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AS BUILT PLAN
OF
SUBSURFACE DISPOSAL SYSTEM
LOCATEDIN
WORTH AAJ DOVER, MASS -.--
AS PREPARED FOR_
JE"A ki ORlOff.
DATE: OCTDBEFR 3b,194Z
SCALE: l
#339 ABBor
IF M. 1`38
IIMERRIMACK ENGINEERING SERVICES, INC.
PROFESSIONAL ENGINEERS • LAND SURVEYORS • PLANNERS:
66 PARK STREET 0 ANDOVER, MASSACHUSETTS 01810 0 TEL. (508) 475-3555, 373.5721
COMMONWEALTH OF MASSACHUSETTS
�, (j, H .
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS co
DEPARTMENT OF ENVIRONMENTAL PROTECTION
TITLE 5
OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
CERTIFICATION
Property Address: _339 Abbott Street
_North Andover_
Owner's Name: Nancy Oriol_
Owner's Address: _339 Abbott Street_
North Andover, Ma. 01845_
Date of Inspection: 8/4/2001_
Name of Inspector: Neil J. Bateson_
Company Name: Bateson Enterprises Inc._
Mailing Address: _111 Argills Road_
_Andover, Ma. 01810`
Telephone Number: ( 978 ) 475-4786_
CERTIFICATION STATEMENT
I certify that I have personally inspected the sewage disposal system at this address and that the information reported
below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my
training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP
approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000). The system:
X Passes
Conditionally Passes
Needs urther Evaluation by the Local Approving Authority
Inspector's Signature: Date: _8/4/2001_
The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or
DEP) within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000
gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the
DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving
authority.
Notes and Comments
****This report only describes conditions at the time of inspection and under the conditions of use at that
time. This inspection does not address how the system will perform in the future under the same or different .
conditions of use.
,R'^ kQ 0 201
Page 2 of 11
OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 339 Abbott Street_
_North Andover—
Owner: Oriol
Date of Inspection: 8/4/2001_
Inspection Summary: Check A,B,C,D or E / ALWAYS complete all of Section D
A. System Passes:
XT I have not found any information which indicates that any of the failure criteria described in 310 CMR
15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below.
Comments:
B. System Conditionally Passes:
One or more system components as described in the "Conditional Pass" section need to be replaced or
repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass.
Answer yes, no or not determined (Y,N,ND) in the for the following statements. If "not determined" please
explain.
The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally
unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the
existing tank is replaced with a complying septic tank as approved by the Board of Health.
*A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance
indicating that the tank is less than 20 years old is available.
ND explain:
Observation of sewage backup or break out or high static water level in the distribution box due to broken or
obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if (with
approval of Board of Health):
broken pipe(s) are replaced
obstruction is removed
distribution box is leveled or replaced
ND explain:
The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will
pass inspection if (with approval of the Board of Health):
broken pipe(s) are replaced
obstruction is removed
ND explain:
Page 3 of 11
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: _339 Abbott Street_
_North Andover—
Owner: Oriol
Date of Inspection: 8/4/2001_
C. Further Evaluation is Required by the Board of Health:
Conditions exist which require further evaluation by the Board of Health in order to determine if the system
is failing to protect public health, safety or the environment.
1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b) that the
system is not functioning in a manner which will protect public health, safety and the environment:
Cesspool or privy is within 50 feet of a surface water
_ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh
2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the
system is functioning in a manner that protects the public health, safety and environment:
_ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a
surface water supply or tributary to a surface water supply.
The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply.
_ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well.
_ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a
private water supply well**. Method used to determine distance
**This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform
bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and
the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other
failure criteria are triggered. A copy of the analysis must be attached to this form.
3. Other:
Page 4 of 11
OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address:
339 Abbott Street_
_North Andover_
Owner: _Oriol
Date of Inspection:
8/4/2001_
D. System Failure Criteria applicable to all systems:
You must indicate "yes" or ` no" to each of the following for all inspections:
Yes No
No Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool
_No Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or
clogged SAS or cesspool
No Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or
cesspool
No Liquid depth in cesspool is less than 6" below invert or available volume is less than V2 day flow
_No_ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).
Number of times pumped
No Any portion of the SAS, cesspool or privy is below high ground water elevation.
No Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface
water supply.
—NoAny portion of a cesspool or privy is within a Zone 1 of a public well.
_No_ Any portion of a cesspool or privy is within 50 feet of a private water supply well.
—No 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 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.]
No (Yes/No) The system fails. I have determined that one or more of the above failure criteria exist as
described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of
Health to determine what will be necessary to correct the failure.
