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LOCATEDIN
NORTH ANDOVER, .,ASS.
AS PREPARED Fool
MARIO GIORDANO
-DATE: AUGUST, t984
SCALE Z,40'
4
MERPIMACX, I NIGINEEIZING Sif RV I C E $ INC.L
JAND %AVEYMS 0 PLANNERS
14,6 PAVII Sli.PaT ANIDOVEP MASSA04'JISSTT'S MW Tf 1 ;617- 47.S-,3555, 373-5r72l
LO f �7_1- 4 A
Q�JAAJIU.L;'::�
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Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form Not for Voluntary Assessments [,-7
265 Granville Lane
Property Address 7Y
Mario Giordano
Owner Owners Name
information is
required for every North Andover MA 01845 06/05/2015
page. Cityrrown State Zip Code Date of Inspection
Inspection results must be submitted on this form. Inspection forms may not be altered in any
way. Please see completeness checklist at the end of the form.
Important: When
A. General Information
filling out forms
RECEIVED
on the computer,
use only the tab
key to move your
1 Inspector:
JUN 15 2015
cursor - do not
Benjamin C. Osgood, Jr.
use the return
key.
Name of Inspector
TOWN OF NORTH ANDOvER—
none
HEALTH DEPARTMENT
Company Name
157 Bluff Street
Company Address
rem
Salem
NH
03079
CityrFown
State
Zip Code
978-435-1324
870
Telephone Number
License Number
B. Certification
I certify that I have personally inspected the sewage disposal system at this address and that the
information reported below is true, accurate and complete as of the time of the inspection. The inspection
was performed based on my training and experience in the proper function and maintenance of on site
sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of
Title 5 (310 CMR 15.000). The system:
0 Passes Ej Conditionally Passes El Fails
F Needs Further Evaluation by the Local Approving Authority
Inspector's9rignature
6/8/2015
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 DER The original should be sent to the system owner
and copies sent to the buyer, if applicable, and the approving authority.
****This report only describes conditions at the time of inspection and under the conditions of use
at that time. This inspection does not address how the system will perform in the future under
the same or different conditions of use.
t5ins - 09108 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 1 of 17
1 � ji�
L
01-0-0
Owner
information is
required for every
page.
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
265 Granville Lane
Property Address
Mario Giordano
Owners Name
North Andover MA 01845 06/05/2015
City,rrown 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:
This is an old system with very low flow. There is no guarantee or warrantee in regards to future
system functionalitv.
13) 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.
El Y El N [I ND (Explain below):
t5ins - 09108 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 2 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
265 Granville Lane
Property Address
Mario Giordano
Owners Name
North Andover MA 01845 06/05/2015
Cityrrown State Zip Code Date of Inspection
B. Certification (cont.)
B) System Conditionally Passes (cont.):
El 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):
F1 broken pipe(s) are replaced
obstruction is removed
F1 Y 0 N F1 ND (Explain below):
E] Y E] N [] ND (Explain below):
M distribution box is leveled or replaced F1 Y F1 N E] ND (Explain below):
F1 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):
F1 broken pipe(s) are replaced F] Y E] N E] ND (Explain below):
EJ obstruction is removed
El Y F1 N [I ND (Explain below):
C) Further Evaluation is Required by the Board of Health:
F� 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(l)(b) that the system is not functioning in a manner which will protect public health,
safety and the environment:
E] Cesspool or privy is within 50 feet of a surface water
El 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 117
Owner
information i's
required for every
page.
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
265 Granville Lane
Property Address
Mario Giordano
Owner's Name
North Andover MA 01845 06/05/2015
City[Town 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:
El 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.
n The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water
supply.
F] The system has a septic tank and SAS and the SAS is within 50 feet of a private water
supply well.
E] 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:
D) System Failure Criteria Applicable to All Systems:
You must indicate "Yes" or "No" to each of the following for all inspections:
Yes No
El E Backup of sewage into facility or system component due to overloaded or
clogged SAS or cesspool
El E Discharge or ponding of effluent to the surface of the ground or surface waters
due to an overloaded or clogged SAS or cesspool
El E Static liquid level in the distribution box above outlet invert due to an overloaded
or clogged SAS or cesspool
El 0 Liquid depth in cesspool is less than 6" below invert or available volume is less
than 1/2day 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
265 Granville Lane
Property Address
Mario Giordano
Owner Owners Name
information is
required for every North Andover MA 01845 06/05/2015
page. Cityrrown State Zip Code Date of Inspection
B. Certification (cont.)
Yes No
El 0 Required pumping more than 4 times in the last year NOT due to clogged or
obstructed pipe(s). Number of times pumped:
E] 0 Any portion of the SAS, cesspool or privy is below high ground water elevation.
El 0 Any portion of cesspool or privy is within 100 feet of a surface water supply or
tributary to a surface water supply.
Any portion of a cesspool or privy is within a Zone 1 of a public well.
El Z Any portion of a cesspool or privy is within 50 feet of a private water supply well.
El Z 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.]
El Z The system is a cesspool serving a facility with a design flow of 2000gpd-
10,000gpd.
0 z 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 11 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 - 09108 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 5 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
265 Granville Lane
Property Address
Mario Giordano
Owner Owner's Name
information i's
required for every North Andover MA 01845 06/05/2015
page. Cityrrown 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
Z E] Pumping information was 'provided by the owner, occupant, or Board of Health
E] Z Were any of the system components pumped out in the previous two weeks?
Z n
Has the system received normal flows in the previous two week period?
El Z
Have large volumes of water been introduced to the system recently or as part of
this inspection?
Z El
Were as built plans of the system obtained and examined? (If they were not
available note as N/A)
Z E]
Was the facility or dwelling inspected for signs of sewage back up?
2 El
Was the site inspected for signs of break out?
Z F1
Were all system components, excluding the SAS, located on site?
Z El
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?
Z El
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:
Z
Existing information. For example, a plan at the Board of Health.
El Z
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): 600
t5ins - 09/08 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
265 Granville Lane
Property Address
Mario Giordano
Owner Owners Name
information is
required for every North Andover
page. Cityrrown
D. System Information
Description:
Number of current residents:
MA 01845 06/05/2015
State Zip Code Date of Inspection
Does residence have a garbage grinder?
