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HomeMy WebLinkAboutMiscellaneous - 45 WOODBERRY LANE 4/30/2018o u� �(( J �� L S o U 2 w Q m� a � 0 \ � a w o Ll � ti h Q 0 W O� =24,r ZS L o U 2 w Q m� \ W � W =24,r ZS L ,� �t S f /�,�{/ ///I' / f J��� - -- Town of North Andover Office of the Health Department Community Development and Services Division 27 Charles Street North Andover, Massachusetts 01845 Heidi Griffin Acting Public Health Director Fid TOWN OF NORTH ANDOVER BOARD OF HEALTH CERTIFICATE OF COMPLIANCE DATE OF COMPLIANCE 9/26%03 This is to certify that The Distribution Box constructed () or repaired (X by James Currier at 45 Woodberry Lane Telephone (978) 688-9540 Fax (978) 688-9542 has been installed in accordance with the provisions of Title V of the State Sanitary Code and with the North Andover Board of Health regulations. The Issuance of this certificate shall not be construed as a guarantee that the system will function satisfactorily. l rian J. LaGrasse Board of Health Inspector BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PL NI NINC 688-9535 THIS IS TO by James Currier Commonwealth of Massachusetts Board Of Health / North Andov Cer=hidividual ompliance NTIFY,ewage Disposal System (Repair) Map--Block-Lot 038.0- 0138 - ----------------- ------------------------------------------------------ - --------------------------------------------------------------------------------------------------------------- lnstaller at No 45 WOODB - Y LANE ---------------------- ----------------------------------------------------------------------------------------------------------------------------------- has been installed ' accordance with the provisions of TITLE 5 of the State Environmental Code as described in the application for sposal Works Construction Permit No. BHP -2003-028 Dated _ September 22, 2003 -- -- -------------------------------------- Printed On: Sep -22-2003 Board Of Health ............................................................................................................................................................................... Commonwealth of Massachusetts Map -Block -Lot 038.0- 0138 - Board Of Health PemitNo North Andover - BHP -2003-0288 ---- ------------------ FEE $250.00 ----------------------- Disposal Works Construction Permit Permission is hereby granted James -Currier to (Repair) an Individual Sewage Disposal System. at No 45 WOODBERRY LANE as shown on the application for Disposal Works Construction Permit No. BHP -2003-028 Dated September 22, 2003 ------------------------------------------------------ 11 Issued On: Sep -22-2003 -- ------------------------- ---------- K�—Ioard Of Health ,4 TOWN OF NORTH ANDOVE BOARD OF HEALTH Location Permit # Food Service $ Retail Food $ Limited Retail $ Seasonal $ Disposal Works Installers /$ Disposal Works Constructiori $ Soil Testing $ Design Approval Permit $ Dumpster Permit $ Burial Permit $ — Swimming Pool Permit $ Animal Permit $ Recreational Camp Permit $ Well Construction Permit $ Funeral Directors Permit $ Massage Establishment License $ Massage Practice. License $ Suntanning Establishment $ offal/Trash Hauler $ Other $ 065 Health Agent White - Applicant Yellow - Dept. Pink - Treasurer APPLICATION FOR DISPOSAL WORKS CONSTRUCTION PERMIT DATE: Z� CURRENT INSTALLER'S LICENSE# LOCATION: 5 Gt/O O l t /'r o LICENSED INSTALLER: -- SIGNATURE: TELEPHONE# -7 CHECK ONE: REPAIR: NEW CONSTRUCTION: IF NEW CONSTR,JCTION, PLEASE ATTACH FOUNDATION AS -BUILT. 0a s dam, r �3 Administrative Use Only $ .00 Fee Attached? Yes No Foundation As -built? Yes No Floor plans on file? Yes No Approval Date: INSTALLER PROJECT MANAGEMENT OBLIGATIONS As the North. Andover licensed installer for the construction of the septic system for the property at (/�� �r G yl relative to the application 0 f L v�'r,` dated yZ O for plans by and dated with revisions dated . I understand the following obligations for management of this project: 1. As the installer I am obligated to call for any and all inspections. If homeowner, contracto project manger, or any other person not associated with my company schedules an inspectio and the system is not ready then item two shall be applicable. 