supply well 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- 10,000gpd. ❑ ® 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. 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 — 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. Title V Form - 12/07 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 5 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 2240 Turrnpike St Property Address Guen Aoo Ra Owner Owner's Name information is required for North Andover every page. Cityrrown Ma. 01845 5-17-08 State Zip Code Date of Inspection 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) ® ❑ 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? ® ❑ 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: ® ❑ 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)] Title V Form • 12/07 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 6 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 2240 Turrnpike St Property Address Guen Aoo Ra Owner Owner's Name information is North Andover Ma. 01845 5-17-08 required for every page. Citylrown State Zip Code Date of Inspection D. System Information Residential Flow Conditions: Number of bedrooms (design): 4 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x # of bedrooms): 110 - 440gpd 4 Number of current residents: Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage d 9 ( Y 9 (gpd)): well Sump pump? ❑ Yes ® No still occupied Last date of occupancy: 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: Last date of occupancy/use: Date Other (describe): Title V Form " 12107 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 7 of 15 Commonwealth of Massachusetts IS Title 5 Official Inspection Form E. Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 2240 Turrnpike St Property Address Guen Aoo Ra Owner Owner's Name information is North Andover Ma' required for every page. Cityrrown State D. System Information (cont.) 01845 5-17-08 General Information Pumping Records: Source of information: Was system pumped as part of the inspection? If yes, volume pumped: How was quantity pumped determined? Reason for pumping: Date of Inspection last pumped 2 year8 information from owner gallons ❑ Yes ® No 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) ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other (describe): Approximate age of all components, date installed (if known) and source of information: 4 years old information from owner & plans Were sewage odors detected when arriving at the site? ❑ Yes ® No Title V Form • 12/07 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 8 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 2240 Turrnpike St Property Address Guen Aoo Ra Owner information is required for every page. Owners Name North Andover Citylrown Ma. 01845. State Zip Code 5-17-08 Date of Inspection D. System Information (cont.) Building Sewer (locate on site plan): 15in Depth below grade: feet Material of construction: ❑ cast iron ® 40 PVC ❑ other (explain): Distance from private water supply well or suction line: 30ft from incoming water line to outgoing sewer line Comments (on condition of joints, venting, evidence of leakage, etc.): joints & venting good condition no evidence of leakage Septic Tank (locate on site plan): Depth below rade: 6in with riser & cover at grade p 9 feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other (explain) If tank is metal, list age: Years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No -------------------------------------------------------------------------------------------------------------------------- Dimensions: 10ft long - 5ft deep - 5ft wide 1500 gal lin Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle 34in Scum thickness lin Distance from top of scum to top of outlet tee or baffle 7 in Distance from bottom of scum to bottom of outlet tee or baffle 15in How were dimensions determined? measuring rod & tape measure Title V Form • 12/07 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 9 of 15 Commonwealth of Massachusetts u Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 2240 Turrnpike St Owner information is required for every page. Property Address Guen Aoo Ra Owner's Name North Andover Cityrrown 01845 5-17-08 Zip Code Date of Inspection 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.): tank does not need to be pumped - inlet & outlet tees in good condition - liquid at bottom of outlet invert - no sign of leakage in or out of tank 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 Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): na 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): Title V Form • 12/07 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 10 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 2240 Turrnpike St Property Address Guen Aoo Ra Owner Owner's Name information is North Andover Ma. 01845 5-17-08 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Tight or Holding Tank (cont.) 