D
Yes
[]
No
Is laundry on a separate sewage system? [if yes separate inspection required]
El
Yes
ED
No
Laundry system inspected?
El
Yes
0
No
Seasonaluse?
El
Yes
Z
No
Water meter readings, if available (last 2 years usage (gpd)):
Detail:
Sump pump?
El
Yes
Z
No
Last date of occupancy:
current
Date
Commercial/industrial Flow Conditions:
Type of Establishment:
Design flow (based on 310 GMR 15.203):
Basis of design flow (seats/persons/sq.ft., etc.):
Grease trap present?
Industrial waste holding tank present?
Non -sanitary waste discharged to the Title 5 system?
Water meter readings, if available:
Gallons per day (gpd)
El
Yes
[:]
No
n
Yes
Fj
No
Ej
Yes
E]
No
t5ins - 09/08 Title 5 Official Inspection Form: 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
D. System Information (cont.)
Last date of occupancy/use:
Other (describe below):
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
NOT SINCE NEW
gallons
Type of System:
H Septic tank, distribution box, soil absorption system
El Single cesspool
R Overflow cesspool
M Privy
06/05/2015
Date of Inspection
EJ Shared system (yes or no) (if yes, attach previous inspection records, if any)
E] 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
F] Tight tank. Attach a copy of the DEP approval.
F-1 Other (describe):
t5ins - 09/08 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 8 of 17
265 Granville Lane
Property Address
Mario Giordano
Owner
Owners Name
information is
required for every
North Andover MA 01845
page.
Cityrrown State Zip Code
D. System Information (cont.)
Last date of occupancy/use:
Other (describe below):
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
NOT SINCE NEW
gallons
Type of System:
H Septic tank, distribution box, soil absorption system
El Single cesspool
R Overflow cesspool
M Privy
06/05/2015
Date of Inspection
EJ Shared system (yes or no) (if yes, attach previous inspection records, if any)
E] 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
F] Tight tank. Attach a copy of the DEP approval.
F-1 Other (describe):
t5ins - 09/08 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 8 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
265 Granville Lane
MA 01845 06/05/2015
State Zip Code Date of Inspection
Approximate age of all components, date installed (if known) and source of information:
Built 1984 Der Board of health records
Were sewage odors detected when arriving at the site?
El Yes Z No
Building Sewer (locate on site plan):
Depth below grade: 1.5
feet
Material of construction:
E cast iron [] 40 PVC El other (explain):
Distance from private water supply well or suction line: N/A
feet
Comments (on condition of joints, venting, evidence of leakage, etc.):
Pipe new in basement
Septic Tank (locate on site plan):
Depth below grade:
Material of construction:
Z concrete El metal
1.5
feet
El fiberglass El polyethylene El other (explain)
If tank is metal, list age: years
Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) r-1 Yes E] No
Dimensions: 1500 Gallons
Sludge depth:
211
t5ins - 09108 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 9 of 17
Property Address
Mario Giordano
Owner
Owner's Name
information is
required for every
North Andover
page.
Cityrrown
D. System Information (cont.)
MA 01845 06/05/2015
State Zip Code Date of Inspection
Approximate age of all components, date installed (if known) and source of information:
Built 1984 Der Board of health records
Were sewage odors detected when arriving at the site?
El Yes Z No
Building Sewer (locate on site plan):
Depth below grade: 1.5
feet
Material of construction:
E cast iron [] 40 PVC El other (explain):
Distance from private water supply well or suction line: N/A
feet
Comments (on condition of joints, venting, evidence of leakage, etc.):
Pipe new in basement
Septic Tank (locate on site plan):
Depth below grade:
Material of construction:
Z concrete El metal
1.5
feet
El fiberglass El polyethylene El other (explain)
If tank is metal, list age: years
Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) r-1 Yes E] No
Dimensions: 1500 Gallons
Sludge depth:
211
t5ins - 09108 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
265 Granville Lane
Property Address
Mario Giordano
Owner Owners Name
information is
required for every North Andover
page. City/Town
D. System Information (cont.)
Septic Tank (cont.)
MA 01845 06/05/2015
State Zip Code Date of Inspection
Distance from top of sludge to bottom of outlet tee or baffle 2811
Scum thickness 2"
Distance from top of scum to top of outlet tee or baffle 811
Distance from bottom of scum to bottom of outlet tee or baffle 16"
How were dimensions determined? Measure Stick
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
Tank in aood condition. Concrete tees in OK condition
Grease Trap (locate on site plan):
Depth below grade: feet
Material of construction:
El concrete El metal El fiberglass El polyethylene F1 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:
t5ins - 09/08
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
265 Granville Lane
Property Address
Mario Giordano
Owner Owner's Name
information is
required for every North Andover
page. Cityrrown
MA 01845 06/05/2015
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.):
Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan):
Depth below grade:
Material of construction:
El concrete El metal El fiberglass El polyethylene El other (explain):
Dimensions:
Capacity:
Design Flow:
Alarm present:
Alarm level:
gallons
gallons per day
El Yes 0 No
Alarm in working order: El Yes [] No
Date of last pumping: Date
Comments (condition of alarm and float switches, etc.):
* Attach copy of current pumping contract (required). Is copy attached? El Yes E] No
t5ins - 09108 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page I I of 17
L
Owner
information is
required for every
page.
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
265 Granville Lane
Property Address
Mario Giordano
Owner's Name
North Andover MA 01845 06/05/2015
Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Distribution Box (if present must be opened) (locate on site plan):
Depth of liquid level above outlet invert 01,
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.):
Box in good condition. Distribution equal. No evidence of soilids carryover or leakage in or out. Cover
cracked. Box found to be 37" below grade so a riser and new cover were added as part of the
inspection.