E. Large Systems:
To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000
gpd•
You must indicate either `yes" or "no" to each of the following:
(The following criteria apply to large systems in addition to the criteria above)
yes no
— _ the system is within 400 feet of a surface drinking water supply
— _ the system is within 200 feet of a tributary to a surface drinking water supply
the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area — IWPA) or a mapped
Zone II of a public water supply well
If you have answered "yes" to any question in Section E the system is considered a significant threat, or answered
"yes" in Section D above the large system has failed. The owner or operator of any large system considered a
significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR
15.304. The system owner should contact the appropriate regional office of the Department.
Page 5 of 11
OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: _339 Abbott Street
_North Andover_
Owner: Oriol
Date of Inspection: _8/4/2001_
Check if the following have been done. You must indicate "yes" or "no" as to each of the following:
Yes No
Yes_ _ Pumping information was provided by the owner, occupant, or Board of Health
No Were any of the system components pumped out in the previous two weeks ?
Yes_ _ Has the system received normal flows in the previous two week period ?
_No Have large volumes of water been introduced to the system recently or as part of this inspection ?
Yes_ — Were as built plans of the system obtained and examined? (If they were not available note as N/A)
_Yes_ _ Was the facility or dwelling inspected for signs of sewage back up ?
Yes — Was the site inspected for signs of break out ?
_Yes_ _ Were all system components, excluding the SAS, located on site ?
_Yes_ _ 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 ?
_Yes_ _ Was the facility owner (and occupants if different from owner) provided with information on the
proper maintenance of subsurface sewage disposal systems ?
The size and location of the Soil Absorption System (SAS) on the site has been determined based on:
Yes no
_Yes_ _ Existing information. For example, a plan at the Board of Health.
_an
No Determined in the field (if any of the failure criteria related to Part C is at issue approximation of
distce is unacceptable) [3 10 CMR 15.302(3)(b)]
Page 6 of 11
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 339 Abbott Street_
_North Andover,
Owner: Oriol
Date of Inspection: 8/4/2001
FLOW CONDITIONS
RESIDENTIAL
Number of bedrooms (design): _4_ Number of bedrooms (actual): J4_
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x # of bedrooms): _660_
Number of current residents: _2
Does residence have a garbage grinder (yes or no): No
Is laundry on a separate sewage system (yes or no): No [if yes separate inspection required]
Laundry system inspected (yes or no):
Seasonal use: (yes or no): _No
Water meter readings: _On well water, 110' from SAS_
Sump pump (yes or no): _No_
Last date of occupancy: —
Current-C
OMMERCIAL/INDUSTRIAL
Type of establishment:
Design flow (based on 310 CMR 15.203): gpd
Basis of design flow (seats/persons/sgft,etc.):
Grease trap present (yes or no):
Industrial waste holding tank present (yes or no):
Non-sanitarywaste discharged to the Title 5 system (yes or no):
Water meter readings, if available:
Last date of occupancy/use:
OTHER (describe):
GENERAL INFORMATION
Pumping Records
Source of information: _Pumped two years ago, owner
Was system pumped as part of the inspection (yes or no)_ Yes_
If yes, volume pumped: _1500Jgallons -- How was quantity pumped determined? _Measured tank _
Reason for pumping: Inspect tank & tees._
TYPE OF SYSTEM
X_ Septic tank, distribution box, soil absorption system
T Single cesspool
Overflow cesspool
Pavy
_ Shared system (yes or no) (if yes, attach previous inspection records, if any)
_ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract (to be
obtained from system owner)
T Tight tank ____ Attach a copy of the DEP approval
— Other (describe):
Approximate age of all components, date installed (if known) and source of information: _9 years old. 10/30/1992.
As built plan._
Were sewage odors detected when arriving at the site (yes or no): _No
Page 7 of 11
OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 339 Abbott Street_
North Andover_
Owner: _Oriol
Date of Inspection: _8/4/2001_
BUILDING SEWER (locate on site plan) X
Depth below grade: 20"
Materials of construction: _X_cast iron _X_40 PVC other (explain):
Distance from private water supply well or suction line_: _90'_
Comments (on condition of joints, venting, evidence of leakage, etc.): _4" Cast iron thru wall 4" PVC to septic
tank. 3" PVC in house. No leaks.
SEPTIC TANK: X locate on site plan)
Depth below grade: 8"
Material of construction: —X—concrete ____metal _fiberglass ____polyethylene
_other(explain)
If tank is metal list age: _ Is age confirmed by a Certificate of Compliance (yes or no): _ (attach a copy of
certificate)
Dimensions: 10' x 5' x 4'
Sludge depth 2"
Distance from top of sludge to bottom of outlet tee or baffle: _27"_
Scum thickness: _0
Distance from top of scum to top of outlet tee or baffle: —8"—
Distance from bottom of scum to bottom of outlet tee or bale: _2111
_
How were dimensions determined: _Subtract scum & sludge depth to tee length.