2. As the installer I am required to have the necessary work completed prior to the applicabl inspections as indicated below. I understand that requesting an inspection,. withou completion of the items in accordance with Tile 5 and the Board of Health Regulations mw result in a $50.00 fine being levied against my company. a) Bottom of Bed - generally first inspection unless there is a retaining wall which should be don, first. Installed°must request the inspection but does not have to be present. b) Final inspection — Engineer must first do their inspection for elevations, ties, etc. As -built of verbal OK from engineer must be submitted to Board of Health, after which installer calls fw inspection time. Installer must be present for this inspection. With pump system all electrical work must be ready and able to cause pump to work and alarm to function. c) Final Grade — Installer must request inspection when all grading is complete. Does not have to be on site. 3. As the installer I understand that persons or companies not associated with my company may not perform the work required by my company to complete the installation of the system identified in. the attached application for installation. I further understand that work by others unlicensed to installseptic systems in North Andover can constitute reasons for denial of the, system, and/or revocation or suspension of my license in the Town of North .Andover plus significant fines to all persons involved. 4. As the Installer I understand that I must be on site during the performance of the following construction steps: a) Determination that the proper elevation of the excavation has been reached. b) Inspection of the sand and stone to be used. c) Final inspection by Board of Health staff. d) Installation of tank, D -box, pipes, stone, vent, pump chamber, retaining wall and other components. 5. As the installer I understand that I am solely responsible for the installation of the system as per the approved plans. No instructions by the homeowner, general contractor, or any other persons shall absolve me of this obligation. Licensed Septic Installer Date: Z L D Disposal Works Construction Permit # /A TOWN OF NORTH ANDOVER SEWAGE DISPOSAL SYSTEM INSTALLATION CERTIFICATION The dersigned hereby certify that the Sewage Disposal System ( ) constructed; ( repaired; by \j q- m e r L6,1->ej, e located at liv0p��:L fes. C - was installed in conformance with the North Andover Board of Health approved plan, System Design Permit .# , plan dated , with a design flow Of gallons per day. The materials used were in conformance with those specified on the approved plan; the system was installed in accordance with the provisions of 310 CMR 15.000, Title 5 and local regulations, and the final grading agrees substantially with the approved plan. All work is accurately represented on the As -built which has been submitted to the Board of Health. Bed inspection date: Final inspection date: Installer: Engineer: Engineer Representative Engineer Representative Lic.#: Date: Date: 0 [1 SEOPTIC&D. RAIN9 �s- o� Residential / Commercial Septic Tanks - Cesspools - Drywells - Leaching Fields Installed, Cleaned or Repaired OV t7� 0 -70t 60YN �km EA1 2M 131 Forest Street, Middleton, MA 01949 * 978.774-6685 A-7, 0 [1 SEOPTIC&D. RAIN9 �s- o� Residential / Commercial Septic Tanks - Cesspools - Drywells - Leaching Fields Installed, Cleaned or Repaired OV t7� 0 -70t 60YN �km EA1 2M 131 Forest Street, Middleton, MA 01949 * 978.774-6685 COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION O TITLE 5 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 49 wQn1)RFRRy LANE N _ ANDMIER. MA 01-845 Owner's Name: SHASH—PATEI Owner's Address: 45 WOODBERRM Y LANE � a1 N NDGI.T 'A r i 1 TTSTT-STD' Date of Inspection: 9110103 Name of Inspector: (please print) T.AMF S—WRICHT Company Name: R j TNCUp.rm-rnn S- INC. Mailing Address: C1NE—OSCl1G1D—ST METHUEN MA 01844 Telephone Number: 978-681-8759 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: 'Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails i Inspector's Signature: Date: The system inspector $ 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 ?h: system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 page 1 Page 2 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 45 WAAI.1RED1DY TAMV N- AMOVER MA X11 $ 45 Owner: SHA SH RATE Date of Inspection: 9/10/03 Inspection Summary: Check A,B,C,D or E / ALWAYS complete all of Section D A. System Passes: . I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B. System. Conditionally Passes: One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Answer yes, no or not determined (Y,N,ND) in the for the following statements. If "not determined" please explain. The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. NDex I✓ 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 broke�settl�e,runeven distribution box. System will pass inspection if (with approval of Board of Health): roen pipe() ?le replaced ction 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: 45 WOODBERRY',' LANE N. ANDOVER MA 01845 Owner: SHASH PATEL Date of Inspection: 9 11 010 -j 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 15303(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: 4 5 WOODBERRY LANE N. ANDOVER MA 01845 Owner: SHASH PATEL Date of Inspection: 9/10/03 D. System Failure Criteria applicable to all systems: You must indicate "yes" or "no" to each of the following for all inspections: Yes No� _ ✓✓�ackup 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 .,a4�ogged SAS or cesspool Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool _ �uid depth in cesspool is less than 6" below invertor available volume is less than % day flow Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number 19kines pumped E/'y 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 iter supply. y portion of a cesspool or privy is within a Zone 1 of a public well. _ Any portion of a cesspool or privy is within 50 feet of a private water supply well. y 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.] All`(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 c�.ia above) yes no _ the system is within 400 f of a surface drinking water supply the system is wi ' 200 feet of a tributary to a surface drinking water supply the syste located in a of 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. 4 Page 5 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 45 WOODBERRY LANE N. ANDOVER MA 01845 Owner: SHASH PATEL Date of Inspection: 9/ 1 0/ 0 3 Check if the following have been done. You must indicate "yes" or "no" as to each of the following: Yes o Xwere Pumping information was provided by the owner, occupant, or Board of Health any of the system components pumped out in the previous two weeks Has the system received normal flows in the previous two week period ? Have large volumes of water been introduced to the system recently or as part of this inspection ? ✓ Were as built plans of the system obtained and examined? (If they were not available note as N/A) Was the facility or dwelling inspected for signs of sewage back up _ Was the site inspected for signs of break out ? T _ Were all system components, excluding the SAS, located on site ? Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum ? Was the facility owner (and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems ? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: Yes no� �' xisting 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) [33 10 CMR 15.302(3)(b)] I Page 6of11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 45 WOODRERRY LANE N ANDOVER MA 01845 Owner: RHASH PATEL Date of Inspection: 9111 gT03 FLOW CONDITIONS RESIDENTIAL Number of bedrooms (design): Number of bedrooms (actual):12 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x # of bedrooms): Number of current residents:CP- Does residence have a garbage grinder (yes or no): Is laundry on a separate sewage system (yes or no): [if yes separate inspection required] Laundry system inspected (yes or no): Seasonal use: (yes or no): Water meter readings, if avail le (last 2 years usage (gpd)): Sump pump (yes or no): _ Last date of occupancy: COMMERCIAL/INDUSTRIAL Type of establishment: Design flow (based on 310 C 3):- gpd- Basis pdBasis of design flow (se ersons/sgft,etc.): Grease trap presen es or no): _ Industrial was olding 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/use: OTHER (describe): GENERAL INFORMATION Pumping Records Source of information: V Was system pumped as part of the inspection (yes or no): y If yes, volume pumped: gallons -- How was quantity