Pump Chamber (locate on site plan):
Pumps in working order:
El
Yes
E]
No
Alarms in working order:
El
Yes
E]
No
Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.):
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
265 Granville Lane
Property Address
Mario Giordano
Owner Owners Name
information i's
required for every North Andover
page. CityrFown
D. System Information (cont.)
Type:
MA 01845 06/05/2015
State Zip Code Date of Inspection
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 F1 Yes [:] No
t5ins - 09/08 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 13 of 17
leaching pits
number:
leaching chambers
number:
D
leaching galleries
number:
n
leaching trenches
number, length:
z
leaching fields
number, dimensions: 1-21'X 63"
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.):
Area of leach field looks normal. No evidence of pondinq, damp soil, or unusual veqetation.
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 F1 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
265 Granville Lane
Property Address
Mario Giordano
Owner Owners Name
information is
required for every North Andover MA 01845 06/05/2015
page. Cityrrown 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.):
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
!1sm z
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
265 Granville Lane
Property Address
Mario Giordano
Owner Owner's Name
information is
required for every North Andover
page. Cityrrown
RAA
01845 06/05/2015
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:
0 hand -sketch in the area below
El drawing attached separately
ni
V*
FA P c
-rAjilk
:2 -T-A tj I L. 1
217/ 23-.0
17 t� gz, - to
t5ins - 09108 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 15 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
265 Granville Lane
Property Address
Mario Giordano
Owner Owner's Name
information is
required for every North Andover
page. CityfTown
D. System Information (cont.)
Site Exam:
Check Slope
Surface water
Check cellar
Shallow wells
Estimated depth to high ground water:
MA
State
01RAr,
-.F -...
4
feet
06/05/2015
Date of Inspection
Please indicate all methods used to determine the high ground water elevation:
A -
a
FEW
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:
El Checked with local excavators, installers - (attach documentation)
0 Accessed USGS database - explain:
usgs maps
You must describe how you established the high ground water elevation:
System built in an area which was raised between 2 and 4 feet above old existing grade. Water table
in the area bewteen 2 and 4 feet below existing grade (from inspector experience and knowledge of
the area) USGS maps indicate water table > 6 feet below arade.
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
265 Granville Lane
Property Address
Mario Giordano
Owner Owner's Name
information i's
required for every North Andover MA 01845
page. Cityfrown State Zip Code
E. Report Completeness Checklist
06/05/2015
Date of Inspection
0 inspection Summary: A, B, C, D, or E checked
Z 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 Form: Subsurface Sewage Disposal System - Page 17 of 17
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forms on the
computer, use
only the tab key
to move your
cursor - do not
use the return
key.
Commonwealth of Massachusetts
City/Town of NORTH ANDOVER, MASSACHUSETTS
System Pumping Record
Form 4
DEP has provided this form for use by local Boards of Health. The Syst m Ptlz$ .
be submitted to the local Board of Health or other approving authority. I j i Fd 1. -R ic Lo# rg
A. Facility Information
1 . System Location:
TOWN OF NORTH ANDOVER
HEALTH DEPARTMENT
Address
City/Town State Zip Code
2. System Owner:
Name
Address (if different from location)
City/Town
B. Pumping Record
I. DateofPumping
3. Type of system: E]
El Other (describe):
StateL Zip Code
Felephone Number
bD ait e 2. Quantity Pumped: Gallons
Cesspool(s) Septic Tank El Tight Tank
4. Effluent Tee Filter present? El Yes [I No . If yes, was it cleaned? El Yes El No
5. Condition of System:
6. System Pumped By:
C"
Name
6-7
� Company
E
io
7. Location where tents were disposed:
.. ok6L'e�
Signature of Hauler
hftp://www.mass-gov/dep/water/approvaIs/t5forms.htm#inspect
Vehicle License Number
Date
t5form4.doc- 06/03
System Pumping Record - Page 1 of 1
F)
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4599
4
Town of North Andover
HEALTH DEBARTMENT
CHU
CHECK DATE: A4?
Type
of Permit or License: (Check box)
0
Animal
$
0
Body Art Establishment
$
0
Body Art Practitioner
$
0
Dumpster
$
0
Food Service - Type.
$
0
Funeral Directors
$
0
Massage Establishment
$ L
0
Massage Practice
$
•
Offal (Septic) Hauler
$
•
Recreational Camp
$
0
Sun tanning
$
•
Swimming Pool
$
•
Tobacco
$
•
TrashlSol id Waste Hauler
•
Well Construction
$
SEP77C Systems
Septic - Soil Testing
$
0
Septic - Design Approval -
$- "
0
Septic Disposal Works Construction (DWQ
$
13
Septic Disposal Works Installers (DWf)
$
0
Title 5 Inspector
Zle
$
0�,
5 Report
0 Other. (Indicate) $
Health Agent Initials
White - Applicant Yellow - Health Pink - Treasurer,
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.
Commonweaft of Massachuseft. RECEIVED � P;
Title 5 Official Inspection Form DEC 3 0 2009
Subsurface Sewage Disposal System Form - Not for Voluntary Assessme ts
TOWN OF NORTH ANDOVER
265'Granville Lane -Y DEPARTMENT
Property Address
Margaret Giordano
Owner's Name
N rth Andover MA 01845 12/5/09
City/Town 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. 4 Ili
A. General Information 77
1. Inspector:
Benjamin C. Osgood, Jr.
Name of Inspector
none
Company Name
224 High Street, Apt 1
Company Address
Newburyport
Cityrrown
978-255-2261
Telephone Number
B. Certification
MA
State
870
License Number
01950
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 6 (310 CMR 15.000). The system:
Z Passes El Conditionally Passes El Fails
n Needs Further Evaluation by the Local Approving Authority
9, <�- '�2 ") 12/5/09
lfllp—ocl!�Aignature Date
The system inspector all submit a copy of this inspection report to the Approving Authority (Board
of Health or DEP) withi 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 DER 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.
Commonwealth of Massachuse"t-s-
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
"VW
Property Address
^-A
Owner Own;rs Name
information is North Andover MA 01845 12/5/09
required for State Zip Code Date of Inspection
every page. City/Town
B. Certification (cont.)
Inspection Summary: Check A,B,C,D or E / always complete all of Section D
A) System Passes:
Z 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.
R Y F1 N Ej ND (Explain below):
IBM
Owner
information is
required for
every page.
