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HomeMy WebLinkAboutMiscellaneous - 275 DALE STREET 4/30/2018IY C;, m C) m 41 TO:U0 - A." Dove �- NORTH ANDOVER, MASS. o f) & I s- 19 60AR-D or- 14r=,&L-T/4 BOARD OF HEALTH FROM: &EUWA5 DESIGN ENGINEER Re: Soil Absorption AssOL I A,-rC-S /J C- Sewaqe Disposal System This is to certify that I have inspected the construction materials of said disposal system at z -o -r gz-> D A L E Site Location North Andover, Mass. The grades and construction materials are as specified in my plans and spedif i4cations dated Dee 'Ci '1991 and A B Ut �'JVIJ6 1!�- n tj Reg. Prof.Engineer/R&rg.-Sanitarian 19%1. INVOICE Bateson Enterprises Inc. Tel. (617) 475-1474 formerly Ray Fortune 111 Argilla Road * Andover, Mass. 01810 Sold to U(,� C(- d 7-19 cb WROMMIKE, DESCRIPTION LMUI91 ""Withl .. ...... AMOUNT DUE WROMMIKE, Bo ard o f He al th North An�-Ov7xy-as3- Z' I J /—/ _/ jo 4 MAIL OK Y_�' BEPTIC SYSTM INS7ALLATION CE3rK LIST . T�//q LOT 9 OK AI L 1. Distance Toi a. 'Wetlands b. Drains c. Well 2. Water Line Location _N -P1 _p 4. Septic Tank a. -Teas -Length & To Clean, Out Covers. b. Cement Pipe to Tank - Cn Both Sides of Tank 5. Distribution Box a. Covers & Box - No Gracks b. All Lines Flowing Eqiial Amounts c. No Back Flow 6*. Leach neld or Trench a. Dimensions b. Stone Depth C* . Capped 'Ends d. Clean Diouble-Washed Stone 7. Leach Pits a. Dimansions 1. 42-4-- In -&U c Splash Pads d. Tees e. Cement Pipe to Pit Bo th Sides f. Clean Double Washed Stone 8. -No Garbage Disposal 9. -71nal Grading Inspection 10. Barricading Covered System 11. As Built Submitted a. Lot Location b. Dim.Emsions of System C. Location -4th Regard -to Perc Test d. FlevatiorLb e 0' Water Table n Doard of K^rth, AadovsrtMas a APPROM DATE Providedi SUBSURFACE DISPOSAL DISIGN CHECK LIST LOT #__�' /_ �/' ) i DISAPPROVED DATE Reasonst Z4�� TMle V FAIL 09 Reg 2.5 e submitted plan must show as a minimim: the lot to be served-area.,dimensions lot # abutters location and log deep observation gles-dis'Otance to ties location and results percolation tests -distance to ties design calculations & calculations showing requireA leaching area e location and dimensions of aystem-including reserve area existing and proposed contours (g) location any wet areas within 100 1 of sevage disposal system or disclaimer -check wetlands mapping L-,'(h):su.rface and subsurface drains within 1001 of sewage disposal ,,` system or disclaimer W location any drainage'easements idthin 1001 of as -*,-age disposal system or disclaimer-PL=u-dzg Board files (J) knom sources of water supply within 2001 of sewage disposal system or disclaimer (k) location of any proposed well to serve lot -1001 from leaching facility (1) location of water lines on property -3.01 from leaching facility (A) location of benchmark (n) driveways L, -'(o garbage disposals 6119 W no PVC to be used in construction (q profile of system- elevations of basement.. plumb.* pipe, septic tank,, distribution box inlets and outletsv distribution field piping and Other elevations maximum ground water elevation in area sewage disposal system (a) plan must be prepared by a Professional Engineer or other professional authorized by law to prepare such plans Reg 6 Septic Tanks a) capacities -150% of flow,, water table., tees,, depth of tees., accesso pumping L,�,'(b) cleanout c 101 from cellar wall or inground suL=dmg pool (d) 25f from subsurface drains Reg 10.2 Distribution Boxes a) slope grea—te-r-TRE 0.08 Reg 10.4 �74b) mup Libsurfar ge SA _ FAIL Reg 11.2 11-4 U.10 n.n Reg 15.1 1�.4 15.8 3.7 Reg 14.1 14.3 14.4 14.6 14.7 lhao Reg 9.1 9.6 Check LI OK . I PajV,e Leacidm.pits Leaching pits are preferred mhere the installation is possible a) calculations of leaching area-minimt 500 sq ft, b) spacing c surface drainage 2% dj cover material e) I'x2'x4" splash pad f) tee at elbow g) no bends in pipe from d -box to pipe Leaching Fields a) no greater than 20 minutes/inch b area-minimxm 900 eq ft c� construction of field d) surface drainage 2 % e) 201 from cellar vall or inground e-Anning pool Lnn� Trenches calculation—s'oeacbing area -min 500 eq ft, spacing -4 ft min 6 ft with reserve betwen dimensions construction stone surface drainage 2% Dounhill Slove a) slope,��-­M be shown b) y/.