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels
as related to outlet invert, evidence of leakage, etc.): _Pumped septic tank Inlet & outlet tees ok. Depth of liquid
at outlet invert. No evidence of leakage. _
GREASE TRAP: _(locate on site plan)
Depth below grade: _
Material of construction: _concrete metal —fiberglass _polyethylene _other
(explain):
Dimensions:
Scum thickness:
Distance from top of scum to top of outlet tee or baffle:
Distance from bottom of scum to bottom of outlet tee or baffle:
Date of last pumping:
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels
as related to outlet invert, evidence of leakage, etc.):
Page 8 of 11
OFFICIAL INSPECTION FORM – NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 339 Abbott Street
_North Andover
—
Owner: Oriol
Date of Inspection: _8/4/2001_
TIGHT or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan)
Depth below grade:
Material of construction: concrete metal fiberglass _polyethylene other(explain):
Dimensions:
Capacity: gallons
Design Flow: gallons/day
Alarm present (yes or no):
Alarm level: _ Alarm in working order (yes or no):
Date of last pumping:
Comments (condition of alarm and float switches, etc.):
DISTRIBUTION BOX: X (if present must be opened)(locate on site plan)
Depth of liquid level above outlet invert: _0_
Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of
leakage into or out of box, etc.): —D -box level & distribution equal. No evidence of leakage. No evidence of
carryover. D -bog cover broken, replaced same. _
PUMP CHAMBER: (locate on site plan)
Pumps in working order (yes or no):
Alarms in working order (yes or no):
Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.):
Page 9 of 11
OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: _339 Abbott Street _
_North Andover _
Owner: _Oriol
Date of Inspection: _8/4/2001_
SOIL ABSORPTION SYSTEM (SAS): _X (locate on site plan, excavation not required)
If SAS not located explain why:
Type
leaching pits, number: _
leaching chambers, number:
leaching galleries, number:
_X_ leaching trenches, number, length: _2 Trenches 76' long _
leaching fields, number, dimensions:
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.): _Soil ok. Vegetation ok. No sign of ponding to surface. _
CESSPOOLS: (cesspool must be pumped as part of inspection)(locate on site plan)
Number and configuration:
Depth — top of liquid to inlet invert:
Depth of solids layer:
Depth of scum layer:
Dimensions of cesspool:
Materials of construction:
Indication of groundwater inflow (yes or no):
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.):
PRIVY: (locate on site plan)
Materials of construction:
Dimensions:
Depth of solids:
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc_):
Page 10 of 11
OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 339 Abbott Street _
North Andover_
Owner: Oriol
Date of Inspection: 8/4/2001_
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.
\ -1 '
76'
Garage
Driveway
/B
House
A
Septic Tank
1 2 3
D -Bog
Sun D Fell
Head
Room
C OA--
A to 1 =26'10"
Ato2=26'4"
Ato3=26'9"
A to D -Bog = 3314"
Bto1=15'5"
Bto2=19'6"
Bto3=23'7"
B to D -Bog = 26110"
C to Well = 915"
D to Well = 2415"
Page 11 of 11
OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 339 Abbott Street _
North Andover _
Owner: Oriol
Date of Inspection: 8/4/2001_
SITE EXAM
Slope
Surface water
Check cellar
Shallow wells
Estimated depth to ground water 4 feet
Please indicate (check) all methods used to determine the high ground water elevation:
_X Obtained from system design plans on record - If checked, date of design plan reviewed: _4/9/1991_
Observed site (abutting property/observation hole within 150 feet of SAS)
Checked with local Board of Health -explain:
Checked with local excavators, installers- (attach documentation)
Accessed USGS database -explain:
You must describe how you established the high ground water elevation: As per design plan_
Tel: (978) 475-4786
Fax: (978) 475-5451
BATESON ENTERPRISES, INC.
Excavating -Water.& Sewer Lines -Septic Systems & Pumping Service
111 Argilla Road Andover, Mass. 01810
Title 5 Inspection Report
Property Address: 339 Abbott Street, North Andover
Owner: Oriol
Date of Inspection: 8/4/2001
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.
l
c
Neil J. Bateson
Bateson Enterprises, Inc.
COMMONWEALTH OF MASSACHUSETTS
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
DEPARTMM OF ENVIRONMENTAL PROTECTION
ONE WIIVTER STREET, BOSTON MA 02108 (617) 292-5500
TRUDY COKE
SemvtU7
ARGEO PAUL CELLUCCI DAVID B.STRUHS
GovernorCommis�oner
SUBSURFACE SEWAGE DISPOSAL SYSTEM 1111111SPECTIOlill FORM
PART A
CERTIRCATION
Property Address: 339 Abbott Street North Andover Name of Owner: Jean Oriol
Address of Owner: 339 Abbott Street North Andover, Me. 01845
Data of Inspection: 913199
Name of Inspector: Neil J. Bateson
I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000)
Company Name: Bateson Enterprises Inc.