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
265 Granville Lane
Property Address
Margaret Giordano
Owners Name
North Andover MA 01845 12/5/09
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):
El broken pipe(s) are replaced
R obstruction is removed
F1 Y El N El ND (Explain below):
n Y El N El ND (Explain below):
F1 distribution box is leveled or replaced F1 Y El N El ND (Explain below):
Ej 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):
El broken pipe(s) are replaced El Y El N El ND (Explain below):
F1 obstruction is removed [I Y n N El ND (Explain below):
C) Further Evaluation is Required by the Board of Health:
El 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(l)(b) that the system is not functioning in a manner which will protect public health,
safety and the environment:
E] 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
Owner
information is
required for
every page.
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
265 Granville Lane
Property Address
Margaret Giordano
Owner's Name
North Andover MA 01845 12/5/09
Cityfrown 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:
F1 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.
F1 The system has a septic tank and SAS and the SAS is within a Zone I of a public water
supply.
n The system has a septic tank and SAS and the SAS is within 50 feet of a private water
supply well.
F1 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 forrn.
3. Other:
D) System Failure Criteria Applicable to All Systems:
You must indicate "Yes" or "No" to each of the following for all inspections:
Yes No
0
0
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
El
E
Static liquid level in the distribution box above outlet invert due to an overloaded
or clogged SAS or cesspool
El
0
Liquid depth in cesspool is less than 6" below invert or available volume is less
than 1/2day flow
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
.265 Granville Lane
Property Address
Margaret Giordano
Owner Owners Name
information is
required for North Andover MA 01845 12/5/09
every page. Cityrrown State Zip Code Date of Inspection
B. Certification (cont.)
Yes No
El z Required pumping more than 4 times in the last year NOT due to clogged or
obstructed pipe(s). Number of times pumped:
Ej 10 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.
Z Any portion of a cesspool or privy is within a Zone 1 of a public well.
El Z Any portion of a cesspool or privy is within 50 feet of a private water supply well.
El 0 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.]
El 0 The system is a cesspool serving a facility with a design flow of 2000gpd-
10,000gpd.
E] z 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 16,000 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
E the system is within 400 feet of a surface drinking water supply
E] 0 the system is within 200 feet of a tributary to a surface drinking water supply
R z the system is located in a nitrogen sensitive area (interim Wellhead Protection
Area — IWPA) or a mapped Zone 11 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.
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
265 Granville Lane
12/5/09
Date of Inspection
Check if the following have been done. You must indicate "yes" or "no" as to each of the following:
Yes No
Z El
Property Address
Margaret Giordano
Owner
Owner's Name
information is
required for
North Andover MA 01845
every page.
Cityrrown State Zip Code
C. Checklist
12/5/09
Date of Inspection
Check if the following have been done. You must indicate "yes" or "no" as to each of the following:
Yes No
Z El
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?
D z
Have large volumes of water been introduced to the system recently or as part of
this inspection?
Z El
Were as built plans of the system obtained and examined? (if they were not
available note as N/A)
Z
Was the facility or dwelling inspected for signs of sewage back up?
Z E]
Was the site inspected for signs of break out?
Z F1
Were all system components, excluding the SAS, located on site?
Z El
Were the septic tank manholes uncovered, opened, and theinterior of the tank
inspectedfor the condition of the baffles or tees, material of construction,
dimensions, depth of liquid, depth of sludge and depth of scum?
Z El
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:
M E]
Existing information. For example, a plan at the Board of Health.
El Z
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): 600
Commonwealth of Massachusetts
uTitle 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
�A,
,p 265 Granville Lane
Owner
information is
required for
every page.
Property Address
Margaret Giordano
Owner's Name
North Andover MA 01845 12/5/09
City/Town State Zip Code Date of Inspection
D. System Information
Description:
Number of current residents:
Does residence have a garbage grinder?
Is laundry on a separate sewage system? [if yes separate inspection required]
Laundry System inspected?
Seasonaluse?
Water meter readings, if available (last 2 years usage (gpd)):
Detail:
Sump pump?
Last date of occupancy:
Commercial/industrial Flow Conditions:
Type of Establishment:
Design flow (based on,310 CMR 15.203):
Basis of design flow (seats/persons/sq.ft., etc.):
Grease trap present?
Industrial waste holding tank present?
Non -sanitary waste discharged to the Title 5 system?
Water meter readings, if available:
El
Yes Z
No
El
Yes 0
No
0
Yes Z
No
El
Yes Z
No
El Yes 0 No
current
Date
Gallons per day (gpd)
El Yes [:1 No
El Yes E] No
1:1 Yes El No
<r
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
265 Granville Lane
Property Address
Margaret Giordano
Owner Owner's Name
information is
re uired for North Andover MA 01845 12/5/09
-1
every page.
CityfTown
D. System Information (cont.)
Last date of occupancy/use:
Other (describe below):
Pumping Records:
Source of information:
State Zip Code
General Information
Was system pumped as part of the inspection?
If yes, volume pumped:
How was quantity pumped determined?
Reason for pumping:
Date
NOT SINCE NEW
gallons
Type of System:
z Septic tank, distribution box, soil absorption system
El Single cesspool
FI Overflow cesspool
Privy
Date of Inspection
El Yes E No
El Shared system (yes or no) (if yes, attach previous inspection records, if any)
F1 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):
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
265 Granville Lane
Property Address
Margaret Giordano
Owner Owners Name
information is
required for North Andover MA 01845 12/5/09
every page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Approximate age of all components, date installed (if known) and source of information:
Built 1984 per Board of health records
Were sewage odors detected when arriving at the site?