��,X 150 = (to be shown� EMS a) amyoval b) rnd-by power Coin mon weal t It of Massachusetts D. "fflLkk— , Massachuscl.ts System Pumping Record I System Owner *fkj1,v Date of Pumping: 5 - I � - zo C)o Cesspool: No lv� Yes 11 System Location a-, 1-5 M (3 Quantity Pumped: I 5-Clo gallons SepticTank: No Yes Systent Pumped by: Fetircooff Srf&,�ftaa License Contents tiansret-tred to - Greater Lawrence Sanitary District Date: _ Inspector ry ON N IV Is N E L -E Nir , r - I_N)L LhLV_P_12E_l iu -PIPE INTQ D.2>oX_ Z_ 11. il�iV_Pj PE -OUT ID- PSOX zo Z_ 1 0. -z- 1 5 , 'R /67 0. gg ? % 03 09 ?o.; u i L -r 4-0 y 45 _T r__ m 1---4/ 8 -Z, a ci SEPTIC SYSTEM INSPECTION FORM ADDRESS -Z (Q IMTE INSPECTED 42 PROPERLY FUNCTIONING? �D N WEATHER CONDITIONS COMMENTS: WATIER QUALITY TESTEb' IZESOLTS� DYE TEST PERFORMED? Y N DATE? SKETCH: WATERSHED RESIDENTS QUESTIONNAIRE 1. Name 2. Street Address 7�, 3. How many members are in your household? 4. What type of sewage disposal system do you have? cesspool septic tank and leaching area * connection to municipal sewer * other (describe) 7 do not know 5. Are the plans (drawings) for your sewage disposal system on file with the Board of Health? El yes E-1 no Er do not know' - 6. How old is your sewage disposal system? a/0-5 years El 6-10 years El 11-20 years El over 20 years F] do not know 7. Has your sew disposal system been rebuilt or repaired? El yes 7no F� do not know If yes, approximately how long ago? years. What was done? 8. How frequently is your sewage disposal system pumped out? El annua / F-1 every 2-4 years El every 5-10 years El over 10 years [�/ never 9. Have you had any problems with your sewage disposal system? If yes, what problems? El repeated pump -outs needed El system clogs, backs up, or drains slowly F-1 odors El sewage surfaces through ground El yes 10. How many of each appliance are connected to your sewage disposal system? washing machine I dishwasher garbage disposal dehumidifier drain sump pump toilet roof/pavement drains shower/bathtub 11. Please state thebpnd and type (liquid or powder) of detergent you use for: dishwasher 62,/n clotheswasher 12. Does your property have a lawn? R/Yes no If yes, approximately what si ? El less than 1/4 acre r;4 acre El % acre 0 3/4acre El 1 acre F� more than 1 acre (Specify) - acres 13. How often do you fertilize your lawn? No. of applications per year Season(s) of the year f 14. Please state the brand and type (liquid or granular) of lawn fertilizer you use: E/Check here if your law . n is maintained by a professional landscape contractor. no CommonwValth of Massachusetts VAe'-� Massachusetts 7SY-Stem Owner, g Record System Location -2�' Date of Pumping: Quafitity Pumped: (S C-'� gallons Cesspool: No Yes Ll Septic Tank: No System Pumped by: Varejar't License Contents ttansferrred to : Greater Lawrence Sanitary District .Date: -- Inspector: Yes Co n ealth of Massachusetts Plnz��Massachusetts System Purnping Record System Owner I �,-? , I Date of Pumping: Cesspool: No 1411-�yes Ll System Location Quaittity Pumped: / �;� gallons Septic Tank: No 11 Yes va�� Systenillumpedby: Fefre,40,rf Frj&M ,tqijed License Contents transreurred to : Greater Lawrence Sanitary District Date: Inspector: COMMONWEALTH OF MASSACHUSETTS 'C OF HEAL -F-4 EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DuARTMENT OF ENVIRONMENTAL PROTECTION -ONE WRUER STREET, BOSTON MA 02108 (617) 292-5500 TRUDY C'03M Secretau ARGEO PAUL CELLUCCI DAVM B. STRUHS Commi ioner Governor SUBSURFACE SEWAGE DISPOSAL SYSTEIIII INSPECTION- FORM PART A CERTIFICATION NoWtV Address Je_ f Ownw L).j2.K- `�4. Address at Owner: )n te Date at A) Name of Inspector. I DEP kwootor pursulaw Socklon 15. " of ride 5 (310 CMR 15.000) Compllffw= Udk* Address: Tellwhons Number: CERTIFICATION STATEARM 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 inspection. The inspection was performed based on my training and experience in the proper function and m i a Sawa I aintenanclit of on -sit sposal systems. The system: Conditionally Posses Needs Further Evaluation By the Local Approving Authority Fai s Date: 1-7- kapectoes SkInatu- 4_ The System Inspector shall submit a copy of this Inspdction report to the Approving Authority (Board of Health or DEP)within thirty (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 Department of Environmental P . rotection. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. NOTES AND COMMENTS revised 9/2/98 Page I of 11 Z.1- Printed an Recycled Paper SU13SURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERT93CATION (continued) Property Addiress: Ownen Date af Inspection - INSPECTION SUMMARY: Chea A, 8, C, of A A. =SYSTMES: I have not found any information which indicates that any of the failure conditions described in 310 CIVIR 15.303 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. Indicate yes, no, or not determined (Y, N, or ND). Describe basis of determination In all Instances. If "not determined". explain why not. The septic tank Is metal, unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance latteched) indicating that the tank was installed within twenty (20) years prior to the date of the inspection; or the septic tank, whether or riot metal, is cracked, structurally unsound, shows substantial Infiltration or exfiltration, or tank failure is imminent. The system will pass Inspection if the existing septic tank is replaced with a complying septic tank -as approved by the Board of Health. Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. The system will pass inspection if (with approval of the Board of Health). broken pipe(s) are replaced obstruction is removed distribution box is levelled or replaced I The system required pumping more than four 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 revised 9/2/98 Page 2 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CER I IFICATHM (continuef) Peopm tV Addrss;s:Q"5 Owner: W 64'-� Date of bapec6W. I " CH C. FURTHER EVALUATION IS R E 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 the public health, safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES IN ACCORDANCE WITH 310 CMR 15.303 OHM THAT THE SYSTEM 9S NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a saft 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 AND SAFE I V AND THE ENVIRONMENT: The system has a septic tank and *oil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and the SAS is within a Zone I of a public water supply well. The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well, urdess a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5ppm. Method used to determine distance — (approximation not valid). 3) OTHER revised 9/2/98 Page 3 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) ftopeirty Addms: A. Ownw: Daftaflinspwtion. D. SYSTEM FALS: You must Indicate either -Yes" or "No" to each of the following: I have determined that one or more of the following failure conditions exist as described In 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should he contacted to deterrnine what will be necessary to correct the failure. Yes No Backup of sewage into facility or system component due to an overloaded or dogged 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 112 day flow. Required pumping more than 4 times in the lost year NOT du*e to clogged or obstructed pipe(s). Number of times pumped Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone I of a public well. Any portion of a cesspool or privy is within 60 feat of a private water supply well. Any portion of a cesspool or privy is less -than 100 feet but greater than 60 feet from a private water -supply well with no acceptable *water quality analysis. If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria, volatile organic 6ompounds, ammonia nitrogen and nitrate nitrogen. E. LARGE SYSTEM FAILS: You must Indicate either "Yes" or "No" to each of the following: The following criteria apply to large systems in addition to the criteria above: The system serves a facility with a design flow of.10,000 gpd or greater (Large System) and the system Is a significant threat to public health and safety and the environment because one or more of the following conditions exist. 