Mailing Address: 111 Argilla Road Andover MA 01810
Telephone Number: ( 978 ) 475-4786
CERTIFICATION STATEMENT
I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate
and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and
maintenance of on-site sewage disposal systems. The system:
_X Passes
Conditionally Passes
Needs Further Evaluation By the Local Approving Authority
Fails
Inspector's Signature:m�,°/�-.�% Date: 913199
- e
The System Inspector shall submit a copy is inspection 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 Protection. The original should be sent to the
system owner and copies sent to the buyer, if applicable, and the approving authority.
NOTES AND COMMENTS
TC',IVN OF NORTH ANDOVER/
BOARD OF HEALTH
SEP 1 0 1999 ,
revised 9/2/98 Page I of 11
Printed on Recycled Paper
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 339 Abbott Street North Andover
Owner: Oriol
Date of Inspection: 913199
INSPECTION SUMMARY: Check A, 8, C, or D:
A. SYSTEM PASSES:
X I have not found any information which indicates that any of the failure conditions described in 310 CMR 15.303 exist. Any failure
criteria not evaluated are indicated below.
COMMENTS:
B. SYSTEM CONDITIONALLY PASSES:
One or move 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 NO). Describe basis of determination in all instances. If "not determined", explain why not.
_ The septic tank is metal, unless the owner or operator has provided the system inspector with a copy of a Certificate of
Compliance (attached) indicating that the tank was installed within twenty (20) years prior to the date of the inspection; or
the septic tank, whether or not 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 leveled or replaced
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 912198 Page 2 of 11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 339 Abbott Street North Andover
Owner. Oriol
Date of Inspection: 913/99
C. FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH:
Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the
public health, safety and the environment.
1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES IN ACCORDANCE WITH 310 CMR 15.303 (1xb) THAT
THE SYSTEM IS 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 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 AND SAFETY AND THE ENVIRONMENT:
The system has a septic tank and sal 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 sal absorption system and the SAS is within a Zone I of a public water supply well.
The system has a septic tank and sal absorption system and the SAS is within 50 feet of a private water supply well.
The system has a septic tank and sal absorption system and the SAS is less than 100 feet but 50 feet or more from a
private water supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the
well is free frau pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less
than 5 ppm. 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)
Property Address: 339 Abbott Street North Andover
Owner: Oriol
Date of Inspection: 913199
D. SYSTEM FAILS:
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 be contacted to determine what will be necessary to correct the failure.
Yes No
Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool.
Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool.
Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool.
Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/2 day flow.
Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).
Number of times pumped —
Any portion of the 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 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. If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria, volatile
organic compounds, ammonia nitrogen and nitrate nitrogen.
E. LARGE SYSTEM FAILS -
You must indicate either "Yes" or "No" to each of the following:
The following criteria apply to large systems in addition to the criteria above:
The system serves a facility with a design flow of 10,000 god 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 information.
revised 912198 Page 4 of 11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: 339 Abbott Street North Andover
Owner: Oriol
Date of Inspection: 913199
Check if the following have been done: You must indicate either "Yes" or "No" as to each of the following:
Yes No
—X Pumping information was provided by the owner, occupant, or Board of Health.
—X None of the system components have been pumped for at least two weeks and the system has been receiving normal flow
rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection.
—X— As built plans have been obtained and examined. Note if they are not available with NIA.
—X— The facility or dwelling was inspected for signs of sewage back-up.
e
X The system does not receive non -sanitary or industrial waste flow. The site was inspected for signs of breakout.
All system components, excluding the Soil Absorption System, have been located on the site.
—X The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles
or tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum.
The size and location of the Soil Absorption System on the site has been determined based on:
—X Existing information. For example, Plan at B.O.H.
X Determined in the field (if any of the failure criteria related to Part C is at issue, approximation of distance is unacceptable)
— — [I 5.302(3)(b)l
—X 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 Page 5 of 11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 339 Abbott Street North Andover
Owner: Oriol
Date of Inspection: 913199
FLOW CONDITIONS
RESIDENTIAL:
Design flow.:_165_ .g.p.d./bedroom.
Number of bedrooms (design): 4_ Number of bedrooms (actual): -3
Total DESIGN flow _660_
Number of current residents: _2_
Garbage grinder (yes or no): _No_
Laundry (separate system) (yes or no):_No_; If yes, separate inspection required
Laundry system inspected (yes or no)
Seasonal use (yes or no):_No
Water meter readings, if available (last two years usage (gpd): On well water
Sump Pump (yes or no): _No_
Last date of occupancy: Current
COMM ERCIALIINDUSTRIAL:
Type of establishment:
Design flow: gpd ( Based on 15.203)
Basis of design flow
Grease trap present: (yes or no)
Industrial Waste Holding Tank present: (yes or no)
Non -sanitary waste discharged to the Title 5 system: (yes or no)
Water meter readings, if available:
Last date of occupancy:
OTHER: (Describe) _
Last date of occupancy:
GENERAL INFORMATION
PUMPING RECORDS and source of information: Pumped three years ago - Owner
System pumped as part of inspection: (yes or no)_Yes.