Building Sewer (locate on site plan):
Depth below grade: 1.5
feet
Material of construction:
0 cast iron El 40 PVC El other (explain):
Distance from private water supply well or suction line: N/A
feet
Comments (on condition of joints, venting, evidence of leakage, etc.):
PiDe new in basement
Septic Tank (locate on site plan):
Depth below grade:
Material of construction:
0 concrete D metal
1.5
feet
El Yes 0 No
E] fiberglass El polyethylene E] other (explain)
If tank is metal, list age: years
is age confirmed by a Certificate of Compliance? (attach a copy of certificate)
1500 Gallons
Dimensions:
Sludge depth: 2"
El Yes El No
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
265 Granville Lane
Property Address
Margaret Giordano
Owner Owner's Name
information i's
required for North Andover MA 01845 12/5/09
every page. 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 2811
Scum thickness 211
Distance from top of scum to top of outlet tee or baffle 81'
Distance from bottom of scum to bottom of outlet tee or baffle 1611
How were dimensions determined? Measure Stick
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence ofleakage, etc.):
Tank in good condition. Concrete tees in good condition
Grease Trap (locate on site plan):
Depth below grade: feet
Material of construction:
El concrete D metal Ej fiberglass [:1 polyethylene El 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
Commonwealth of Massachusetts
lugTitle 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
265 Granville Lane
Owner
information is
required for
every page.
Property Address
Margaret Giordano
Owner's Name
North Andover
MA 01845
12/5/09
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.):
Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan):
Depth below grade:
Material of construction:
El concrete [] metal El fiberglass El polyethylene El other (explain):
Dimensions:
Capacity: gallons
Design Flow: gallons per day
Alarm present: El Yes [] No
Alarm level: Alarm in working order: n Yes E] No
Date of last pumping: Date
Comments (condition of alarm and float switches, etc.):
* Attach copy of current pumping contract (required). Is copy attached? R Yes E] No
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
265 Granville Lane
Property Address
Margaret Giordano
Owner Ownees Name
information is
required for North Andover MA 01845 12/5/09
every page. Cityfrown State Zip Code Date of Inspection
D. System Information (cont.)
Distribution Box (if present must be opened) (locate on site plan):
Depth of liquid level above outlet invert 01,
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.):
Box in good condition. 'Distribution equal. No evidence of soilids carryover or leakage in or out. Cover
cracked
Pump Chamber (locate on site plan):
Pumps in working order:
El
Yes
El
No
Alarms in working order:
El
Yes
n
No
Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.):
Soil Absorption System (SAS) (locate on site plan, excavation not required):
If SAS not located, explain why:
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
265 Granville Lane
Property Address
Margaret Giordano
Owner Owners Name
information is
required for North Andover MA 01845 12/5/09
every page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Type:
El leaching pits number:
11 leaching chambers number:
El leaching galleries number:
El leaching trenches number, length: 1-21'X 63f' YC PJL
leaching fields number, dimensions:
overflow cesspool number:
El 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.):
Area of leach field looks normal. No evidence of ponding, damp soil, or unusual vegetation.
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
El Yes El No
Owner
information is
required for
every page.
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
265 Granville Lane
Property Address
MaEgaret Giordano
Owner's Name
North Andover
MA 01845
12/5/09
City/Town 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.):
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.):
Commonwealth of Massachuseft
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
265 Granville Lane
Property Address
Margaret Giordano
Owner Ownees Name
infDrmation is North Andover MA 01845 12/5/09
required for 'Zip Code Date of Inspection
every page. okyrrown
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
U dirawing audlullt;u 51%;P01 at -'Y
T, -rAfJILI 2-
�tK
2- TO
Owner
information is
required for
every page.
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
265 Granville Lane
Property Address
Margaret Giordano
Owner's Name
North Andover
Cityfrown
D. System Information (cont.)
Site Exam:
ED Check Slope
MA 01845
State Zip Code
12/5/09
Date of Inspection
Estimated depth to high ground water: 4
feet
Please indicate all methods used to determine the high ground water elevation:
11 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:
n Checked with local -excavators, installers - (attach documentation)
ED Accessed USGS database - explain:
usgs maps
You must describe how you established the high ground water elevation:
System built in an area which was raised between 2 and 4 feet above old existing grade. Water table
in the area bewteen 2 and 4 feet below existing grade (from inspector experience and knowledge of
the area) USGS maps indicate water table > 6 feet below grade.
Before filing this Inspection Report, please see Report Completeness Checklist on next page.
Surface water
Check cellar
Z
Shallow wells
MA 01845
State Zip Code
12/5/09
Date of Inspection
Estimated depth to high ground water: 4
feet
Please indicate all methods used to determine the high ground water elevation:
11 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:
n Checked with local -excavators, installers - (attach documentation)
ED Accessed USGS database - explain:
usgs maps
You must describe how you established the high ground water elevation:
System built in an area which was raised between 2 and 4 feet above old existing grade. Water table
in the area bewteen 2 and 4 feet below existing grade (from inspector experience and knowledge of
the area) USGS maps indicate water table > 6 feet below grade.
Before filing this Inspection Report, please see Report Completeness Checklist on next page.
4N Commonwealth of Massachusetts
j Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
265 Granville Lane
Property Address
Margaret Giordano
Owner Owner's Name
information is
required for North Andover MA 01845
every page. City/Town State Zip Code
E. Report Completeness Checklist
12/5/09
Date of Inspection
Z inspection Summary: A, B, C, D, or E checked
Z Inspection Summary D (System Failure Criteria Applicable to All Systems) completed
Z System Information — Estimated depth to high groundwater
Z Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file
Town of North Andover
Health Department Date:
Location:
(Indicate Address, if Residential, or
Name of Business)
Check
\1_1
#:
lype
of Permit or License: (Circle)
>
Animal
$
>
Dumpster
>
Food Service - Type.-
>
Funeral Directors
$
>
Massage Establishment
$
>
Massage Practice
$
>
Offal (Septic) Hauler
$
>
Recreational Camp
$
>
SEPTIC PERMITS:
El
Septic - Soil Testing
$
El
Septic - Design Approval
$
El
Septic Disposal Works Construction (DWO
L]
Septic Disposal Works Installers (DWI) $
>
Sun tanning
$
>
SwimmingPool
$
>
Tobacco
$
>
TrashlSolid Waste Hauler
>
Well Construction
$
> OTHER- (Indicate)
1465 fleegtfi Agent Initials
White -Applicant Yellow -Health Pink -Treasurer
NEw ENGLANDENGINEERING SERWES, INC,
1600 Osgood Street
Building 20 Suite 2-64
North Andover, MA 01843
'Fel: (978) 686-1768 0 Fax: (978) 327-6138
Benjamin C. Osgood, Jr., P.E.