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.): na * Attach copy of current pumping contract (required). Is copy attached? ❑ Yes ❑ No 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 was level - distribution was equal - no sign of any solids carryover - no sign of leakage in or out of d -box - d -box was 5 in below grade - size was 16x16in inside depth 16in good condition no tee from pump chamber into d -box Pump Chamber (locate on site plan): Pumps in working order: ® Yes ❑ No Alarms in working order: ® Yes ❑ No Title V Form - 12/07 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 11 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 2240 Turrnpike St Property Address Guen Aoo Ra Owner Owner's Name information is required for North Andover Ma. every page. Cityfrown State D. System Information (cont.) 01845 5-17-08 Date of Inspection Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): pumped & alarm good working order - pump chamber 10 in below grade with riser & cover at grade 10 ft Iona - 5ft deer - 5ft wide 1500 oal Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ® leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: 3 trenches 70 ft long each 21 Oft Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): dry sand soil - no hydraulic failure - no ponding - system was under front lawn Title V Form - 12/07 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 12 of 15 Commonwealth of Massachusetts MAM Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 2240 Turrnpike St Property Address Guen Aoo Ra Owner information is required for every page. Owner's Name North Andover Cityrrown 01845 Zip Code 5-17-08 Date of Inspection D. System Information (cont.) Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth — top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): na 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.): na Title V Form - 12/07 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 13 of 15 Owner information is required for every page. k Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form = Not for Voluntary Assessments 2240 Turin ike St Property Address r_`rrcn Ann Pn Owner's Name North Andover Cityrrown D. System Information (cont.) Ma. 01845 State Zip Code 5-17-08 Date of Inspection Sketch of Sewage Disposal System: Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. w r t AL3 r 4v / S _ IL, ( g API gc-, q i Rj tl Tills 5 official Inspection Forth: Subsurface Sewage Disposal System - Page 14 of 15 Title VForm - 12107 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 2240 Turrnpike St Property Address Guen Aoo Ra Owner Owner's Name information is required for North Andover Ma. every page. Cityrrown State D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells 01845 5-17-08 Date of Inspection Estimated depth to high ground water: 8ft from original grade sysetm is raised 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: Date 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: You must describe how you established the high ground water elevation: from plans eshgw at30in groundwater at 1 00i raised bed Title V Form - 12/07 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 15 of 15 TOWN OF NORTH ANDOVER BOARD OF HEALTH CERTIFICATE OF COMPLIANCE DATE OF COMPLIANCE: 11/24/99 This is to certify that the individual subsurface disposal system constructed (X) or repaired ( ) by Peter Breen at #2240 Turnpike Street _ has been installed in accordance with the -provisions of Title V of the State Sanitar} Code and with the North Andover Board of Health regulations as described in the Design Approval Site System Permit # 1045 dated 1/11/99. The Issuance of this certificate shall not be construed as a guarantee that the system will function satisfactorily. Board of Health Inspector TOWN OF NORTH ANDOVER SEWAGE DISPOSAL SYSTEM INSTALLATION CERTIFICATION The undersigned hereby certify that the Sewage Disposal System ()() constructed; ( ) repaired; by A -VZ located at #2ZLj Q-ruP,"N5 was installed in conformance with the North Andover Board of Health approved plan, System Design Permit #/fl �5 ' dated 1111--117Y , with an approved design flow ofA140 gallons per day. The materials used were in conformance with those specified on the approved plan; the system was installed in accordance with the provisions of 310 CMR 15.000, Title 5 and local regulations, and the final grading agrees substantially with the approved plan. All work is accurately represented on the As -built which has been submitted to the Board of Health. Installer: Lic. #: Date: f , Design Engineer: �. a^-- ✓1 �c� ,.�_ Date: OF DANIEL KORAVOS CIVIL No. 37752 APPLICATION FOR DISPOSAL WORKS CONSTRUCTION PERMIT DATE: CURRENT r STALLER'S LICENSE" LOCATION: G6 G A 7-eJrlfPl, Ie � LICENSED L`ZSTALLER: PP_ Tc -/- SIGNATURE:- cfSIGNATURE: �� TELEPHONE# b % - / Y CHECK ONE: • "m NEW CONSTRUCTION: IF NEW CONSTUCTION, PLEASE ATTACH FOUNDATION AS -BUILT. Administrative Use Only 575.00 Fee Attached? Yes No_ Foundation As -Built? Yes No Floor Plans? Yes No Approval Date: �� / f AS -BUILT CHECKLIST LOT NUMBER, STREET NAME ASSESSORS MAP & PARCEL NUMBER LOT LINES & LOCATION OF DWELLINGS LOCATION & DEMENSIONS OF SYSTEM, NCLUDING RESWVE r/ TIES TO LOT LINES & DWELLING, WELLS a. FROM SEPTIC TANK b, FROM LEACH AREA ' LOCATIONS OF DEEP HOLES & PERC TESTS y ELEVATIONS OF DISPOSAL SYSTEM TOP OF FDN ELEVATION LOCATIONS OF WELLS, DRAINS, WATERCOURSES W/N 1 50' OF SYSTEM LOCATION OF WATER, -GAS, ELECTRIC LINES, CABLE DISTANCES FROM CORNERS OF HOUSE TO CENTER OF TANK & D -BOX STAMP & SIGNATURE IMPERVIOUS, AREAS - DRIVEWAYS, ETC. NORTH ARROW FINAL CONTOURS / LOCATION & ELEVATION OF BENCHMARK USED LOCUS PLAN MERRIMACK ENGINEERING