If yes, volume pumped: _1500_gallons
Reason for pumping: Inspect tank & tees.
TYPE OF SYSTEM
_X Septic tank/distribution boxisoil absorption system
Single cesspool
Overflow cesspool
Privy
Shared system (yes or no) (if yes, attach previous inspection records, if any)
VA Technology etc. Attach copy of up to date operation and maintenance contract
Tight Tank Copy of DEP Approval
af" 1-
APPROXIMATE AGE of all components, date installed (if known) and source of information: 7 years old, Oct 30, 1992 , as built plan.
Sewage odors detected when arriving at the site: (yes or no)_No_
revised 9/2/98 Page 6 of 11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 339 Abbott Street North Andover
Owner: Oriol
Date of Inspection: 9/3/99
BUILDING SEWER: X
(Locate on site plan)
Depth below grade: 20"
Material of construction: _ X cast iron X 40 PVC _ other (explain)
Distance from private water supply well or suction line: 90'
Diameter :4"
Comments: 4" Cast iron thru wall . 4" PVC to septic tank. 3" PVC in house.
SEPTIC TANK:X
(locate on site plan)
Depth below grade:8"
Material of construction: _X concrete _metal _Fiberglass _Polyethylene _other (explain)
If tank is metal, list age _Is age confirmed by Certificate of Compliance _ (Yes/No)
Dimensions: 10' x 5' x 4' x 7.5 = 1500 Gallons.
Sludge depth: 3"
Distance from top of sludge to bottom of outlet tee or baffle: 24"
Scum thickness: 2"
Distance from top of scum to top of outlet tee or baffle: 8"
Distance from bottom of scum to bottom of outlet tee or baffle: 19"
How dimensions were determined: Subtract scum & sludge depths to tee length
Comments: Pumped septic tank, inlet & outlet tees ok. Depth of liquid at outlet invert. No evidence of leakage.
GREASE TRAP: None
(locate on site plan)
Depth below grade:
Material of construction: concrete _metal _Fiberglass _Polyethylene_other(explain)
Dimensions:
Scum thickness:
Distance from top of scum to top of outlet tee or baffle:
Distance from bottom of scum to bottom of outlet tee or baffle:
Date of last pumping:
Comments:
revised 9/2/98 Page 7 of 11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 339 Abbott Street North Andover
Owner: Ortol
Date of Inspection: 913199
TIGHT OR HOLDING TANK: _None (Tank must be pumped prior to, or at time of, inspection)
(locate on site plan)
Depth below grade:
Material of construction: concrete _ metal _Fiberglass Polyethylene _other(explain)
Dimensions:
Capacity:_gallons
Design flow:_allons/day
Alarm present
Alarm level: Alarm in working order: Yes _ Nc
Date of previous pumping:
Comments:
DISTRIBUTION BOX.:_X_
(locate on site plan)
Depth of liquid level above outlet invert: 0
Comments: D -box level And distribution equal. Evidence of carryover. Pumped D -box to clean. No evidence of leakage.
PUMP CHAMBER: _None, gravity system_
(locate on site plan)
Pumps in working order. (Yes or No)
Alarms in working order (Yes or No)
Comments:
Revised 9/2/98 Page 8 of 11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued))
Property Address: 339 Abbott Street North Andover
Owner: Oriol
Date of Inspection: 913199
SOIL ABSORPTION SYSTEM (SAS): X
(locate on site plan, if possible; excavation not required, location may be approximated by non -intrusive methods)
If not located, explain:
Type:
leaching pits, number
leaching chambers, number:
leaching galleries, number:
leaching trenches, number, length: 2 Trenches 76' long.
leaching fields, number, dimensions:
overflow cesspool, number:
Alternative system:
Name of Technology:
Comments: Soil ok. Vegetation ok. No sign of ponding to surface.