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) The owner or operator of any such system shall upgrade the system In accordance with 310 CMR 15.304(2). Please consult the local regional office of the Department for further inforSnation. A revised 9/2/98 Page 4 of 11 SUBSURFACE SEWAGE IMSPOSAL SYSTBA NSPEC710M FORM PART 8 CHECKLIST Paiparty Address: Owner: Daft at kwpsction:W&A-J�Ous Check if the following have been done: You must indicate either "Yes" or "No" as to each of the following: Pumping information was provided by the owner, occupant, or Board of Health. None of th a system components have been pumped for at least two weeks and the -system has been-recelvingimmall flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this Inspection. As built plans have been obtained a*nd examined. Note if they are not available with N/A. The facility or dweWing was Ins pected for signs of sewage back-up. Tho system does not receive non-aanitary or industrial waste flow. The site was inspected for signs of breakout. All system components, excluding the Sall Absorption System, have been located on the site. The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or toes, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum. T he size and location of the Soil Absorption System on the site has been determined based on: Existrig Information. For example, Plan at B.O.H. Determined in the field (if any of the failure criteria related to Part C is at issue, approximation of distance is unacceptable) (11 5.302(3)lb)) The facility owner (and occupants, if different from owner) were provided with information on the proper maintenance of SubSurface Disposal Systems. revised 9/2/98 ftge 5 of 11 PropairtV Address: Owner: Date of Inspecdon: SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION LK) FLOW CONDITIONS RESIDENTIAL Design fiow._150g.p.d./bad Number of bedrooms (design); Number of bedrooms factual)._q Total DESIGN flow -Gen Number of current residents: Garbage grinder IV" or no): Laundry (separate system) Was or no).- Kb, If yes, separate] pection required AS C�Q :I Laundry system Inspected � s or no) Seasonal use (yes or no).Jr_:�_% Water motor reading&, If rilable (last two year's usage (gpd): Sump Purnp tyes or no)*. 0 last date of occupancy::ZjU-rVV-k&� COMMERCIALINDUSTRIAL: Type of o3tablishmem: Design flow: . apd ( Based on 15-2031 Basis of design flow Gross* trap present. lyes; or no)_ Industrial Waste Holding Tank present: (yes or no)_ Non-3anitery Waste discharged to the Title 6 system: (yes or no)_ Water motor readings, if available: Last data of occupancy:_ OTHER: (Describe) Lost data of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of Information: Syst I am pumped as part of inspection: (yes 6r no) If yes, volume pumped 1� : allo s Reason for pumping; I\S cnke" =AS,*P$ti,C�tm-Ink/distributio'n boX/3011 absorption system Other A. (4 — owv\ Q4 - Single cesspool Overflow cesspool Privy Shared system (yes or nol (if yes, attach previous Inspection records, If any) I/A Technology etc. Attach copy of up to date operation and maintenance contract Tight Tank _Copy of DEP Approval . ,A"O)qMATE AqE of all components, date installed (if known) and Uu\ 14- Pk"V— Saw"* odors detected when arriving at the site: (yes or no) -eo source of Information: revised 9/2/98 Page 6 of 11 CA:" SUBSURFACE SEWAGE DISPOSAL SYSTEM WSPECTION FORM PART C SYSTBA NFORMATION (coittinuaid) PmpwW Addn=: We P&JAA— Ak.A� Owner; Daft at kwpoicdon; -4s BUILKING SEWER:, fLocate an site plan Depth below grade:�D 4 t-rialofqq!istEpction;i_leasti�ron_iz APVC—C Distance from private water supply well or suction line Diameter Comments: 1conditio of joints, venting, evidence of leakage, etc.) SEP'M TANK.je"-- (locate on site plan) -Ac, Ae�"�-- -�(j e, k V\ VAOja-e- Depth below grade: k a . Material of construction: oncrote —metal ­Fibergless —Polyethylene _other(explain) If tank Is metal, list age _ Is age confirmed by Certificate of Compliance _ tYes/No) Dimensions: t 0 9 L4 'K -7 Sludgedepth- R'I Distance from top of pludge to bottom of outlet tee or baffle:_ Scum thickness: C<5 Distance from top of scum to top of outlet too or baffle: Distance from bottom of scum to bottpm Qf coot too �r baffle: 15 How dimensions were determined: Comments: (mcorruriondation for pumpin ondition of onlot and outlet too baff! s, da;tth o liquilevel in rellog art, evidence qf leakage, ItIc.) V `�;r =N— I Y� I -e7 (locate on site plan) Depth below grade:. Material of construction: _concrete —metal —Fiberglass _Polyethylene _other(explain) Dimensions: Scum thickness: Distance from top of scum to top of