SERVICES INC. Engineers • Surveyors • Planners 66 Park Street ANDOVER, MASSACHUSETTS 01810 (5esi 475-3555 Fax (508) 475-1448 TO `zjA Z0 car_ HEAL 1 H Z! cH/iIZG1F S STT �► 2 z I Vol WE ARE SENDING YOU ❑ Shop drawings ❑ Copy of letter LLIEUumn OF DATE JOB NO. ATTENTION 3u r RE: '* _L40 'Up L(Pj 1aCST" 2 S-✓ic— ❑ Attached ❑ Under separate cover via the following items: ❑ Prints ❑ Plans ❑ Samples ❑ Specifications ❑ Change order ❑ COPIES DATE NO. DESCRIPTION 2 S-✓ic— THESE ARE TRANSMITTED as checked below: REMARKS COPY TO ❑ For approval ❑ For your use As requested ❑ For review and comment ❑ FORBIDS DUE ❑ Approved as submitted ❑ Approved as noted ❑ Returned for corrections ❑ Resubmit ❑ Submit ❑ Return —copies for approval copies for distribution corrected prints 19 ❑ PRINTS RETURNED AFTER LOAN TO US TRZ- SCF j RJ= CW57A a C,3 Pi r__S 'TD {Z,C-PtA CJS THEy l iZS U__ 6ODi f SIGNED: If enclosures are not as noted, kindly notify us at once. C CVS Z E 0 LL i un a� 7 t U H � J � Q L w I O LL C 0 Q t � }+ Q O 0 Z CO 140 c .a O Q = F - _ .O` N Q W_ iV LL. O .� a .51 c O Z 2 a Vi c vi L < > fl. d 0 fl. fl O Q C N v D O N � L O U O c 0 v) c `^ a� � N L N d N -" a 0 D L � d � N (71\ 0, L - s :a O €w :A � � W �ONk 0 , E r coCLN fl EM C2 C/) N C O O rr, 1-+� U c E..� W r� O v J cc r cmcm F� i cm C_ �C N CD o � Z 0 o � 1 N u CD Q ai L ,Qs R` ^w li O y Q C CO CM CA Q O H O C m m 0 CD Cco ~ = R� C CD Q O C' O. 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L.± y C- O C •C C43 C ,&ORTN F w D SACMUS t� Town of North Andover, Massachusetts BOARD OF HEALTH Form No. 2 DESIGN APPROVAL FOR SOIL ABSORPTION SEWAGE DISPOSAL SYSTEM Applicant Test No. Site Location SAT 1 , Cl(1�.�0 �� C JC'� �- Reference Plans and Specs.— ENGINEER DESIGN r�AE Permission is granted for an individual soil absorption sewage disposal system to be installed in accordance with regulations of Board of Health. �5 0 Fee /J16' CHAIRMAN, BOARD OF HEALTH Site System Permit No. 6 MERRIMACK ENGINEERING SER VICES, INC. 66 PARK STREET ANDOVER, MA 01810 (978)473-3555 FAX: (978)475-1448 FACSIMILE COVER PAGE DATE: NUMBER OF PAGES:(INCLUDING COVER SHEET) TO: FROM: C 6 o D i tij COMMENTS: Zz : I" Z2.444 TDuLkPof�-, iT- A!7' SENDING TO FAX NUMBER: q_Cq -2_ CONFIRMING TELEPHONE NUMBER: FOR PROBLEMS, PLEASE CALL OPERATOR: (978)475-355555 TRANSMISSION: CONFIRM t NO CONFIRMATION NEEDED MERRIMACK ENGINEERING SERVICES, INC. • 66 PARK STREET • ANDOVER, MASSACHUSETTS 01810 SEPTIC PLAN SUBMITTAL FORM LOCATION: 4T- / (`'1-tq� /09(-1 /Z� r l -kms S NEW PLANS: YES $125.00/Plan REVISED PLANS: YES SITE EVALUATION FORMS INCLUDED DATE: /(&a Iq � $ 60.00/Plan (Ds NO sup; L DESIGN ENGINEER: /%�2r'�y ��.� Grre�..2,i•.� - o _ DATE TO CONSULTANT: When the submission is all in place, route to the Health Secretary. dIj Town of North Andover OFFICE OF COMMUNITY DEVELOPMENT AND SERVICES 27 Charles Street North Andover, Massachusetts 01845 WILLIAM J. SCOTT Director ' (978)688-9531 January 11, 1999 Merrimack Engineering Services 66 Park Street Andover, MA 01810 Attn: Les Godin RE: Lot 1, Map 108C Turnpike St. Dear Mr. Godin: This letter is to inform you that the proposed septic plan for Lot 1, Map 108, Turnpike Street has been approved for a dwelling with a maximum of nine rooms. If you have any questions, please do not hesitate to call the Board of Health. Office at the number below. Sincerely, Sandra Starr, R.S. Health Administrator cc: Orange Street Development, Inc. Fax(978)688-9542 BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 X FORM U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from 3oards and Departments having jurisdiction have been obtained. This does not relieve he applicant and/or landowner from compliance with any applicable or requirements. """""'"APPLICANT FILLS OUT THIS SECTION kP.PLICANT Q/Z PHONE .00ATION: Assessors Map Number - �� PARCEL ;UBDIVISION LOT (S) STREET -7--L11-z— n ST. NUMBER USE ONLY**************&**** RECQMMENDATIONS OF TOWN AGENTS: ` ( tt' CONSERVATION ADMINISTRATOR COMMENTS t S TOWN PLANNER 11 COMMENTS FOOD INSPECTOR -HEAL -T -f= -S.EPT'IN COMMENTS R -HEALTH uHl C At,rmuvCu DATE REJECTED DATE /APPROVED DATE REJECTED - DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED PUBLIC WORKS - SEWER/WATER CONNECTIONS DRIVEWAY PERM T FIRE DEPARTMENT ti n Kew r; S I n� RECEIVED BY BUILDING INSPECTOR DATE s.. SS -1-3o Ys Town of North Andover OFFICE OF COMMUNITY DEVELOPMENT AND SERVICES 27 Charles Street North Andover, Massachusetts 01845 WILLIAM J. SCOTT Director ` (978)688-9531 January 11, 1999 Merrimack Engineering Services 66 Park Street Andover, MA 01810 Attn: Les Godin RE: Lot 1, Map 108C Turnpike St. Dear Mr. Godin: This letter is to inform you that the proposed septic plan for Lot 1, Map 108, Turnpike Street has been approved for a dwelling with a maximum of nine rooms. If you have any questions, please do not hesitate to call the Board of Health Office at the number below. Sincerely, �- Sandra Starr, R.S. Health Administrator cc: Orange Street Development, Inc. Fax(978)688-9542 BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 Dec -06-98 09:25P Paul D. Turbide, PE/PLS 508-465-0313 P.02 December 6, 1998 Sandra Stan: North Andover Board of Health Administrator Office of Community Development and Services 30 School St. North Andover, MA 01845 RE: Title V review for Turnpike Street (108C-1) Dear Sandra, Enclosed find the "Checklist for North Andover Septic System Plans" for the above- mentioned site. We did not find any problem areas or deficiencies. (Two observations not related to the Title 5 review for which no revisions are necessary: I. The bottom of proposed foundation footing would be about 5 feet above existing grade. Probably a double foundation will have to be poured. 