CESSPOOLS: None
(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 (cesspool must be pumped as part of inspection)
Comments:
PRIVY: None
(locate on site plan)
Materials of construction: Dimensions:
Depth of solids:
Comments:
revised 9/2/98 Page 9 of 11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 339 Abbott Street North Andover
Owner: Oriol
Date of Inspection:
SKETCH OF SEWAGE DISPOSAL SYSTEM:
include ties to at least two permanent reference landmarks or benchmarks
locate all wells within 100' (Locate where public water supply comes into house)
revised 9/2/98 Page 10 of 11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 339 Abbott Street North Andover
Owner: Oriol
Date of Inspection: 913199
NRCS Report name
Soil Type
Typical depth to groundwater
USGS Date website visited
Observation Wells checked
Groundwater depth: Shallow Moderate Deep
SITE EXAM Slope
Surface water
Check Cellar
Shallow wells
Estimated Depth to Groundwater _4_ Feet
Please indicate all the methods used to determine High Groundwater Elevation:
_X Obtained from Design Plans on record
Observed Site (Abutting property, observation hole, basement sump etc.)
—X—Determined from local conditions
—X—Checked with local Board of health
Checked FEMA Maps
Checked pumping records
Checked local excavators, installers
Used USGS Data
Describe how you established the High Groundwater Elevation. Must be completed) As per design plan, water 4' below trenches.
revised 912/98 Page 11 of 11
Tel: (978) 475-4786
Fax: (978) 475-5451
BATESON ENTERPRISES, INC.
Excavating -Water.& Sewer Lines -Septic Systems & Pumping Service
111 Argilla Road Andover, Mass. 01810
Title 5 Inspection Report
Property Address: 339 Abbott Street North Andover
Owner: Oriol
Date of Inspection: 9/3/99
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.
- 84v�---
Neil J. leson
Bateson Enterprises, Inc.
rkORTH
• Gf <•`a �e,h0
'i
SSACHUSEt
Applicant
Town of North Andover, Massachusetts
BOARD OF HEALTH
/ 0 lb-- 1 9-2 •
Form No. 3
DISPOSAL WORKS CONSTRUCTION PERMIT
? C•�^-- l� I «Qrnvivc
Site Location .,OJO
Permission is hereby granted to Construct (L4,OT Repair an Individual Soil Absorption
Sewage Disposal System as shown on the Design Approval S.S. No.
X/ 'jz�7/
CHAIRMAN, BOARD OF HEALTH
Fee v/ D.W.C. No. 5qb
WELL DATABASE
33 T �!
ADDRESS:-3
AGE OF WELL: WELL DRILLER: D. r (�� ✓!
WELL PERNNUT 4: WELL LOCATION: D
WELL PER -WL T DATE: I ��- DEPTH OF WELL: 4 _
TYPE OF WELL: C -.DRILLED b. DAG c. Ul'��Ni0v
TYPE OF WATER BEARING ROCK:
WATER ANALYSIS DATE: % / J HIGH MANGANESE: Y
HIGH IRON: Y <� OTHER CONTAMI`i;ANI TS: Y N
-rp�
1715
401 - `ods � Lo
to
1 %0(40 `4$.
- ` 30II, D lJF" ' �
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DATE
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� Benchmark
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DATE_
Sheet of
BOARD OF HEALTH
TOWN OF NORTH ANDOVER
SUBSURFACE DISPOSAL DESIGN REVIEW
FEE PERMIT #
APPLICANT
ADDRESS
ENGINEER 004 k)
ADDRESS /
PLAN DATE
DATE RECEIVED � 3
ASSESSOR'S MAP -70,-6re
PARCEL # _ S?
LOT # /9
STREET
REVISION DATE
CONDITIONS OF�APPROVAL:
APPROVED
DISAPPROVED
/lc} �- eX ca va � -ed - o,k"
n
House
Tank IN
Tank OUT
D -box IN
D -box OUT
Trench Inverts
Line 1
Line 2
Line 3
Line 4
Bottom of Exc.
Stone OK? —
AS -BUILT CHECK LIST
and
FINAL INSPECTION
Proposed Elevations
7S"
A3/--:�3
A31106
, .0-J-9
A3o, 4.'Z
As -Built Elevation
x•07
a3/, 6,q
P,,61 a 7
a31,17
ok3/.00
,930,00 a,3 n, g,9- A,30— �
,5� 30, 1-,0 - g 30 . o y
;� a9.o
D -box checked? ✓ Pipes cemented?