pumped determined? Reason for pumping: TYP SYSTEM ank, distribution box, soil absorption system _ Single cesspool _ Overflow cesspool Privy Shared system (yes or no) (if yes, attach previous inspection records, if any) _ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract (to be obtained from system owner) — Tight tank _ Attach a copy of the DEP approval — Other (describe): Approximate age of all components date installed (f known) and source of i Were sewage odors detected,when arriving at the site (yes or no): N Page 7 of I 1 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 45 WOODBERRY LANE N. ANDOVER MA 01845 Owner: SHASH ATEL Date of Inspection: 9/10103 BUILDING SEWER (locate on site plan) rr Depth below grade: Materials of construction: _40 PVC _other (explain): Distance from private water supply well or suction line: Comments (on condition of joints, venting, evidence of leakage, etc.): SEPTIC TANK: _ (locate on site plan) /r Depth below grade. - Material of construc!ion:�--"c`oncrete _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: 0 en Sludge depth: Distance from top of slud�e to bottom of outlet tee or baffle: Scum thickness: — Distance from top of scum to top of outlet tee or baffle: y Distance from bottom of scum to bottom of outlet tee or baffle: J How were dimensions determined: Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to%outlet invert, evidences of eakage, etc.): GREASE TRAP: _(locate on site plan) Depth below grade: _ Material of construction: concrete (explain): Dimensions: metal _fiberglass ___polyethylene _other Scum thickness: Distance from top of scum to of outlet tee or baffle: Distance from bottom o um to bottom of outlet tee or baffle: Date of last pumpi Comments (on ping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 7 Page 8 of I I OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 4 5 WOODBERRY LANE N_ ANDOVER MA n1845 Owner: SHASH PATEL Date of Inspection:9 111 BTB3 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: ._ Design Flow: allons/day Alarm present (yes o Alarm level: Alarm in working order (yes or no): Date of last ping: Comments (condition of alarm and float switches, etc.): DISTRIBUTION BOX: (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into r out of box, etc.): 'Ik7 S — el - PUMP PUMP CHAMBER: (locate on site plan) Pumps in working order (yes or no): Alarms in working order (yes or n Comments (note conditio ump chamber, condition of pumps and appurtenances, etc.): 8 Page 9 of I 1 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 4 5 WOODBERRY LANE N_ ANDOVER MA 01845 Owner: SHASH PATEL Date of Inspection: 9�� 10 3 SOIL ABSORPTION SYSTEM (SAS): (locate on site plan, excavation not required) If SAS not located explain why: Type leaching pits, number: _ leaching chambers, number: leaching galleries, number: ?leaching trenches, number, length: r 2 leaching fields, number, dimension overflow cesspool, number: innovative/altemative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): CESSPOOLS: (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: Depth — top of liquid to inlet invert- Depth nvertDepth of solids layer: Depth of scum layer: Dimensions of ce ool: 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 co io 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: 4 5 WOODBERRY LANE N_ ANDOVER MA 01845 Owner: SHASH PATEL Date of Inspection: 9.110,/ 03 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. L en ers e m me. 10 Page 11 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 4 5, WOODBERRY LANE N_ ANDOVER MA 01845 Owner: SHASH PATEL Date of Inspection:g SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water met Please indicate (check) all methods used to determine the high ground water elevation: Obtained from system design plans on record - If checked, date of design plan reviewed: Observed site (abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health -explain: Cl�eeked with local excavators, installers- (attach documentation) Accessed USGS database -explain: You must descdbe how you established the high Around,Kater elevation: 11 LAJ A 92 :t U11 1% PI- N ak C%j Ln CN cq N NNOM LAU" 0 0 ==LAO 0 ON N N N, =coca=== U)OOOIN' 0-o'ch L" LA 0 to Tw T, 9- r, -r 0 Ln 01 1% r 00 m = = a OG 0 .4 m = T N w 4 