2. While there is a detail of proposed siltation control, there is no siltation control shown on the plan.) (I do not need to review this plan if revisions are made dealing with the above two non - Title 5 observations.) If you have any questions or comments please feel free to contact us. Sin i� ariton A. Brown, PE/pLS PTOR INGINERING Civil Engineers & Land Surveyors One Harris Street Newburyport, MA 01950 (978)465.8594 pmt Materiai ( geologic ]: Glacial TO Depth to Bedrock: > 108" Depth to Grbtirtdwater:lo6" Standing Water in Hole: Weeping from Pit Fac:e:1W Estimated Seasonal High Ground Water: 30".. tleterminstl2p for Seaffimilill High Water Tabl® Method used:. (j . Depm 0 Swan inOWwva*m Holt:. incites ( x l Depth weeping from side of 4b$004 tiort Hole: 106 intoes [ X ] Depth io soil Mottles in Observation mole: 20" uncles [ ] taro" water Adit,e� feet UxW Well N wtbar: ReadingZal e: Wee Lwl: Adjutgment Factor: Adjusted ground water lovel: Does at feast four feet of naturally oceuring pervious material e)dst in all areas observed throughout the area proposed for the Sol absorption systern ? Yes ( x j No (] • BASEQ MW 0 MM ONLY' S not, what istta4epth ed CIMuCetty occong pervious maesri*? WA ICertib�tfsaton: •.ttcgs.Edste}usa�asseo->fsesoitevan+eaor bg►,tne Deperirpe+Rt�€ Ier�ViieniaLP15,waspe by ma4amis�ent 1d, Uh *0 #airiing, -CMR 1b:04� Signature Date Commonwealth of MassachuffUs No. Andover, Massachusetts percolation_ lost* Date: 8.15.98 Time: Monting DepIh of Perc: W Peroolation Hole 1 1 Start Pre -Soak: 10:53 End Pre-soak: U ;16 Time @ 12':1.1:16 Time @ 9":11:46 Time @ S":1:04 Time (9"- Or): Minutes VS. I Rade Minn I Inch: (26 * Minimum of 1 percolation test must be performed in both the primary area AND the reserve area. Site Passed LX 1..... . Site PAW( ] Performed By: Peter Sheridan Witnessed By: Rudy -Rotolo Comments: £d WC62:60 8661 SO ""ON : 'ON SNOHd N3nNti1d3HS : WOa_� SOIL. EVALUATOFL .FORM PAGE 2 OF 2 Location Address or Lot No.1 Turnpike, No. Andover 898-T.: Dean Observation Note LOU Depth tram Surtax Sai HMmn Sal Texture ] Soli Cala Sol mauft Other I irrdr.s ] I Veda 1 1 mu d ( auchire. stones, . b z idv&aandstency, %,;nivel j 0-4 OA Sandy Loam 10yr 416 Friable, Fine Sandy Low ,Wlgravel,Fd's. 12 ow Sw*.Lown 5y5W Fit", Fine Sandy Low, Massive, Wt. 24 01 Loan Sand SyV4 020" Friable, Fine Sandy Loam, Mase, Firm 106 Cd Compeict Loamy Sand, 2.Sy5N Platrty, Fine Sandy Loam, Massive, Firm pmt Materiai ( geologic ]: Glacial TO Depth to Bedrock: > 108" Depth to Grbtirtdwater:lo6" Standing Water in Hole: Weeping from Pit Fac:e:1W Estimated Seasonal High Ground Water: 30".. tleterminstl2p for Seaffimilill High Water Tabl® Method used:. (j . Depm 0 Swan inOWwva*m Holt:. incites ( x l Depth weeping from side of 4b$004 tiort Hole: 106 intoes [ X ] Depth io soil Mottles in Observation mole: 20" uncles [ ] taro" water Adit,e� feet UxW Well N wtbar: ReadingZal e: Wee Lwl: Adjutgment Factor: Adjusted ground water lovel: Does at feast four feet of naturally oceuring pervious material e)dst in all areas observed throughout the area proposed for the Sol absorption systern ? Yes ( x j No (] • BASEQ MW 0 MM ONLY' S not, what istta4epth ed CIMuCetty occong pervious maesri*? WA ICertib�tfsaton: •.ttcgs.Edste}usa�asseo->fsesoitevan+eaor bg►,tne Deperirpe+Rt�€ Ier�ViieniaLP15,waspe by ma4amis�ent 1d, Uh *0 #airiing, -CMR 1b:04� Signature Date Commonwealth of MassachuffUs No. Andover, Massachusetts percolation_ lost* Date: 8.15.98 Time: Monting DepIh of Perc: W Peroolation Hole 1 1 Start Pre -Soak: 10:53 End Pre-soak: U ;16 Time @ 12':1.1:16 Time @ 9":11:46 Time @ S":1:04 Time (9"- Or): Minutes VS. I Rade Minn I Inch: (26 * Minimum of 1 percolation test must be performed in both the primary area AND the reserve area. Site Passed LX 1..... . Site PAW( ] Performed By: Peter Sheridan Witnessed By: Rudy -Rotolo Comments: £d WC62:60 8661 SO ""ON : 'ON SNOHd N3nNti1d3HS : WOa_� 10: SOIL EVALUATOR FORM RAGE 2 01F.2 Location Address or Lot No.1 Turnpike, No. Andover ams -1; Depth frau Swam sot Horizon Sob Team.). ad Cdor sol Mottling 011ie► [MW" [aruolm$tam, . bmAlem,owoldeney. `%. gr" 1 0-9 OA serrdy Loam 10yr 415 Fri", Fine Sandy Lwn .WlgraW.RPs. 1D -am Ri4b, Fjos Saaftbludw, RCS. 30 W L"M Sind 2.W4 ®30" Frwbie. Fk% Sally Lown, Massive, FUM 48 Cdt carpad Lo" Sand 2'iy5r4 Pitdrty, Re Sm* Lome, Mamire. Fin 132 C2 Fms Sally Loam SM Minimum of 2 Mbl ftukW at Evrxr ProwM Dls>MM Aces__ ` Patent Mat" (geologjC 1: GAC1111 Til Depth to Bedrock: > 132" Depth to Grourciwater:1WI Sfandft Water in Hole: Weeping from Pit Fwo;106" Estimated Seasonal High Ground Water: 30" Deter>EelnaBon for Seasonal 1#trrta WA ME Uwe Method I 1 Depth Observed stands% in ObsenrAftn Hose: irjohes [ x 1 Depth Wing from side of Observation Hole: 106 itches [ x j Depth to sal Mottles in Observation mate: W iricbes [ 1 Ground wader Adiustmenc feet index well Number: Ra&SV Date: Index.Well Level: Adjusirneni Foolm: A4ustea ground water level: Den�th at n>stursllV Ocet rinaPAnrous Ma1:aw Does at least four feet of naturally oc curing pervious material exist in all areas observed throughout the area proposed for the soil absorption syslarn ? Yes 1 x.1 No.