4 PLAN REVIEW CHECKLIST
ADDRESS ENGINEER
GENERAL / /
3 COPIES �� STAMP �/ LOCUS C/ SCALE CONTOURS
PROFILE SECTION BENCHMARK ELEVATIONS i,-"- SOIL
j & PERC INFO I/ WETS. DISCLAIMER WELLS & WETLANDS��
WATERSHED DISTRICT DRIVEWAY WATER LINE DRAINS
RESERVE AREA SCH40 SLOPE
SEPTIC TANK
MIN 1500G. 1// .17 INVERT DROP GARB. GRINDER(+200% EDF)
25' TO CELLAR MANHOLE TO GRADE ELEV 0 GW U
D—BOX
# OUTLETS �J FIRST 2' LEVEL STATEMENT INLET A3D,, /�—
OUTLETZZ-�7Z = /7 ( 2" OR .17 FT)
LEACHING
100' TO WETLANDS v--' 100' TO WELLS 325' TO SURFACE H2O SUPP
35' TO FND & INTRCPTR DRAINS 4' TO S.H.GW 2% SLOPE /
4' PERM. SOIL BELOW FACILITY MIN 12" COVER FILL? if
above natural elevation; Of below)
TRENCHES
4
MIN 660 SLOPE (min .005 or 6"/1001) L� >3' COVER? - VENT
SIDEWALL D\I'ST. 2X EFF. W OR D (MIN 6') IS RESERVE BETWEEN
TRENCHES? 'y IN FILL? MUST BE 10' MIN.L----�
T _$
BOT 4,'11-6 X LDNG Idl-q'(0 + SIDE 316 X LDNG a5� = TOT >
(L x W x #) (G/ft2) (DxLx2x#)
FORM U - IAT RELEASE FORK
INSTRUCTIONS: This form is used to verify that all necessary
approvals/permits from Boards and Departments having jurisdiction
have been obtained. This does not relieve the applicant and/or
landowner from compliance with any applicable local.or state law,
regulations or requirements.
****************Applicant fills out this section*****************
T
APPLICANT: Tea, ¢ Phone
V
LOCATION: Assessor's Map Number 33 Parcel
Subdivision A Lot(s) S�
Street b bot S f' St. Number 339
************************Official Use only************************
RECOMMENDATI
ONS
OF TOWN AGENTS:
Conservation Administrator
Comments
Town Planner
Comments
A.
Health Agent
Date Approved 4/150
Date Rejected
I MIUMM
Date Approved _(i -q7
Date Rejected
Date Approved 7Z/ -- A
Date Rejected
Comments /.C1-�PB�O�ry -rROV Y- �l�y6�sYe5� To ,d
Public Works - sewer/water connections
- driivveewaermit LEddai
Fire Department `
Received by Building Inspector
Date
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NUM,ZF.R FEE
'�,� THE COMMONWEALTH OF MASSACHUSETTS
L 2r; . 00-
---- TOWN
0-
----TOWN _-_. of -------- NORTH _ ANDOVER
Thisis to Certify that ....D...J._...Ogden.......................................................................................
NAME
17 Catherwood Road, Tewksbury, MA
.......................................................................................................................................................
ADDRESS
IS HEREBY GRANTED A LICENSE
For --------------Well Drilling Permit — 339 Abbott Street
.................................. ---............................--------...-----......----------......-----.-----.....----.
....---------------------------------------------------------------------------------:-------------.........------......---.........------.------......----------..........
---------------------------------------------------------------------------------------------------------------------- ...............................................
------------------------------------------------------------------------- .----------...------......----.------------..........---...........------..........
This license is granted in conformity with the Statutes and ordinances relating thereto, and
expires_ DeCLmber.... 3.1 ...... 19.92 ...... Mess sooucrwnde r rwl
r
•
FORM 433 HOBBS WARREN. INC.
....
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I-Od W�iVS:C, _,r-TST •I '1 TSOG, IS`, : ';Diti 31A;--Hcc . T"El'i 11,13,TDC., 1 1, : ,-
3 . Department of Environmental Management/Division of Water Resources
3u WATER WELL COMPLETION REPORT
WELL LOCATION
Address
City/Town//Q/ Al ve-ay_ fe% &A
Well own er/l 4&4
Address h!7/v %? t✓
Board of Health permit: yes ❑ no ❑
WELL USE
Domestic Vublic ❑ Industrial ❑
Monitoring ❑ Other
Method drilled"✓!ntlltf j"
Date drilled
CASING
Type/H
741 e,� .
Length ft. DIa(I.D.) In..
Length into bedrock / Q ft.
Protective well seal:
GEOGRAPHIC DESCRIPTION
dVoS E W of
(feet) (circle)
(road)
N S (F� W of
(mi. in tenths) r_ (circle)
intersect. w%
(road)
MILL UA I A /
Total well depth / �5 ft.
Depth to bedrock --61 ft.
Water-bearing
jro�ck/uncJonsolidated material:
Description
Water -bearing zones:
1) From Z Y59 To % S
2) From To
3) From To
Gravel pack well
Screen:
Grout.❑ Otherj?/? a'r, I slot 01.
dia.
dia.
length from_
PUMP TEST .47
Static water level below land surface ft. Date 1
Drawdown e ft. after
w�after pumping lir. 0 min. at�gpm
How measured 5" Recovery ft. after -hr. -min.