0 0 0 N T- 0 %0 �w L3iAti + O 'ccs N Ar c 0 N q- rM d� 17 i,; W 3LL GSQr '- V- T- T- _ cvl"c*cn Comm= LAJ A 92 :t U11 1% PI- N ak C%j Ln CN cq N NNOM LAU" 0 0 ==LAO 0 ON N N N, =coca=== U)OOOIN' 0-o'ch L" LA 0 to Tw T, 9- r, -r 0 Ln 01 1% r 00 m = = a OG 0 .4 m = T N w 4 0 0 0 N T- 0 %0 CI) 0: 0 m O ch 92 a cp La .27 -4 7F FN� M Ln Cc cc 16� 1, U G1 Km 2 a 04 -0 CO m m CO MM MM ON.' US4 r- N .14 Z y:-" 0 c ©m670© LIJ N N N N C14 N N N.N N 04 ts clSLA a Ir 04 LLI 22 r Ix Z5 CL cn O M rdol en on "nn + O 'ccs N Ar c 0 N q- rM d� 17 i,; W 3LL GSQr '- V- T- T- _ cvl"c*cn Comm= .......... m V, I= CI) 0: 0 m O ch 92 a cp La .27 -4 7F FN� M Ln Cc cc 16� 1, U G1 Km 2 a 04 -0 CO m m CO MM MM ON.' US4 r- N .14 Z y:-" 0 c ©m670© LIJ N N N N C14 N N N.N N 04 ts clSLA a Ir 04 LLI 22 r Ix Z5 CL cn O M rdol en on "nn http://ma.water.usgs.gov/current-cond/data/03-09.txt SUMMARY OF GROUND -WATER LEVELS SEPTEMBER 2003 PROVISIONAL (NOTE: Wells with * also available in real-time at top of Ground -Water Data page; OWc, monthly measured value used in high ground -water level estimation report, USGS Open -File Report 80-1205.) WELL L START NET CHANGE DEPARTURE WATER LEVEL T I YEAR IN MONTH IN ONE FROM BELOW LAND - 0 T OF YEAR MONTHLY SURFACE P H RECORD 22 MEDIAN DATUM 0 0 0.39 + 0.35 (OWc) 0.06 4.33 25 (FEET) (FEET) (FEET) (FEET) DAY MASSACHUSETTS ACTON 158 * TS 1965 - 0.61 + 2.55 + 1.53 18.35 > 30 ANDOVER 462 VS 1968 - 0.47 ----- - 0.04 15.30 22 ATTLEBORO 83 VS 1964 - 0.39 + 0.35 + 0.06 4.33 25 BARNSTABLE 230 FS 1957 - 2.01 + 2.22 + 0.54 24.03 30 BARNSTABLE 247 FS 1962 - 0.63 + 3.02 + 0.77 24.25 30 BECKET 12 TS 1986 - 0.24 + 0.58 + 0.91 2.77 25 BILLERICA 363 HS 1962 - 1.73 ----- - 0.01 10.82 22 BLANDFORD 9 VS 1986 + 0.65 + 1.13 + 0.81 1.78 25 BOURNE 198 FS 1962 - 0.57 + 1.15 + 0.07 33.99 24 BREWSTER 21 FS 1962 - 0.25 + 3.20 + 0.01 10.17 30 BREWSTER 22 * FS 1962 - 0.36 + 2.42 + 0.24 31.16 30 CHATHAM 138 FS 1962 - 0.54 + 2.19 + 1.05 23.42 30 CHESHIRE 2 HT 1951 + 0.81 + 7.35 + 6.27 2.45 24 CHICOPEE 95 TS 1984 - 0.36 + 1.83 - 0.24 22.20 24 COLRAIN 8 VS 1965 + 0.25 + 1.38 + 1.49 19.56 '24 CONCORD 165 TS 1965 - 0.18 + 2.83 - 0.55 42.12 23 CONCORD 167 TS 1965 - 1.07 + 2.42 - 0.63 9.04 23 CUMMINGTON 13 VS 1986 + 1.31 + 1.70 + 1.14 4.59 24 DEDHAM 231 ST 1965 - 1.64 + 2.05 - 0.12 11.19 24 DEERFIELD 44 VS 1965 + 0.75 + 1.84 + 0.98 2.23 24 DOVER 10 TS 1965 - 0.50 + 0.62 + 0.69 33.69 24 DUXBURY 79 * VS 1965 - 0.35 + 0.59 + 0.56 8.61 30 DUXBURY 80 VR 1965 - 0.47 + 0.70 + 0.73 21.95 24 EAST BRIDGEWATER 30 HT 1958 - 2.53 + 5.41 + 3.62 9.95 24 EDGARTOWN 52 VS 1976 - 0.68 + 3.35 + 1.41 16.71 29 FOXBOROUGH 3 TS 1965 - 0.58 + 0.47 + 0.46 19.75 25 FREETOWN 23 TS 1964 - 0.54 + 2.14 + 0.88 13.19 25 GEORGETOWN 168 VS 1965 - 0.38 + 0.46 + 0.22 5.44 22 GRANBY 68 VS 1954 - 0.77 + 2.67 + 1.66 7.79 24 GRANVILLE 5 TS 1965 - 0.29 ----- + 1.47 32.12 25 GRANVILLE 6 SS 1965 + 2.01 + 4.12 + 2.70 4.19 25 GREAT BARRINGTON 2 VT 1951 + 0.13 + 0.65 + 1.05 11.49 24 HANSON 76 VS 1964 - 0.27 + 0.82 + 0.08 4.99 24 HARDWICK 1 TS 1965 - 0.50 + 1.28 + 1.11 15.00 27 HARDWICK 31 TS 1984 + 0.14 ----- + 1.78 9.73 > 25 HAVERHILL 23 TS 1960 - 0.79 + 0.43 + 0.41 13.39 22 HAWLEY 8 ST 1986 + 0.04 + 2.39 + 1.43 3.32 > 24 LAKEVILLE 14 * TS 1964 - 1.55 + 6.60 + 3.20 14.66 30 LEXINGTON 104 VS 1965 - 0.61 - 0.15 + 0.80 2.34 23 MASHPEE 29 FS 1976 - 0.53 + 1.32 + 0.59 8.59 24 MIDDLEBOROUGH 82 VT 1965 - 5.67 + 6.28 + 4.83 10.52 24 MONTGOMERY 19 SS 1986 + 0.53 + 2.53 + 1.02 1.30 25 NANTUCKET 228 FS 1976 ----- ----- ----- ----- NEW BEDFORD 116 VS 1964 - 0.25 + 0.18 + 0.03 4.35 25 NEWBURY 27 VT 1965 - 1.56 + 1.38 + 1.12 9.58 22 SUMMARY OF GROUND -WATER LEVELS SEPTEMBER 2003 PROVISIONAL (NOTE: Wells with * also available in real-time at top of Ground -Water 1 of 4 10/8/2003 2:21 PM http://ma.water.usgs.gov/cun-ent-cond/data/03-09.txt Data page; OWc, monthly measured value used in high ground -water level estimation report, USGS Open -File Report 80-1205.) WELL L START NET CHANGE DEPARTURE WATER LEVEL T I OF IN MONTH IN ONE FROM BELOW LAND - 0 T RECORD YEAR MONTHLY SURFACE P H 1.65 MEDIAN DATUM 0 0 NORTON 37 FS (OWc) - 1.43 (FEET) (FEET) (FEET) (FEET) DAY MASSACHUSETTS (CONTINUED) NORFOLK 27 * VS 1965 - 0.02 + 0.00 - 0.13 6.75 30 NORTHBRIDGE 54 VS 1984 + 0.74 + 1.65 + 1.47 3.07 > 27 NORTON 37 FS 1964 - 1.43 + 