[ .1 "_BASED ON W /98 ro1'eM-TES �tJLY N not.what isle dap1h.of nah refit ? NIA �e�ll;rRd*IAN - t. twtat-act: ti 1 t t� E dace.}.t.eu�a.passed-tbe sat�vatuatorc�ca�aa� tr�r the D"#ftW4"-fW0qAM0FAa Rasperforated by tteewsi�tent with the reranireo>rairgft, eKperje andexperience de.9cr;be6 k1410 CUR t&OV Signature Date if ommonwealth of Mosaachusetts No. Andover, Massachusetts Parcelatlon Teat ' Dais: 9.15-% Time: Morning DspM of Pero: 60" Parooiation Hole #: 99&2 SM Pre -Soak: 1124 End Pre-soak:11:39 Tette 0 12":11:39 Time @ 9": 12:09 Time @ 6":12:56 Time (9' - r y MrLAsS: [471 Rate Wn / inch: [1s1 " Minimum of 1 percolation test must be pertormed in both the primary area AND the reserve area. Site Passed [ X 1 Site Failed [ 1 Performed By: Peter Sheridan Comments: Ed Wb62:60 86ET SB '^C)N : 'ON 3NOHd NZIANUIdZI-iS : WOad LE40wSERIES PUMP The pump(s) shall be model as manufactured by Liberty Pumps, Bergen, NY, or equal. The pump(s) shall have a capacity of GPM at a total dynamic head of feet. Motor size shall be 4/10 horsepower, single phase, 60 hz. and 115 volt operation. MOTOR The pump motor shall be of the submersible type, oil filled, hermetically sealed and shall be thermally protected. The overload element shall automatically reset when motor cools. Motor windings shall be of the class B insulation rating. The rotor shaft shall be made of 416 stain- less steel and shall be supported by lower bronze and upper sleeve bearings. The power cord shall be of the quick -disconnect design allowing replacement of the cord without breaking seals to the motor and/or oil chamber. TECHNICAL IMPELLER The pump shall have a impeller capable of pa; 2" spherical solid. � dstylej 0 (9 98 g a -minimum_ .I SEAL The shaft seal shall be of the carbon/ceramic unitized design, with BUNA N elastomers and stainless housings. EXTERNAL CONSTRUCTION The pump volute, legs and motor housing shall be heavy gray iron castings, class 25 or better. All castings shall be enamel coated before assembly. All fasteners shall be of 300 -series stainless steel or brass. LEVEL CONTROL The pump shall be controlled by an adjustable, mercury -free, wide angle float switch. Float cord shall be equipped with a series plug for manual by-pass operation. MODELS HP VOLTS PHASE AMPS DISCHARGE NO IMPELLER 13 2 FNPT VORTEX LE41 M 4/10 115 1 LE41 A 4/10 115 1 13 2" FNPT YES VORTEX 10' cord standard on above models. For 20' option, add a "-2" suffix to model number. Example: LE41A-2 DIMENSIONAL DATA. - Weight: LE41 M: 39 LBS. Height: 13.25" Major Width:10.75" (manual models) Maximum fluid temperature 140 degrees F. Peat, S Zo G PM - 10' t . 1, 30 GPM GO -Certified City of LA certification available PERFORMANCE CURVE 1550 RPM 24 6 4 x 2 0 20 16 m z o f 0 10 203U wu av - U.S. Gallons Per Minute 0 1.4 2.6 4.2 5.6 Liters Per Second Liberty Pumps a 7307 Lake Rd • Bergen, New York 14416 • Phone (716) 494-1817 Fax (716) 494-1839 7291-2/93 *m"aaftmofti,st sun t-wom AOL: P&Vtmmwt~i..GwNTN DOM 1108 I " I'> 132' Depth ID Gwiowm:icmr 9talrtc3rlp WOW in HOW VA"ov "M Pit Focclos" Es*r*W S4&w%I Ho GMW4 WSW 30p Depth omwvsd ewd% in owwwom How mm (xlDepth wnpifVIsom eft atObmvaftntiW:loo Irchn t x I DqM 10 adi td OM in Obmvom Hft 3W E I QW4 Vfto A*OVMM reef VON WO N~ PA@ftom kdwvvd Uwe: Hent Fates: A*mo rw4 wawtsvow -amurion MUM Raw Does at *0 low hW of n"m0y ww" pe Amm ffmimna a" in so we" Mwved ft**h" Me area I I I 1 4 W 9W WN IM Mfg 10 ft &J9Wn 7 YeS I t, j No SAM as M M MM ZEST M if nOt•w�ti6medr�ll�OfnaL�reYy WA f 9 some so in cim "."IF om to iata+wrMith of sest►whta row mmila Demotpomw Poutolon MW t W&2 SM Pro4kak: 1124 sw prowdc 11,7w Tftoir.il2s Tittle 0 fr. 120 Tkft4@ fr: 12M Time (W -S'): Lftft.- (471 PA* Min/ MM: (lit IdMm of I pwwMm IM Mug be pwWffwd In both the plimmy area AND " mwve ww. aft Pawed IX I Sim Fated I I PWWwisd bf POW SMddw Hmns"o ft au&AStatoil) Comm": ad w62:60 emi so : 'ON SNCHd N-:W)Nbrr4F-+6 : w0hu SOM EVALUATOR FOM min 2 OF.; Lmmon A4d#wm or Lot moa Twnwkik, ub. Andovw 000ftm&omw edflotm abmrvmooa-km So Tett n.1 Los Od Cdor SOW" o1w E nor" L. twumm boidAmift lifft-Aor"I 0.9 OA l*F44 Fr;@*, FM Sw* LmmmoravwJ 11%. ID -Dw awfum -ZW Alow — -- .- mmjftwhv� Are. 30 W Loony bold Lw aw Fm* fto 6Yi0i LmA Mw W, Fim 40 GO Q~ L"M Gdod P -W P". Fft 80* Lown� MOM Fin lit C2 F&wSw*tarn aw *m"aaftmofti,st sun t-wom AOL: P&Vtmmwt~i..GwNTN DOM 1108 I " I'> 132' Depth ID Gwiowm:icmr 9talrtc3rlp WOW in HOW VA"ov "M Pit Focclos" Es*r*W S4&w%I Ho GMW4 WSW 30p Depth omwvsd ewd% in owwwom How mm (xlDepth wnpifVIsom eft atObmvaftntiW:loo Irchn t x I DqM 10 adi td OM in Obmvom Hft 3W E I QW4 Vfto A*OVMM reef VON WO N~ PA@ftom kdwvvd Uwe: Hent Fates: A*mo rw4 wawtsvow -amurion MUM Raw Does at *0 low hW of n"m0y ww" pe Amm ffmimna a" in so we" Mwved ft**h" Me area I I I 1 4 W 9W WN IM Mfg 10 ft &J9Wn 7 YeS I t, j No SAM as M M MM ZEST M if nOt•w�ti6medr�ll�OfnaL�reYy WA f 9 some so in cim "."IF om to iata+wrMith of sest►whta row mmila Demotpomw Poutolon MW t W&2 SM Pro4kak: 1124 sw prowdc 11,7w Tftoir.il2s Tittle 0 fr. 120 Tkft4@ fr: 12M Time (W -S'): Lftft.