0
LOG of FORMATIONS COMMENTS
Materials From To wif, ///4W6G!5 _-5 (a6 OW
Mass. Registration 4L
Firm
Address
Dunnu yr IFILAL I it uur T
:7houte- wen 4
06 UTratok F40AD WWFORD
MA
Report Number: C^ogd-6213
Chant:
Thomas Ogden
17 Cat;herwood
Tewksbury, MA 01876
sample Taken By. Ogden Staff
PSC.
(608) SV2.8395 FAX �i 4,p' "9' TEs'r
Report Darn: July 14#19112
Sample Taken At:
337 Abbott Rd.
N, Andover KA
On; July 13, 1992
r,F•R.TIFIGATE OP ANALYSIS
TEST PARAME'1bK:
EPA Max
RESULTS
UNITS
Total Coliform (P)
0
0
Pe: 100m1
mg/L
Calcium
No Limit
27.4
m8/1j
Copper (S)
1.3
0.03
mg/L
Iron (S)
0.3
No Limit
_0 0.63
6.5
rng/L
Magnesium
Manganese (S)
0.05
0 0,31_
mg/L
Sodium
i0
8.9
m8/L
Potassium (S)
No Lirr:i t
2
m8/L
Alkalinity (S)
No Limit
mg/L
Ammonia
No Limi t
t..,-3
M&/L
Chloride (S)
250
20.8
mg/L
Chlorine (total)
Not Spec
<0.02
mg/L
Color (S)
15
10
CPU
Conductivity
No Limit
250
umkios,/em
llardness
No Limit
95
m$/1.
Nitrates(as N,;P)
10
0.0:
Ing/L
Nitrites(as N)
1
<0.0,
ma/L
pli (S)
5.5-8.5
7,:'
STJ
Odor (S)
3
raN
Sulphates ;S'
250
16.x+
mg/L
Turbidity
ix b.F`
NTU
Sediment
pos/rias
neg
NT=Not. Tested, U=Value Fxceeds EPA STD, TNTO=To.) Numerous to Count:
*-Background Bacteria Noted, "-EPA Advisory Limit
Exceeds EPA Advisory Limit
(P)=Primary Ell, ndard, (S)=Secondary EPA Standard (may affect
aeathetic:s of drinking water i..e, taste, color, etc.)
This waL r -ample, iAS Lk:btbd# is ,APR to drillk accordinp
to EPA guidelines, however, one or move of the parameters. exceodg
EPA standards aR indicated by tht� (0) szSn.
s�iabsachuE yiicli,ael Y. Garlaon, for
Testing 1. Thorstensen 3.aboratory Inc.
yoveiteaaem
LITTLETON ROAD WESTFORD. MA 01686
Report Number: C-ogd-7205
Client:
Thomas Ogden
17 Catherwood
Tewksbury, MA 01876
PINC.
(508) 692.8395 FAX (1
081692 7�1 ST
Report Date: Nov. 03, 1992
Sample Taken At:
Gene and Nancy Oriole
339 Abbot St,
N. Andover MA .
Sample Taken By: Ogden Staff On: November 02, 1992
CERTIFICATE OF ANALYSIS
TEST PARAMETER:
EPA Max
RESULTS
UNITS
Total Coliform (P)
0
0 Per 100ml
Calcium
No Limit
24.5
mg/L
Copper (S)
1.3
0.12
mg/L
Iron (S)
0.3
0.22
mg/L
Magnesium
No Limit
5.3
mg/L
Manganese (S)
0.05
4k 0.29
mg/L
Sodium
20
12.9
mg/L
Potassium (S)
No Limit
5.7
mg/L
Alkalinity (S)
No Limit
34
mg/L
Ammonia
No Limit
0.03
mg/L
Chloride (S.)
250
22.8
mg/L
Chlorine (total)
0.7
<0.02
mg/L
Color (S)
15
10
CPU
Conductivity
No Limit
230
umbos/cm
Hardness
No Limit
83
mg/L
Nitrates(as N)(P)
10
0.07
mg/L
Nitrites(as N)
1
<0.01
mg/L
pH (S)
6.5-8.5
7.1
SU
Odor (S)
3
0
TON
Sulphates (S)
250
16.6
mg/L
Turbidity
5
0.81
NTU
Sediment
pos/neg
poo
NT=Not Tested, #=Value
Exceeds EPA STD,
TNTC=Too Numerous
to Count
*=Background Bacteria Noted, "=EPA Advisory Limit
'=Exceeds EPA Advisory
Limit
(P)=Primary EPA Standard, (S)=Secondary
EPA Standard (may
affect
aesthetics of drinking
water i.e. taste,
color, etc.)
This water sample, as tested, is considered SAFE to drink according
to EPA guidelines. However, one or more of the parameters exceeds
EPA secondary standards as indicated bythe (41) sign.
B
Massachusetts State Certified Michael P. Carlson, for
Testing Laboratory #MA048 Thorstensen Laboratory Inc.