President
Ms. Susan Sawyer
North Andover Board of Health
400 Osgood Street
North Andover, MA 0 1845
RECEIVED
MAR 2 12006
TOWN OF NORTH ANDOVER
HEALTH DEPARTMENT
RE: TME V REPORT: 265 Granvflle Lane, No. Andover, MA
Dear Ms. Sawyer:
March 17, 2006
Enclosed is the Title 5 Report for the above referenced property. The system PASSES
the inspection.
If there are any questions please call me at my office, 686-1768.
Sincerely,
Blenji 2 C. Osgood, r.
Certified Title 5 Inspector
I Of 11
COMMONWEALTH OF MASSACHUSETTS
EXECUTIVE OMCE OF ENVIRONMENTAL AFFAIRS
DEPARTMENT OF ENVIRONMENTAL PROTECTION
TITLE 5
OFFICIAL INSPECTION FORM- NOT FOR VOLUNTARY ASSESSMENT
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
CERT ICATION
Property Address: 265 Grairville Lane No Andover, MA 01943
Owner's Name: Margaret Giordano
Ownees Address: 265 Granville Lane No Andover, MA 01845
Date of Inspection: 14 March 2006
Name of Inspector (please print) Benjamin C. Osgood, Jr Certified Title 5 Inspector
Company Name: New England Engineering Services Inc -
Mailing Address: 60 Beechwood Drive North Andover, MA 0 1845
Telephone Number. 978-686-1768
CERTRICATION STATEMZNT
I certify that I have personally inspected the sewage disposal system at tins address and that the information reported below is true,
accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the
proper function and maintenance of the on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section
15340 of Title 5 (3 10 CMR 15.000). The system:
_—ZPasses
Sonditionally Passes
Needs Further Evaluation by the Local Approving Authority
Fails
Inspector's Signature: (b ----7 (f -
The system inspection shall submit a copy of tins inspection report to the Approving Authority ( Board of Health or DEP) within 30
days of completing this inspection. If the system is a shared systern 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 DER The original should be sent to the system
owner and copies sent to the buyer, if applicable, and the approving authority.
Notes and Comments
****Tbis 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 pefform. in the future under the same or different conditions of use.
1
2 of 11
OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 265 Granville Lane No Andover, MA 01845
Owner's Name: Margaret Giordano
Date of Inspection: 14 March 2006
Inspection Summary: Check A, B, C, D or E/&WLYS complete all of Section D
A. System Passes:
a��_ I have not found any information winch indicates that any of the failure criteria described in 3 10 CMR 15.303 or in 3 10 CMR
15.304 exisL Any failure criteria not evaluated are indicated below.
Comments:
IL System Conditionally Passes:
IV 0 One or more system components as described in the "Conditional PasC section need to be replaced or repairedL The system,
upon completion of the replacement or repair, as approved by the Board of Health, will pass.
Answer yes, no or not determined (YNND) in the for the following statements. N -not determined" please expLim.
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 exfilftbon or tank Mure 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 Certfficate of Compliance indicating that the
tank is less than 20 years old is available
ND explain:
—Observation of sewage backup or break out or high static water level in the distribution box due to broken or obsumded plWs)
or due to a brokm settled or uneven distribution box. System will pass inspection if (with approval of Board of Health):
Broken pipe(s) are replaced
Obstruction is removed
Distribution box is leveled or replaced
ND explain:
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 explaiik-,
3 of 11
OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENT
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 265 Granville Lane No Andover, MA 01845
Owner's Name: Margaret Giordano
Date of Inspection: 14 March 2006
C. Further Evaluation is Required by the Board of Health:
&10 Conditions exist which require firither evaluation by the Board of Health in order to determine if the system is Wing to protect
public health, sakty or the environment
System will pass unless Board of Health determines in accordance with 310 CMR 15.303(l)(b) that the system is
not functioning in a manner which will protect public health, safety and the environment:
Cesspool or privy is within 50 feet of a surface water
Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh
2. System will fail unless the Board of Health ( and Public Water Supplier, if any) determines that the system is
functioning in a manner that protects the public health, safety and environment:
The system has a septic tank and (SAS) Soil Absorption System and the (SAS) and the SAS is within 100
feet of a surface water supply or tributary to a surface water supply.
The system has a septic tank and SAS and the SAS is within a Zone I of a public water supply.
The system has a septic tank and the SAS is within 50 feet of a private water supply well.
. T'he system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private
water supply well**. Method used to determine distance
** This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria and
volatile organize compounds indicates that the well is free from pollution from that facility and the presence of
ammonia nitrogen and intrate nitrogen is equal to or less than 5ppm, provided that no other failure criteria are
triggered. A copy of the analysis must be attached to this form.
3. Other.
46f 11
OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENT
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 265 Granville Lane No Andover, MA 01845
Owner's Name: Margaret Giordano
Date of Inspection: 14 March 2006
D. System 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 pondmg of effluent to the surface of the ground or stifface waters due to an overload or clogged SAS or
cessl)ool-
Static liquid level in the distribution box above outlet invert due to an overload or clogged SAS or cessWol
Liquid depth in cesspool is less than 6" below invert or avWOle volume is less than 1/2day flow
Required pumping more than 4 times in the last year XOT 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 sufface water supply
Any portion of a cesspool or privy is within a Zone I of a public well.
Any portion of a cesspool or privy is within 50 feet of a private water supply well.
Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with
no acceptable water quality analysis. (this system passes if the well water analysis, performed at a DEP certified laboratory for
coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the
presence of ammonia nitrogen and nitrogen is equal to or less than 5ppm, provided that no other failure criteria are
triggered. A copy of the analysis must be attached to this form.)
NO (Yes/No) The system fails. I have determined that one or more of the above failure criteria eNist as described in
3 10 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.