1.35 + 1.28 7.61 25 ORANGE 63 TS 1985 - 0.76 + 0.90 + 0.33 7.52 24 OTIS 7 VS 1965 + 0.86 + 1.63 + 1.13 8.28 25 PELHAM 23 * SR 1984 + 0.10 + 3.18 - 1.50 15.62 30 PELHAM 24 SS 1984 + 0.53 + 4.40 + 1.39 3.95 25 PETERSHAM 16 ST 1984 - 0.40 + 0.65 + 0.05 15.37 24 PITTSFIELD 51 * VS 1963 + 0.18 + 7.68 + 5.08 15.57 30 PLYMOUTH 22 TS 1956 - 0.75 + 3.72 + 1.82 22.95 24 PLYMOUTH 494 SS 1985 - 0.30 + 2.91 + 0.52 29.47 24 SANDWICH 252 FS 1962 - 0.19 + 0.66 + 0.23 47.28 24 SANDWICH 253 FS 1962 - 0.23 + 3.78 - 0.54 50.81 24 SEEKONK 275 VS 1964 - 0.55 + 0.96 + 1.15 5.94 25 SHEFFIELD 58 FS 1987 + 0.09 + 3.48 + 0.23 13.47 24 SOUTHBOROUGH 12 HT 1990 - 2.55 + 4.06 + 3.90 9.44 23 SOUTHWICK 95 TS 1986 + 0.46 + 3.45 + 1.31 3.07 25 STERLING 1 ST 1947 - 1.66 + 4.29 + 2.35 7.99 27 STERLING 177 SS 1995 - 0.57 + 0.84 + 0.53 14.96 27 SUNDERLAND 7 SS 1957 - 1.01 + 6.24 + 1.28 13.97 24 SUNDERLAND 68 VS 1983 + 0.67 + 2.71 + 1.14 2.70 24 TAUNTON 337 TS 1964 - 0.89 + 0.64 + 0.33 9.39 25 TEMPLETON 3 VS 1957 + 0.14 + 0.90 + 0.43 3.56 27 TOPSFIELD 1 HT 1936 - 1.05 + 0.96 + 0.70 14.13 22 TOWNSEND 13 TS 1965 - 0.63 + 1.49 + 1.07 12.91 22 TRURO 1 TS 1950 + 0.15 + 0.29 + 0.45 10.50 30 TRURO 89 TS 1962 - 0.20 + 0.28 + 0.28 12.25 30 WAKEFIELD 38 * FS 1965 - 0.15 + 0.74 + 0.89 7.34 30 WARE 43 VS 1965 - 0.07 + 0.23 + 0.46 8.77 25 WAREHAM 51 TS 1959 - 0.66 + 1.27 - 0.27 9.14 24 WAYLAND 2 TS 1965 - 0.68 + 0.56 - 0.09 16.76 23 WEBSTER 1 HS 1958 - 0.61 + 0.06 + 0.53 14.58 27 WELLFLEET 17 VS 1962 - 0.57 + 1.81 + 0.31 10.44 30 WENHAM 76 VS 1965 - 0.48 + 0.22 + 0.08 3.41 22 WEST BOYLSTON 26 SS 1995 + 0.05 + 3.64 + 2.51 7.18 27 WEST BROOKFIELD 2 TS 1959 - 0.49 + 1.96 + 0.46 18.84 27 WESTHAMPTON 20 SS 1986 - 0.94 + 1.59 + 1.53 13.72 25 WESTFIELD 62 SS 1957 + 0.69 + 3.95 + 1.91 6.87 25 WESTFIELD 152 TS 1986 + 0.86 + 1.33 + 1.32 2.25 > 25 WESTFORD 160 VS 2001 + 0.11 + 1.19 ----- 11.29 > 30 WEYMOUTH 2 FT 1965 - 0.78 + 3.55 + 1.95 15.72 26 WEYMOUTH 3 VS 1965 - 0.43 + 2.28 + 0.87 5.93 26 WEYMOUTH 4 TS 1965 - 0.43 - 0.52 - 0.24 7.93 26 WILBRAHAM 55 TS 1965 - 1.59 + 2.14 + 1.35 41.04 24 WILMINGTON 78 * FS 1951 - 0.50 + 0.53 - 0.15 9.35 30 WINCHENDON 13 ST 1939 - 2.37 + 1.78 + 1.06 9.67 27 WINCHESTER 14 ST 1940 - 2.62 ----- + 1.18 12.22 22 SUMMARY OF GROUND -WATER LEVELS SEPTEMBER 2003 PROVISIONAL (NOTE: Wells with * also available in real-time at top of Ground -Water 2 of 4 10/8/2003 2:21 PM http://ma.water.usgs.gov/current-cond/data/03-09.txt Data page; OWc, monthly measured value used in high ground -water level estimation report, USGS Open -File Report 80-1205.) WELL L START NET CHANGE DEPARTURE WATER LEVEL T I OF IN MONTH IN ONE FROM BELOW LAND - 0 T RECORD YEAR MONTHLY SURFACE P H 0.80 MEDIAN DATUM 0 0 1992 + 0.39 (OWc) 1.31 + (FEET) (FEET) (FEET) (FEET) DAY RHODE ISLAND BURRILLVILLE 187 TS 1968 - 1.41 + 0.50 - 0.07 17.06 22 BURRILLVILLE 395 UT 1992 - 0.74 + 2.68 + 0.80 9.89 26 BURRILLVILLE 396 VT 1992 + 0.39 + 1.31 + 0.19 5.76 25 BURRILLVILLE 397 HT 1992 ----- + 3.29 + 3.73 19.60 > 26 BURRILLVILLE 398 HT 1992 - 0.95 ----- + 1.50 10.50 26 CHARLESTOWN 18 FS 1946 - 0.71 + 2.35 + 1.21 18.38 22 CHARLESTOWN 586 VT 1992 - 0.04 + 0.17 - 0.07 4.06 22 CHARLESTOWN 587 ST 1992 - 0.49 ----- + 0.60 10.92 22 COVENTRY 342 VS 1991 - 0.17 + 0.73 + 0.66 10.06 22 COVENTRY 411 SS 1961 - 0.55 + 0.94 + 0.49 21.91 22 COVENTRY 466 VT 1992 + 0.41 + 1.42 - 0.07 3.27 22 CRANSTON CITY 439 ST 1992 - 0.92 + 1.72 + 0.80 18.64 25 CUMBERLAND 265 SS 1946 + 0.09 + 2.39 + 3.68 11.01 22 EXETER 6 VS 1948 - 0.14 + 0.62 + 0.46 6.32 22 EXETER 158 ST 1991 - 1.21 + 2.66 + 1.48 14.76 22 EXETER 238 FT 1991 - 0.06 + 0.30 + 0.07 12.46 22 EXETER 278 HT 1991 - 2.37 + 7.79 + 7.26 12.93 > 22 EXETER 475 VS 1981 - 0.48 + 1.47 + 0.56 15.20 22 EXETER 554 SS 1988 - 0.46 + 1.59 + 0.88 9.91 22 FOSTER 40 HT 1991 + 0.62 + 5.80 + 2.24 5.71 22 FOSTER 290 HT 1992 - 1.54 ----- + 2.71 10.82 26 HOPKINTON 67 ST 1991 - 0.94 + 3.92 + 2.45 17.46 22 LINCOLN 84 VS 1946 - 0.20 + 1.36 + 0.79 5.10 22 LITTLE COMPTON 142 ST 1992 - 2.52 ----- + 1.99 16.36 26 NEW SHOREHAM 258 UT 1991 - 0.38 + 0.95 + 0.63 12.18 22 NORTH KINGSTOWN 255 VS 1954 - 0.47 + 2.84 + 1.68 7.91 22 NORTH SMITHFIELD 21 TS 1947 - 0.20 + 1.55 + 1.14 8.85 22 PORTSMOUTH 551 HT 1992 - 3.55 + 8.14 + 5.85 41.76 25 PROVIDENCE 48 TS 1944 - 0.05 + 0.64 + 2.53 4.35 22 RICHMOND 417 VS 1976 - 0.25 + 0.78 + 0.48 7.08 22 RICHMOND 600 * TS 1977 - 0.39 + 2.11 + 0.76 33.85 22 RICHMOND 785 FS 1989 - 0.41 + 2.90 + 1.16 23.58 22 SOUTH KINGSTOWN 6 VS 1955 - 0.66 + 1.60 + 1.27 12.12 22 SOUTH KINGSTOWN 1198FS 1988 - 0.58 + 1.85 + 0.91 9.35 > 22 TIVERTON 274 TT 1990 - 2.06 + 4.87 + 2.79 5.69 26 WARWICK 59 ST 1991 - 1.10 + 11.05 + 6.99 6.93 22 WESTERLY 522 FS 1969 - 0.24 + 1.44 + 0.47 13.09 22 WEST GREENWICH 181 US 1969 - 0.02 + 0.44 + 0.69 15.87 22 WEST GREENWICH 206 ST 1991 - 0.42 + 1.81 + 0.75 4.81 22 ------------------------------------------------------------------------------- >> SET NEW HIGH OR EQUALED HIGHEST RECORDED WATER LEVEL FOR PERIOD OF RECORD > SET NEW HIGH OR EQUALED HIGHEST RECORDED WATER LEVEL FOR END OF SEPTEMBER << SET NEW LOW OR EQUALED LOWEST RECORDED WATER LEVEL FOR PERIOD OF RECORD < SET NEW LOW OR EQUALED LOWEST RECORDED WATER LEVEL FOR END OF SEPTEMBER ------ - DATA NOT AVAILABLE TOPOGRAPHIC (TOPO) SETTING: F=FLAT, G=FLOOD PLAIN, H=HILLTOP, S=HILLSIDE, T=TERRACE, U=UNDULATING, V=VALLEY, W=UPLAND DRAW LITHOLOGY (LITHO): G=GRAVEL, R=ROCK, S=SAND, T=TILL 3 of 4 10/8/2003 2:21 PM http://ma.water.usgs.gov/current-cond/data/03-09.txt CONTENTS OF MAJOR RESERVOIRS (ESTIMATED END OF MONTH READINGS) (MILLIONS OF CUBIC FEET) MONTH-END PERCENT OF PERCENT RESERVOIR CONTENTS AVERAGE FULL BORDEN BR + COBBLE MTN RES, MA 3184 127 94 QUABBIN RESERVOIR, MA ----- --- --- SCITUATE RESERVOIR, RI 4524 117 92 STREAMFLOW FOR SELECTED INDEX STATIONS (CUBIC FEET PER SECOND) MONTH-END PERCENT MAXIMUM DATE MINIMUM DATE STREAM MEAN MEDIAN FOR MONTH FOR MONTH CHARLES RIVER, MA 102 122 157 26 56 14 E. BR. HOUSATONIC RIVER, MA 132 336 674 29 30 1 PAWCATUCK RIVER, RI 118 167 210 4 83 27 WARE RIVER, MA 51 134 ---- -- ---- -- ------------------------------------------------------------------------------- A MONTHLY REPORT PREPARED BY THE U.S. GEOLOGICAL SURVEY, WATER RESOURCES DIVISION 10 BEARFOOT ROAD, NORTHBOROUGH, MA 01532 IN COOPERATION WITH THE MASSACHUSETTS AND RHODE ISLAND DEPARTMENTS OF ENVIRONMENTAL MANAGEMENT, CAPE COD COMMISSION, AND PROVIDENCE WATER SUPPLY BOARD 4 of 4 10/8/2003 2:21 PM t r t IT1a. 'It TOWN. OF NORTH ANDOVER SYSTEM PUMPING RECORD :.(� 1 , � ya ria\ f¢yryy� �? rS' i 11 �y ,�ur`Yr#�4trt ij#Y OWNER &. ADD RESS SYSTEM LOCATION (example: left front of house) ui-bqcl( i` ;� �lr fi .xNkn�;Lsfkr jriLCc4dr-pice nt! i :. dlt' OF P�JMPING.Lf-0 QUANTITY PUMPED --IWO. GALLONS !!S"+SPOOL: Y NO YIES -._.. .. SEPTIC TANK: NO YES 3 r as a� �'��Ir tag T�A.�'♦1� * x�'ry }{,i.'YYt r e � t t. , ,. ,�►Tv. OF SERVICE; ROUTINE , EMERGENCY i����'+Y��r�t.����{��IK��t�k�° �t�i��,j'� �I It � ' e r � x •. kJMVAkT GOOD CONDII`ION FULL TO CO ".,_., ' � ( VER ,tax jt HEAVY GREASE BAFFLES IN PLACE �> ROOTS_ EXCESSIVE SOLIDS �CHFIELD RUNBACK FLOODED ! I SOLIDS CARRYOVER — OTHER (EXPLAIN) 71� # ? j { �������! R��1�Y�1 r.r t�'�j��1+fit ,}p. �,}i ! t � ' tilt i F � ± i ', d +i :.:•f : Pt t�jr'�g�+iid I¢ , �11144{'�"(}�l,�`' �`''i �� ��T�ry���% R�%• , ��%�1..��.,/ .. � "¢1}'It���a�� )lt�lil�rlr� R;1 :::i�,^t cay�t t ,k~'•x4� �r i^ 4� • (,%A VtV s: �rC .�Me°p•�C. /tfr ]L9,� i ,I[ 1S + a it _ .. M'( t y',, tb4+±J � r i� � k't'•�! Fp ".. P 5r � r,,�, i.. j t 4 .. . E 1��� •Oti{r> RN4T�'+k1 .�) � y'�+. s ,y 7 t {. 1".- ,/, �r � iri'N 1 43A M� a TRA�YFEIItID;O a r � t MAY 4,2001 , d L n;' t }ra !� r��l�a f r/� +.•ry 7 T r.F''>ir r dA +.'1• r . 4' / // i ""�.+•—.+ti. ri?� .tu. „�;. F��.��hr .Gri �fi 11s* i,.q /• a i�i W+ 4 � '. .� __•,,,� /. Town of North Andover, Ml� Watershed Septic System Servicing.Report Date: Feb. 16 1995 Homeowner: Patel Pumper : Bateson Street 45 WnnAhargit bane Address: Phone : 689-9581 Phone : 479-47A6 — Nature of Service: Routine x Emergency Good Condition x, Observations: D Full to Cover Baffles in Place Leachfield Runback Excessive Solids Heavy Grease Roots Other (Explain) t Description of Work: SEPTIC SYSTEM INSPECTION FORM ADDRESS 4 5' * {,tJ Gb� DATE INSPECTED' PROPERLY FUNCTIONING? (Y) N WEATHER CONDITIONS COMMENTS: I^1A i EALy 'I ES t C -N � ?05vi_ i j? DYE TEST PERFORMED? Y N DATE? SKETCH: ,5jg?