- (471 PA* Min/ MM: (lit IdMm of I pwwMm IM Mug be pwWffwd In both the plimmy area AND " mwve ww. aft Pawed IX I Sim Fated I I PWWwisd bf POW SMddw Hmns"o ft au&AStatoil) Comm": ad w62:60 emi so : 'ON SNCHd N-:W)Nbrr4F-+6 : w0hu sf Part M 19l"InDirl 11i Da m t0i96a'pyC i for DepM to GftvxM3B IW Stwwtltfa yVaoer in mow wyapft g **" Pft Fb*.ICW fOi Ad MIM I"- lieftfmd ua� E j . Dopar CbsW." Ong in Obsovatlm Now. in m t x } Doplh WowkV ftm side of Obser omt We: los irtohes E x ) Depot o sloe t kWm In Obuwvaibn tioW 37` irads- E ) G*M wooer Aq ohmti 40 fiMOt Wal murder: Fusdmgoate- - WAM* of t*A: Adjue mai Favor AtJrtAW Wdurld +eager ierei: iii er eatuea„ eek ftwgua mmutl... Ooss at isset tour to of natlaa#y occunrV pery w maul 9*st in ant @rails obaervsd sxouprww ttv am pmpmd for tt+e e9 ebeolpwn $ya wn Z You Ix ) No E ) ` &4smCw :tibm CDm 11:S7M twRltiB COGL D '1 WA !+_arltl�wMLw� t wll�tmm op:. 'sv 9 . Id";! "*MAW WA is adlli � � •-RIR t+iipi�s signature Co1RIn01 w"Ith of M-Cto@ptl No. Andover, MttiteKhu�Atts Lhrcefatten twat • ow Percolown Idml T smpte-saah:10:53 Pwmk:Uw Time 011";11:16 Time t W:11:48 Tins a W, I D4 rn* (W - fr); Mhft Em.t.... Rso Min / W% t•: EJq Minimum co l perctalaoon tact must be parronnso in ban ate primary aim AND ste rmwva am - am Paleeed tX 1..... a* ) Pmtrnud 8y: POW Wwklmn vA By: IRuc>jy.Roblo Commw ta: £d 1.106£:60 8661 SO 'AON 'f]N 3NQFlo N3nNti'ta36 : Wodj OWL EVALVATOR.PORM PA" ZOF2 LD"Uon Addm" of Lot No.1 Turnpike, No. Andovar 040 hoe Swkn 6d Nom , Ds� A�rvattee Shc tuew) 11m_ a ed cow ew boil #A nl% tMet 0.4 OA areey iaMM tqt 0!s ilOtlfdltll, xptiarM} F, . ilia $a* t o.m mir"'F". OntOt.taMt F&MO Aft ft* LMM Moon. Art. a$ Cl Loft Saw %sm atm' Fdoo, fts U* Um. Miw Finn too 00 OonpR4 Lw" a" 2.Sy9K ftft Fftft" lane, M m- fte Part M 19l"InDirl 11i Da m t0i96a'pyC i for DepM to GftvxM3B IW Stwwtltfa yVaoer in mow wyapft g **" Pft Fb*.ICW fOi Ad MIM I"- lieftfmd ua� E j . Dopar CbsW." Ong in Obsovatlm Now. in m t x } Doplh WowkV ftm side of Obser omt We: los irtohes E x ) Depot o sloe t kWm In Obuwvaibn tioW 37` irads- E ) G*M wooer Aq ohmti 40 fiMOt Wal murder: Fusdmgoate- - WAM* of t*A: Adjue mai Favor AtJrtAW Wdurld +eager ierei: iii er eatuea„ eek ftwgua mmutl... Ooss at isset tour to of natlaa#y occunrV pery w maul 9*st in ant @rails obaervsd sxouprww ttv am pmpmd for tt+e e9 ebeolpwn $ya wn Z You Ix ) No E ) ` &4smCw :tibm CDm 11:S7M twRltiB COGL D '1 WA !+_arltl�wMLw� t wll�tmm op:. 'sv 9 . Id";! "*MAW WA is adlli � � •-RIR t+iipi�s signature Co1RIn01 w"Ith of M-Cto@ptl No. Andover, MttiteKhu�Atts Lhrcefatten twat • ow Percolown Idml T smpte-saah:10:53 Pwmk:Uw Time 011";11:16 Time t W:11:48 Tins a W, I D4 rn* (W - fr); Mhft Em.t.... Rso Min / W% t•: EJq Minimum co l perctalaoon tact must be parronnso in ban ate primary aim AND ste rmwva am - am Paleeed tX 1..... a* ) Pmtrnud 8y: POW Wwklmn vA By: IRuc>jy.Roblo Commw ta: £d 1.106£:60 8661 SO 'AON 'f]N 3NQFlo N3nNti'ta36 : Wodj DA T E.- LOCATION: : LOCATION: ENGINES; BOH WITNESS: PEPCOLATION TEST BOTTOM DEPTH OF PL: -:,IRC TEST. 36 t x 1-4 l " TIME AK.: r OF SO _ 3 (,,� IE�s iruies Icrc Tirv1E A I 17' TIME AT T c" l 1 TIMEAT E" =NIGH- S' F\T D_ NEXT 01,"n'Y C i iN1 - , I I PSI ` , TiME,�I (. ,i ecs. Tlrl IZ DATE. � 8 LOCATION: BOF �NITNESS: PEPCOL^�T10N TEST BOTT OM DEPTH OF FERC TE -7 3 TIME OF SOAK: _ �_ 7 (At leasmiru= Icnc) TIME '-"IT 112" � •� �. TIME ATS' TIME AT C�,'E; ,NIGHT SGA. . FI_D IME S I �-.; . T I EA, T Tl � i I E IME A �»e �. . . N�� Rte- . � lx Appl Town of North Andover, Massachusetts BOARD OF HEALTH Form No. 1 —Y19T It� APPLICATION FOR SITE TESTING/INSPECTION Site Location Enginee Test/Inspection Date and Time Fee CHAIRMAN, BOARD OF HEALTH Test No.t S.S. Permit No. D.W.C. No. C.C. Date Plbg. Permit No. ED , Town of North Andover, Massachusetts BOARD OF HEALTH Ila 19 Form No. 1 APPLICATION FOR SITE TESTING/INSPECTI0'' e � '^ Gam Applicant •�\ l 0 V�� `n -p NAME ADDRESS c PHONE Site Location Engineer --�� NAME ADDRESS TELEPHONE Test/Inspection Date and Time '!zz '? AIRMAN, BOARD OF HEALTH Fee l Test No. S.S. Permit No. D.W.C. No. C.C. Date Plbg. Permit No. BOARD OF HEALTH 146 N4AIN STREET NORTH ANDOVER, MASS. 01845 APPLICATION FOR SOIL TESTS DATE:7 e LOCATIO OF SOIL TESTS: Assessor's map & parcel number: TEL. 688-9 540 �"'Lj VI HIEACT'h9 w [ :19,q OWNER: /� J X PL -t,6,- A jg , TEL. NO.: f ��S S7 V-? ADDRESS: ENGINEER: C/1rz, 5-71'*'j5'0- TEL. NO.: TZ? J 73 0J/ o CERTIFIED SOIL EVALUATOR:' Intended use of land: residential subdivision, single family home, commercial THE FOLLOWING MUST BE INCLUDED WITH THIS FORM: 1. Proof of land ownership (Tax bill, deed, or letter from owner permitting tests) 2. Plot plan 3. Fee of $175.00 per lot for new construction. This covers the two deep holes and two percolation tests required for each lot. Fee of $75.00 per lot for repairs or upgrades. GENERAL INFORMATION 1. Only Certified Soil Evaluators may perform deep hole inspections. 2. Only Mass. Registered Sanitarians and Professional Engineers can design septic plans. 3. At least two deep holes and two percolation tests are required for each septic system. 4. Repairs require at least two deep holes and at least one percolation test, at the discretion of the BOH representative. 5. Full payment will be required for all additional tests within two weeks of testing.. 