outlet too or baffle: Distance from bottom of scum to bottom of outlet tee or baffle:— Date of last pumping: Comments: (recommendation for pumping, contrition of Inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidenc* of leakage, etc.) revised 9/2/98 Page 7 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTBA INSPECTION FORM PART C SYSTUA 111FORMATION I Property Address; OwrW: Data of litspectim: L - C1 9 TIGHT OR HOLDNG TANK. Vt�Tank must be pumped prior to, or at time of, inspection) (locate an site plan) - Depth below grade: Material of construction: —concrete -metal _Rberglass —Polyethylene _otherlexplain) Dimensions: Capacity: gallons Design flow.-- gallonsiday Alarm present Alarm level._ Alarm In working order: Yes No— Onto of previous pumping: Comments: (condition of inlet too, condition of Marm and float switches, etc.) DISTRIBUTION BOX.Se (locate on site plan) Depth of liquid level above outlet invert: Cornments: arld solids of leakage into gr out of' boxA etc. I-L-(D- PUMP CHAMBERjN.0V'*VQ . :A(locate an site plan) Pumps in working order: (yes or No)_ Alarms In working order (Yes or No) Comments: Inoto condition of pump chamber, condition of pumps and appurtenances. etc.) revised 9/2/98 Page 8 of 11 , C:��. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION 1continued) Propeft Address: Owrw: Os" of Inspecildn': . I I SOIL ABSORPTION SYSTEM ($A$)* (locate on site plan, if possible; excavation not required, location may be approximated by non -intrusive methods) If not located, explain: Type: leacWn9 pits, number:—. leaching chambers, number: leaching galleries, number: �Qe (CIAO leaching trenches, number, length: lea0drig fields, number, dimensions: overflow cesspool, number: Alternative system: Name of Technology: Comments: (note condition ofsoil, signs of hydramric failure, level o ti 31 A_' . A!AK ", damp soil, condi on of vegetation, etc.) A 0 CESSPOOLS: 0WOV1.12— (locate an 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 (cesspool must be pumped as part of inspection) Comments: inote condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) PRIVY: (locate Wn-Zo plan) Materials of construction: Dimensions: Depth of solids: Comments: (note condition of soil. signs of hydraulic failure, level of ponding, condition of vegetation, etc.) revised 9/2/98 Page 9 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PARI C SYSTEM VIFDRMATION fcontintm4l -)I Property Address: AAk—� Owner. Date of bapection; SKETC11i OF SEWAGE DISPOSAL SYSTEM: Include ties to at least two permanent reference landmarks or benchmarks locate all wells within 100' Mocate where public water supply comes into house) t�OQ,a� Wft, 11 it IV, it 0 1 1 11 i'C4 fo C revised 9/2/98 Page 10 of It & a dD e� V1 C- . -k CbA\�-- 9 ft I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM NFORMATION (contirmed) Property Address: W'�--Vkk- 4k"�Q'f Owner, Date of! UJO& 11 — q Ct NRCS Report name Soil Type_ Typical depth to groundwater USGS Date website visited Observation Wells chocked Groundwater depth: Shallow SITE EXAM Slope Surface water Check Cellar Shallow wells Estimated Depth to Groundwater H Feet Moderate Deep Please Indic all the methods used to determine High Groundwater Elevation: =Obtained from Design Plans on record Observed Site (Abutting property, observation hole, basement sump etc.) Date d from local conditions '!-17" Chocked with local Board of health Chocked FEMA Maps Chocked pumping records Cheoted local excavators, installers �Uad USGS Data Describe how you established the High Groundwater Elevation. (Must be completed) 4 (�j C 62D\ IE-SSQ-% C-ou k4t\ 6&6-'x- k AZDV"" 'A revised 9/2/98 Page 11 of 11 10 Tel: (978) 475-4786 Fax: (978) 475-5451 BATESON ENTERPRISES, INC. Excavating-WaterA sewer Lines -Septic Systems & Pumping Service 111 Argilla Road Andover, Mass. 01810 Title 5 Inspection Report Property Address:_�) " L--- "� �st_ k,�-x�(­� Owner: U`J (3 13 "�, Date of Inspection: t — --I — q C� My report contained herein does not constitute a guarantee of future usage and the functionality of the existing septic system. Such report issued herewith is merely based upon my observations,and I hereby disclaim any further operation of your current septic system. A Neil J. Bateson Bateson Enterprises, Inc.