YowlRust indicate either "yes7 or "no" to each of the following:
ffo
(rhe fo �cnteria apply to huge systems in addition to the criteria above)
Yes No
The system is within 4 o1a a
w te
c
of :
The system is within 200 feet a 7 7o :gAa e ig water Supply
'Me system is located in a nitro nsitive area int Wellhead Protection Area — IWPA) or a mapped Zone 11
e syste n is located m a nitro m Wellhead Protection Area — 'W'
ly
of a pukbhc water supply
fi or ans
nder',
ct
7n
a can
i e:: si=:n t u
is d a
in s oul
in
a S E the
in
If you answZered L"yes" to on in Section E the system is considered a or answered "yesr in Section D above
sw es . M 1
or op 0
the large system has The owner or operator of any large system considered a signifi under Section E or failed under
th st :n d Ith
Section �Dgrade the system in accordance with 310 CMR 15.304. The system owner s,houl the appropriate regional
office o the Department
5 6f 11
OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENT
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: 265 Granville Lane No Andover, MA 01945
Owner"s Name: Margaret Giordano
Date of Inspection: 14 March 2006
Check if the following have been done. You must indicate "veg" or "no" as to each of the following:
Yes No
�Z — Pumping information was provided by the owner, occupant or Board of Health
_Z 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 an 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 inqWed for sip of break out?
Were all system components, excluding the SAS, located on site?
Were all the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the
baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum?
Was the facility owner (and occupants if difference from owner) provided with information on the proper
maintenance of the subsinface sewage disposal systems?
The size and location of the Soil Absorption System (SAS) on the site has been determined based on:
Yes NO
12� — 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) [3 10 CMR 15.302(3)(b)]
6 of 11
OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENT
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 265 Granville Lane No Andover, MA 01945
Owner's Name: Margaret Giordano
Date of Inspection: 14 March 2006
FLOW CONDITIONS
RESIDENTIAL
Number of bedrooms (design)—�— Number of bedrooms (actual)
DESIGN flow based in 310 CMR 15.203 (for example: 110 gpd x #of 6e&oonishj�� �OfC,>
Number of current residents: 3
Does residence have a garbage grinder (yes or no):
Is laundry on a sVaiate sewage system (yes or no): M 0 [ff yes separate inspection required]
Laundry system inspected ( yes or no):
Seasonal use: (yes or no): IV 0
Water meter readings, if available Oast 2 years usage (gpd): Z 1C)aj
SumpPump (yesorno): , AjO.
Last date of occupancv f -,j cce�a-r
COMMERCIAL/INDUSTRUL
Type of establishment:
Design flow (based on 3 10 CMR 15-203): gpd
Basis of design flow (seats/persons/sqk etc
Grease trap present (yes or noh
Industrial waste holding tank present (yes or no):
Non -sanitary waste discharged to the Title 5 systent (yes or no)_
Water meter readings, if available:
Last date of occuparicy/use:
OTHER (describe):
GENERAL INFORMATION
Pumping Records
Source of informatiow. . -Fc) %A? E5 D U W e- e- V,- Fc --(z 0,'k)FPt-
Was system pumped as part of the inspection (yes or no): A/0
If yes, volume pumped: —__gallons - How was quantity pumped determined?
Reason for pumping:
TYPE OF SYSTEM
!�4 Septic Wk 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 cunent operation and mairitenance contract (to be obtained from
system owner)
Tight tank _Attached a copy of the DEP approval
Other (describe):
Approximate age of all components, date installed (if known) and source of information:
j�-�-'---tl- A tq 8 tj
Were sewage odors detected wen arriving at the site (yes or no): 0 Q .
7 of 11
OFFICIAL INSPECTION FORM —.NOT FOR VOLUNTARY ASSESSMENT
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 265 Granville Lane No Andover, MA 01845
Owner's Name: Margaret Giordano
Date of Inspection: 14 March 2006
BUILDING SEWER (locate on site plan)
Depth below grade: 13 1
Materials of construction X ' cast iron 40 PVq__other (explainj,.
Distance from private water supply well or suction line:
Comments (on condition ofjoints, venting, evidence of leakage, etc.):
P,5- L 17ily 91 6-00 D r
Ar
SEPTIC TANK _(locate on site plan)
Depth below grade: 1B "
Material of construction:_X—concrete jnetal-----fiberglass____Wlyethylene
Other (e
If tank is metal list age: Is age confirnied by a Certificate of Compliance (yes or no): —(attach a copy of certificate)
Dimensions:, ls-e o W. -C
Sludge depth-- 4
Distance from top of sludge to bottom of outlet tee or baffle: e q
Scum thickness:, .4 j (
Distance from top of scum to top of outlet tee or baffle:
Distance from bottom of scum to bottom of outlet tee or baffle 15
How were dimensions determined: /viea5L)v,,F 4-n e. it
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet
invert, evidence of leakage, etc.):
-T- f IJ �--O Q CLIj -noj e 0 ji &-C,) Cq --7 0
A) A-) AJ
GREASE TRAP--_LLA_-(1ocate on site plan)
T_ -
Depth below grade:
Materials of construction: concrete_ruetal ----ffiberglass _--polyethylene —_---other
(explainj
Dimensions:
Scum thickness:
Distance from top of scum to top of outlet tee or baffle:
Distance from bottom of sludge to bottom of outlet tee or baffle:
Date of last pumping:
Comments (on pumping recommendations, inlet and outlet tee or baffle condition structural integrity, liquid levels as related to outlet
invert, evidence of leakage, etc.
8 of 11
OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENT
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 265 Granville Lane No Andover, MA 0 1845
Owner's Name: Margaret Giordano
Date of Inspection: 14 March 2006
TIGHT OR HOLDING TANK.-_LJA- (tank must be pumped at time of inspection)(locate on site plan)
Depth below grade:
Materials of constructiow—concrete metal fiberglass ---plyethylene _______pther
(expi
.Dimensions:
Capacity: gallons,
Design Flow: jallons/day
Alarm present (yes or no):
Alarm level: — Alarm in working order (yes or no):
Date of last pumping: i.