6. Within 45 days of testing, a scaled plan (no smaller than 1 "-100') shall be submitted to the Board of Health showing the location of all tests (including aborted tests). 7. Within 60 days of testing soil evaluation forms shall be submitted. lo JL �,, ai", 14� >n a -a I-Yyy ll� /SIR P /osL /3tk ocle"r �as�e -,- L 1-4 & /033 3 y a -9e -i- L k.4 f:, 10.3-3 3 (Yav- 9 9:f , ,, _ s:: .uv' ' Yat v° ' fr..,� '�.' }+••!z-... •1)?•{' f. As t `-', ( .. ` � .iA7 �—�".,M'�.w—+'�►. ! t '�.....,"T� 11 � 'amu ° 1 �..+ t I U. a 4Mt ! F •-�. r ,.taw,, .1, a-,%;,.dw � el 4 f -"J ��.i �✓,� y � 1'}� i��t•�9'� ¢r�•��"tt �ar�i4 t •: ,h� 1 kik � " .. x t. �: .. 4 ,S•r� ``':� n :'�jYgY{r ,ar' � y,�� r w I ,w iii t `'�•r�f(%Ytiitr.� i� si ,. s` � 1 � _ �, � _ -p�i�✓ �-�t' 4' -�/'r� t�'�C, ��1_.r 4� st r .. t� _ L. • 9 +yam � �� ti �~ � �� t. 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'a -r? - tt .8 .rt••+•scc; ......, .t a �? 4 r ;yt u •-s'M.ur-_atOa,,.K1Nyry!�ar-.*er..:e ,.-: �, :� t �'.'�•".�' fl - `� •_ .._.ers J:, t3r_,n1Y..;y:A'..�!•T Yi IMyY � .� �Y r I ��* Y �(. �t!.a �T�•12: L",.'NY',F S::D'[rFjYA-ihpi'di>�i+�4'�. } Lry4 I. y � rr 1 �1.7:R {4�',�' r% 1, ..lr�if }' •!1 f��+'�j•..f. m -- - - - - - - i ----�- - -- - -- I r 1' .......... i -I i A I i I m -- - - - - - - i ----�- - -- - -- I r 1' .......... i -I i I i I i I I j ry � Z �7 �gAi[o �SSACHUS�� Applicant Site Location_ Town of'North Andover, Massachusetts BOARD OF HEALTH 4 I APPLICATION FOR SITE TESTING/INSPECTION Form No. 1 Engineer NAME ADDRESS TELEPHONE Test/Inspection Date and Time 1> Fee CHAIRMAN, BOARD OF HEALTH Test No. C., S.S. Permit No.-D.W.C. No. C.C. Date Plbg. Permit No. mi v NUMBER FEE THE COMMONWEALTH OF MASSACHUSETTS1. -) - AO -L of..................... This is to Certify that .. -OUJA-)6W6 7 . ..... DZZ7Z-!��CIA.).6 .... ................. ......................... .......... NAME L�� 3 ............ as ............. ..... ............................................ /.A�`/�` . ............................................................... ADDRESS IS HEREBY GRANTED A LICENSE For ...... /? .... /-2/7- ..... ....................... ..... ��-3-7 . .......... .................................................................................................................................................. ........................................................................................................................................................................... ........................................................................................................................................................................... This license is granyd in conformity with the Statutes and ordinances relating thereto, and 1-'5g131.1qv unless a ended or voked. ........ expires ............ ; ... ...... .... . ................................ . .. .. .... ..... .... ............................. ... . ........... I ........... ................................ ..... �3 ...... ............ ............. .......... ...... ......................-••--•---...----•...-•------------------------••---•••-• FORM 499 (::I-I&W HOBBSBWARRENrM 53- 01, 3 - NORTIy A F 9 t r BOARD OF HEALTH ,SSACMUSEt NORTH ANDOVER, MASS . APPLICATION FOR WELL AND PUMP PERMIT Permit # W Date r=ci /5� 9 9 A permit is requested to: drill a well ✓ ; install a pumpLI� LOCATION : 2d 30 7`"(f/1-A-)Pi Ke ' Iirf e % Lot # Owner d2, ML -1z ST. )6_bL74Z,- '.r f Address /Sd l HAidl S i CzwicS/SwKy Well ContrctAdd. a 3 Pia2c 6 ILD Telw03-(P,9�,_a // ! Pump Contrctr E/AAdd . Q,¢�L/Ii�U _nw �V /Y 01VrT el WELLS (To be completed at time of pump test.) Type of well Diameter of well Depth of bed rock, Seal been tested? Yes (_) Depth of well Use Size of casing Depth casing into bedrock No (_) Date of test Water -bearing rock Depth to water Delivers GPM for Drawdown feet after pumping hours at (how long?) GPM Date of completion Signature of well contractor PUMPS (To be filled in before installation.) Name & size of pump Type Size of tank Pump delivers GPM Pipe used in well: Cast iron (_) Galvanized (_) Plastic (_) Sleeve used to protect pipe? Yes (_) No (_) Type well seal Date Signature of pump installer Date water analysis report submitted to Board of Health Plumbing inspector Wiring inspector Board of Health I'd SttZV99SO9L ONI11IbG.lSV23NMOG NObJ Hd6t:V 666t -VZ -S 3-24-1999 4:20PM FROM DOWNEAST^DRILLING 16036642113 P.2 Permit # / 96c) BOARD OF HEALTH NORTH ANDOVER, MASS. APPLICATION FOR WELL. AND PUMP PERMIT A permit is requested to: drill a well install a pump L,/ LOCATION: �a3o 7-4rAaiLre 5Tee er Lot # Ownerjo�NC.cr ST_ Address /SS6 / 1-4,;,v 1r T e I T2K7vi7fek V kA Well Contrctr_j�gj„"l- lgr/ri _Q r CAdd..23 P; etc 6 1L17 Pump Contrctr S/,LVJ Add. I WELLS (To be completed at time of pump test. Type of well '� L:,r� �%�4 C Use Diameter of well k Size of casing t` Depth of bed rock / Depth casing into bedrock Seal beers tested? Yes No (_ ) Date of test 2 9 _ ' Depth of well t��0 6 Water -bearing ruck _2AI_r� Depth to water Delivers ,�^ ""'.1 for (how long?) Drawdown' feet after pumping hou at Date of completion �- ig a r o—f well con for PUMPS (To be filled in before installation.) Name & size of pump ".,:p /• 6` �.et Type 3%�L�25�`�LLg i/ Size of tank iZ Pump delivers cS� GPM Pipe used in well: Cast iron (_) Galvanized (_) Sleeve used to protect pipe? Date Plastic (K) o2m�s Date water analysis report submitted to Board of Health( c� Plumbing inspector Wiring inspector Board of Health c4.0—M North Andover Water Treatment Plant Lab 420 Great Pond Road * North Andover, MA 01845 * (978) 688-9574 Mass Certification No. For Bacterial Analysis * M-21054 Sample Number: A4623 Sample Date: 11/22/99 Submitted By: Mr. Russell Ahern 2240 Turnpike Street North Andover, Ma 01845 Sample Source: Private Well Analysis: Total Coliform Bacteria 0 per 100 ml. If you have any further questions please call us at the above number. Sincerely, Kelly Long Senior Water Analyst North Andover Water Treatment Plant Department of Environmental ManagemenUDivision of Water Resources ' f WELL COMPLETION REPORT WELL LOCATION Address - -,;� 'i City/Town,,--) 4— 4 - IMS? Weil owneK a rf4,1 ^ A �� Er-, 2.:E t/ Address iTn'1 VW41,p._� �) nr tl7 / < i /.21,/ V9P,/,V' 9� Board of Health pe ir6fi t obtained: yes P.- no ❑ GEOGRAPHIC DESCRIPTION 6(jo N S �E) W of (feet) (circle) Cr Fy (road) S E W of (mi. i enths) (circle) intersect w/ of WELL USE,{ WELL DATA Domestic lXJ Public E3 Industrial El Total well depth d 0 ft. Monitoring ❑ Other Depth to bedrock ft. Method drilled J�,)%AR I/ Water -bearing rock/unconsolidated material: Z Description Date drilled Water -bearing zones: CASING1) From ---,,:I 6 To � O 7 Type '5_ CSG' L 2) From To Length -91J ft. Dia(LD.) in. 3) From To Length into bedrock o23 ft. Gravel pack well: dia. Protective well seal:D"I, , U dia. Screen: Grout ❑ Other S1210 � Slot# length from to _ STATIC WATER LEVEL (all wells) , Static water level below land surface ft. Date WELL TEST (production wells) Drawdown � ft. after pumping __�/_ 'hr. " min. at gpm How -measured `'',. vPU Recovery ft. after=rhr.min. LOG of FORMATIONS I COMMENTS 0 N W Driller A�wn 0 / Firm t��,l/rilT/I/S�T 121; /fi i i� Co. -j-,x Address �� iQi �,QC (/ R o,6 City/Town Supervising -tars* Reg.# BOARD OF HEALTH COPY 3-24-1999 4_21PM FROM DOWNEAST"DRILLING 160366d2113 P. A ONE OR MORE OF THE ABOVE PARAMETERS HAVE EXCEEDED THE EPA DRINKING WATER SECONDARY STANDARD LIMITS. < LESS THAN OUR LOWEST CALIBRATION POINT GREATER THAN OUR HIGHEST CALIBRATION POINT 1 FLAGS PARAMETERS THAT EXCEED PRIMARY STDS: CAUSES TEST FAILURE. 2 FLAGS PARAMETERS THAT EXCEED SECONDARY STDS: DOES NOT FAIL TEST. * MICROBIOLOGICAL ANALYSIS RUN PAST 30 HOURS OLD MAY NOT BE VALID. NOTE: SUBSEQUENT SAMPLES FROM THE SAME WATER SOURCE MAY VARY. �La�eGa.� Authorized b� Orall(tt Statt ana(vtKaL Snt• Main Office/ Laboratory At: Tramway Marketplace 22 Manchester Rd. ! Rt. 28 Route 16 & 25 Derry, NH 03038 West Oaaipee,.NH 0300 (603) 432.3044 1-ti00-6898820 va.ertif iratt of kx al-gais f err Brixthins Water SENT TO: DOWNEAST DRILLING TEST NO.: 9903-00224-001 23 PIERCE BARRINGTON, NH 03825 SAMPLE 2230 TURNPIKE WEST LOCATION: NORTH ANDOVER, MA ORANGE ST. DEVELOPMENT DATE & TIME SAMPLED: 3/10/199914:00 EPA PARAMETER RESULT RECOMMENDED (mg/1) MAX. LEVEL Drinking Water Basic pH 8.13 6.5 - 8.5 Units Nitrate <0.20 10.0 mg/1 Calcium 79.9 None Set Magnesium 23.0 None Set 2 Hardness 294 150 mg/l Chloride 67 250 mg/l Sodium 76.8 250 mg/1 O'Iron 1.45 0.30 mg/1 z Manganese 0.15 0.05 mg/l Fluoride 0.40 4.0 mg/l Sulfate 23.2 250 mg/1 Coliform Bacteria ABSENT ABSENT /100 ml E. Coli Bacteria ABSENT ABSENT /100 ml ONE OR MORE OF THE ABOVE PARAMETERS HAVE EXCEEDED THE EPA DRINKING WATER SECONDARY STANDARD LIMITS. < LESS THAN OUR LOWEST CALIBRATION POINT GREATER THAN OUR HIGHEST CALIBRATION POINT 1 FLAGS PARAMETERS THAT EXCEED PRIMARY STDS: CAUSES TEST FAILURE. 2 FLAGS PARAMETERS THAT EXCEED SECONDARY STDS: DOES NOT FAIL TEST. * MICROBIOLOGICAL ANALYSIS RUN PAST 30 HOURS OLD MAY NOT BE VALID. NOTE: SUBSEQUENT SAMPLES FROM THE SAME WATER SOURCE MAY VARY. �La�eGa.� Authorized b� R 40 V. A 4 IQVEiLT BUILD/ E C, j t4P4 Iii P.E- 140.0' ZZ'o, lu P,C. ' D -Box OUT RC . = ISS,LIy EuA Tp. -`I. 7q,3' 1103.3' Top pzC = 15-6,,q6 -7a,'7' I 1 D- WIZZ Ov- b- Be>>C = 1 GZ , 044 IUL, TiLwZ s I Sof g7 QL. Trz# 3 ` 15-7,17 i=uD TZ *� 1 = 16, /. S7 TW* Z - 1.59156 ., T)Z 3 - I s7,S8 UEACAW6 T2E GH (Tygp V5"111-- — Co1. kiceTio1,, Yrt4T-114 /± BC)U F_IA._R.IG F_;_ P, EL= 13,58 Lo! A 1,g7fi AC, e#3 � ,848-Z �A EFx,,i;rlu4 �duumTi0xi � ZZ�10 TF EL,= I SS.Zo 17. 1' \ I TOO 6A L . ' E5PT► I Soo 6AL 0 —< - - 31�+ V PES AS BUILT PLAN 0 F o SUBSURFACE DISPOSAL LOCATED IN NORTH AKJ DDVER , M A . AS PREPARED FOR ORAW6 E STI; DE` Z5LOPMe�jr I WG . DATE: NO\/EMBER IZ, I qgq -(2r--v. I1-7.3-11) SCALE: )"= 2o� *-' ZZya Tul2A tR E 1! T7r (-r". 1108-6 PAZ, L� MERRIMACK ENGINEERING S1 66 PARK STREET ANDOVER, MASSACHUSETTS 01810 TAMIL. uM P CNAH&M Aff'ZoX. Lnc Tioi or W2%VE!).1A� (vWl>m r-0jAST•) Z"0 S,wz z t P.v, TO SN A VMJ9 R. 5 Po to D oxo SYSTEM RVICES 1IJVEV-7- FLEVAT►bti15: ��'�>7►uG i 11.1 S,Th.H.(cL) 23.'7 224,13' DVT S,7 I SS,�$ - P.L.m.H 4o,o, ZZ,0, I SS-, 414 1=,uA Te.# l 7q,3' 103 ,3 , 7 -of P. G- :156 tiG, >=Nn T2Z yqS� 757' W D-gox 16, Z. ZZ Oc1T'- D- RnX = I GZ,bzq 11uL,TZwZ IS-q,g7 1 QL. lm'* 3 ` )S-7,17 F-- uD TIL ll- I 16, 1. 5*7 T24 Z ' I sq, 5'8 . `t'# 71,7 L>Ca�N I uG TjZE CFf Cv�+uEc'f"io�.l 30't 31 �± � 1 Lo` A 1.q7t AC, �A Ex ► STu4 Fo' vw ATiowl. # ZZ240 TF EG.= 15620 yo; #3 � 1 ,SqB-Z 0 . 17.1, I TAD 6A L . 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BEuo TD SH�eP>.re'�.S POun ox) SYSTEM .: t OF DANIEL KORAVOS CIVIL No. 37752 'R VICES `Q