/-7� Please forward us as miich of the following information that is possible, 1. Type of system 2. Age oL 3.. Location��6 4- Maintenance Maintenance records and date of last pumping out A/4, 5. Documentation of repairs and reconstruction /U 6. Site conditions 7. Builder of system L/P mss, 8. Engineer who approved% t — Site — System 4 9. Installation Procedure 1.0, Problems o 2 s WATERSHED RESIDENTS QUESTIONNAIRE 1. Name SH PSS►-� K��ii" �ATCL 2. Street Address 4 5' wo any LA �E 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) ❑ do not know 5. Are the plans (drawings) for your sewage disposal system on file with the Board of Health? yes ❑ no ❑ do not know,- 6. now, 6. How old is your sewage disposal system? ❑ 0-5 years 6-10 years ❑ 11-20 years -=_--'- El over 20 years ❑ do not know 7. Has your sewage disposal system been rebuilt or repaired? ❑ yes ❑ no \.Z do not knower -e_LjL If yes, approximately how long ago? years. What was done? 't 8. How frequently is your sewage disposal system pumped out? ❑ annually every 2-4 years ❑ every ,5-10 years ❑ over 10 years ❑ never 9. Have you had any problems with your sewage disposal system? ❑ yes \Z" no If yes, what problems? ❑ repeated pump -outs needed ❑ system clogs, backs up, or drains slowly ❑ odors ❑ sewage surfaces through ground 10. How many of each appliance are connected to -your sewage disposal system? , washing machine dishwasher garbage disposal dehumidifier drain sump pump toilet 3 roof/pavement drains shower/bathtub �- 11. Please state the brand and type (liquid or powder) of detergent you use for: dishwasher c A S c AI E clotheswasher 5CAP- S 12. Does your property have a lawn? %Z yes ❑ no If yes, approximately what size? ❑ less than 1/4 acre -% 1/4 acre ❑ % acre ❑ 3/4 acre ❑ 1 acre ❑ more than 1 acre (Specify) acres 13. How often do you fertilize your lawn? No. of applications per year -3 Season(s) of the year 5PP I W-,,, FA LL FA LL 14. Please state the brand and type (liquid or granular) of lawn fertilizer you use: Sto j ❑ Check here if your lawn is maintained by a professional landscape contractor. TO: NORTH ANDOVER, MASS BOARD OF HEALTH FROM: DESIGN ENGINEER y 19 74 Re: Soil Absorption Sewage System I nspection This is to certify that I have inspected the construction of the said disposal system at d t Wo a b Se /� R North Andover, Mass. SITE LOCATION y The grades and construction are as specified in my plans and specifications dated SOIL PROFILE & PERCOLATION TEST DATA N .&Street %C� cy err !vim Lot No. 'own/City o / Loc. Subdiv. (iceW e r ilcl 2 1 Plan _,Owner Cc.r'� Investigator a!� V Observer WAU ok �4 IY15 Benchmark Elevation SOIL PROFILES -DATE 14_ Elev. 0.- Location Datum Percolaon Tests -Date —A1 JI M Jf�fT'i'.0 / 1 3 4 5 6 10 4'E1ev. Pit Number 1 2 3 4 5 Start Saturation /0.'4- /0:0 i Soak -Mins. m."h Start Test -Time 'U� (2 Drop of 3" -Time %/5 / Drop of 6"7Time -' U Mins.lst 3"Dro Mir 0,n`•] 1tM_ _ /4MpA 1 1111 �•J O �- 1 1 t.l J L i V / �/ �- I• - Notes & Sketches on Back Frank C. Gelinas & Associates, North And. TOWNOF NORTH AND O.vFR/ + 1r'lllillllllflll/NIIII Ur lrhf11lili BOARD OF HEALTH ry�uggl lose tis 1 JUL 91996• ie I i , 1 i • �j�lalrru��ner + � i :: ' � `i� 1^ •nom. 1 P 1 4�..� '/' �;. 1 ►' f i i V11PI�flfil) I►u►1111�1f1' /I Uel# of 11,jol hid y l:Nitl�� '1'dll�•i 1.Li � 1' �E! � .. ,i, `' x{11 Syrlelll 1'ul►Ilsed lf� ! ----- l:u��fellfs.11nll�leiird Id! ` Illsl�erluf i ; i 1 � 1` i ;�.1• M n u n rn -o 0 0 0 II 0 fD Cn I I (n (D n� G) I I G7 (�D CA (D d P I I 0 a 1W- Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. Q imm.. Commonwealth of Massachusetts City/Town of NORTH AND System Pumping Record Form 4 Iq DEP has provided this form for use by local Boards of be submitted to the local Board of Health or other apps A. Facility Information 1. System Location: MAY 1 9 2008 JtThe�SystemiP,ju fecord must ra,v'hrk DEPARTMENT 1 Address T City/Town State Zip Code System Owner: Name Address (if different from location) City/Town B. Pumping Record StateZip Code °/.a Telep one Number 1. Date of Pumping 8 2. Quantity Pumped: Date Gallons 3. Type of system: ❑ Cesspool(s) Septic Tank ❑ Tight Tank ❑ Other (describe): 4. Effluent Tee Filter present? ❑ Yes [ No If yes, was it cleaned? ❑ Yes ❑ No 5. Condition of System: 6. S stem Pumped By: A-E Ne Vehicle License Number y° rtr 'v,1 Company 7. Location where contents were disposed: Signat.ure_oy Hauler Date http://www.mass.gov/dep/water/approvals/t5forms.htm#inspect t5form4.doc• 06/03 System Pumping Record • Page 1 of 1