Comments (condition of alarm and float switches, etc.):
DETRIMUTION BOX:_(if present must be opened)(locate on site plan)
Depth of liquid level above outlet invert: Q
Comments ( note if box is level and distribution to outlets upial, any eviduence of solids carryover, any evidence of leakage into or
out of box, etc.):
Ix ^J 611112 CIL 22� 32 &7--r- 10 CO -10 11 -C 6J 44 L- 0 X�� I -P-C F if
L-vlql� A&CT J^j 09 C', C�l F- <5- f+ -P- 4�L�j .9,j C,� _
PUW CHAMEP,--/,/ 4 ocate on sire plan)
Pumps in working order (yes or no)______.,
Alarms in working order (yes or no)_.
Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.):
9 of 11
OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENT
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C -
SYSTEM INFORMATION (continued)
Property Address: 265 Granville Lane No Andover, MA 01845
Owner's Name: Margaret Giordano
Date of Inspection: 14 March 2006
SOIL ABSORPTION SYSTEM (SAS): (locate on site vlan, excavation not reguired
If SAS not located explain why
TYPE
leaching pits number
leaching chambers, number
leaching galleries numbcr�_
leaching trenches, number in length E 5
leaching fields, number, dimensions:
overflow cesspool, number
innovativetalternative system Typetname of technology:
Comments ( note condition of soil, signs of hydraulic failure. Level of ponding, damp soil, condition of vegetation, etc)
A (z C)q o F Z-00 X5 6,0 -,),D , 41 Ln F- 0),�> C-"//- F- f) f= P
F6 ri -V W C, fz 0 &--1:6-7-7 J A-)
CESSPOOLS: Af 1A (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 or
Cornments(note condition of sod, signs of hydraulic failure, level of ponding, condition of vegetation, etc.):
PRPsrY:_LLLi�L_(locate on site plan)
Material of constructiow.
Dimensions:
Depth of solids
Comments (note condition of sod signs of hydraulic failure, level of pondmg, condition of vegetation, etc.
10 of 11
OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENT
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 265 Granville Lane No Andover, MA 01845
Owner's Name: Margaret Giordano
Date of Inspection: 14 March 2006
SKETCH OF SEWAGE DISPOSAL SYSTEM
Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate
all wells within 100 feet. Locate where public water supply enters the building
11 of 11
OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
. PART C
SYSTEM INFORMATION (continued)
Property Address: 265 Granville Lane No Andover, MA 01845
Owner's Name: Margaret Giordano
Date of Inspection: 14 March 2006
SrFE EXAM
Slope
Surface water
Check cellar
Shallow wells
Estimated depth to ground water L—L—geet
Please indicate (check) all methods used to determine the high ground water elevation:
-t Obtained from system design plans on record — If checked, date of design plan reviewed:
4L Observed site (abutting property/observation hole within 150 feet of SAS)
Checked with local Board of Health — explaur
Checked with local excavator, installers — (attach documentation)
Accessed USGS database -explain:
You must describe how you established the high ground water elevation:
— 5;.,4 -5. 7-C rr�, De -,�.
b ve-
�Lj CJ 1, tv e- e L
9
.1
ard of Health -
irth AnOo
P
W
SISTEX
INSTALUTICK CMK LIST LOT"I
Z4*
BISALPPR E�AVA�a OK AIL
Reammst
1. Distance Tot
a. Wetlands
b. Drains
c.. Well
2. Water Line Location
3�- No PVC Pipe
4. Septic Tank
a. -Tees Length To Clean Out Covers
b. Cement Pipe to Tank -- Oa Both Sides of Tank.
5. Distribution Box
a. Covers &_ Box - No Cracks
b, All Lines Flowing Equal Amounts
c. No Back Flow
6*. Leach Field or Trench up
FW)
a. Dimensions ---2 A
b. Stone Depth 51
ce . Capped 1�aft'
d. Clean Double -Washed Stone'
Leach Pits
a. Dimsnsions
b. Stone Depth
c. Splash Pads
d, Tees
e. Cment Pipe to Pit Both Sides.
f. Clean Double 'Washed Stone
8. No Garbage DisPOS-11
.9. yinal (Irading Inspection
10. Barricading Covexed System
11. As Built Submitted
Lot Location
b. Dimensions of SysteM
C. Location with Regard -to Pere Test
d. 'Elevations
Water Table
ppr �> -- I
1
2
3
4
61-41G 2 -
Start Saturation
SOIL PROFILE & PERCOLATION TEST
DATA
North Andoverg
Mass.
Soak -Minutes
Street No L,1; Ile r-)
I -o t No. 2
Loc/Subdiv.
Start Test-W771me
Pland
Owner
Investigator
CLa CAAC) Observer—
-Drop of 6" -Time
SOIL PROFILE DATES
Mins-Ist 311 drop
1.*Elev
2.Elev 3.Elev
4.Elev
Percolation
V
0
0
0
0
-
Ti -es Test
phs
9
1
Benchmark
Elevation
4
5
6
7
1.1
I
DATES
;3
4
5
6
6.0
7
8
9
10
I
Location
Datum
PERCO;,ATION TESTS
3
4
5
6
I.
9
10
Pit Number
1
2
3
4
5
Start Saturation
Soak -Minutes
Start Test-W771me
Drop of 311 -Time
-Drop of 6" -Time
Mins-Ist 311 drop
NdrLs.2nd 3" Drop
Percolation
SOIL PROFILE & PERCOLATION TEST DATA
pA�dovet, Mass. -Street No �N,/' ct Zot LJ t Lr_4 Lot No ?
Subdiv. Pland Owner !AM
I
Observer 'T.) i.- 4 V f
Investigator 1. Irk,_ 0- �
SOIL PROFILE DATES—
l.'Faev 2.Elev 3.Elev 4.Elev
n
2 —
51
7
Benebmark
Elevation
0
1
2
3
4
5
6
7
8
9
10
11nM14
0
1
2
3
4
5
6
7
8
9
10
Location
Datum
PERCO;JATION TESTS
c? I I r. /a-%
0
1
2
3
Ties t Test
p2q
s
rr
*4 V
A -
Pit Number 2
3
Start Saturation
Soak -Minutes
Start Test--Ttme I'D �O
Drop of 311 -Time in *.74
Drop of 611 -Time 11'. !S
vhms-lst 31' drop 2_3
Ydns.2nd 3" Drop
Percolation