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Home My WebLink AboutMiscellaneous - 48 PADDOCK LANE 4/30/2018 (2) 48 PADDOCK LANE 210/107.D-0098-0000.0 c " 4+ Lot & Street -y�f�i��l�C�' Z% 14 Map/Parcel CONSTRUCTION APPROVAL Has plan review fee been paid: YES NO Permitm Plan Approval: Date: 31161 Approved by: Designer: U2f/M,*6C 1d UF,eC-,-54�Plan Date: Conditions: Water Supply- TownWell Permit: _.Driller: Well Tests: Chemical Date Approved Bacteria I Date-Approved Bacteria H Date Approved Plumbing.Sign-Off. Wiring Sign-Off: Comments: Form"U" Approval: Approval to-Issue: ytN1 NO Date Issued By: Conditions: Final Approval: .All Permits Paid? C YES NO Well Construction Approval? YES NO Septic System Construction Approval? NOi Certification? NO Other NO Any Variance Needed? NO FINAL BOARD OF TH APPROVAL: DATE: 71,-z G APPROVED BY: ,/ SEPTIC SYSTEM INSTALLATION Is the installer licensed? YES NO Type of Construction: NEW New Construction: - ._Certified Plot Plan Review YES NO —Floor Plan Review YES NO — Conditions of Approval from Form U YES NO _Issuance of DWC permit: NO _DWC Permit Paid? —YES NO . ---DWC-Permit# - Installer: BegfriInspection:_ j'-YES NO _-- ,Excavation Inspection: —Needed: ---Passed: By. -- -._Construction Inspection: Needed`. As-Built_Plan Satisfactory: YES: l �/j ��•, Approval of Backfill: Date: By: ---Final Grading Approval: Date: By: —'�� Final Construction Approval: Date: 7/ By: Certificate of Compliance: Approval: Date: Ir I Commonwealth of Massachusetts City/Town of System Pumping Record Form 4 DEP has provided this form for use;by local Boards of Health. Other forms may be'used, but the information must be substantially the same as that provided here. Before using.this form,check with your local Board of Health to determine the form they use.The System Pumping Record must be submitted to the local Board of Health or other approving authority. A. Facility Information 1. System Location: Left/Right front of house,/Righ ar of h , Left/right side of house, Left/ Right side of building, Left/Right front of building, Left/Right rear of building, Under deck Address t4 a ` _ C3�� City/Town State V Zip Code 2. System Owner. Name' Address(if different from location) Citylrown ' State Zi Code Telephone Number L B. Pumping Record 1. Date of Pumping Date 2. Quantity Pumped: 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. �b S 6. System Pumped By: Neil.Bateson F5821 Name Vehicle License Number Bateson Enterprises Inc- Company 7. Location where contents were disposed: G.LS. Lowell Waste Water Sign a Haul Date t5form4.doc•06/03 System Pumping Record•Page 1 of 1 ........................................................................................................................................................................... ti Reference No: BHF-2004-000047 ................................... Permit No: Department: ................................... North Andover BOARD OF HEALTH ......................................................................................... Account No: Septic Account Rev FeeType: .................................... Title 5 Inspection Receipt No: RIEC-2013-000467 ......................................................................................... .................................... Paid By: Paid in Full On: Sat Sep 29,2012 Benjamin C. Osgood,Jr. .................................... ......................................................................................... Check No: 2774 Received By: .................................... Lisa Blackburn ......................................................................................... DEPARTMENT'S COPY Amount: $50.00 ....................................................................................................................................... ........................ ............... ................... ---•--......... ......................................... Reference No: BHF-2004-000047 ................................... Permit No: Department: ................................... North Andover BOARD OF HEALTH ......................................................................................... Account No: Septic Account Rev FeeType: ................................... Title 5 Inspection Receipt No: REC-2013-000467 ......................................................................................... ................................... Paid By: Paid in Full On: Sat Sep 29,2012 ................................... Benjamin C. Osgood,Jr. ......................................................................................... Check No: 2774 Received By: ................................... Lisa Blackburn ......................................................................................... CUSTOMER'S COPY Amount: $50.00 ....................................................................................................................................... .......... Commonwealth of Massachusetts Title 5 Official Inspection Form - Subsurface Sewage Disposal System Form-Not for Voluntary Assessment RECEIV— 48 Paddock-Lange OCT 3 0_2012_ Property Address -- ------ ----------- ------- -- - _ Owner W+INam and Michelle Holland TOWN OF NORTH D VER information is owner's Name -- -� --- — HEALTH DEPA_ __ required for North Andover _ every page. City/Town —— MA 01845--- 9-29-12 _ State Zip Code Date of inspection Inspection results must be submitted on this form, inspection forms may not be altered In way. Please see completeness checklist at the end of the form. Important: When filling out A. General Information forms on the computer,use only the tab key 1 Inspector: to move your cursor-do notBenjamin C. Os ood Jr. use the return Name of Inspector- �--'"`-- -- key- none ------ -------------- ----------- - ------_,.----- --- Company Name ---- - ------ — -- ----- —----------- --- 16 Hillside Avenue, Unit 3 Comparry Address Amesbury -_-- city/Town - ------------ MA 01913 State ------ - _---- - - --------------------- 978-8_34-6585 Zip Code Telephone Number ----------�---- --- - 870__ License Number ----_--� --- -- --_ B, certification �- - - I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as s the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: 0 Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority Inspect Ws-Sinature -- -- 9-29-12 Date ------- The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. if the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. -------------- ""This report only describes conditions at the time of Inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. ,L .5�-�^n.t w�r_� +��t. P F;r^.v� i`?�f�E,er� ,tu,4-�m- 3i2� �t�r rvT a ' Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 48 Paddock Lane Property Address William and Michelle Holland Owner Owners Name information is required for North Andover _ MA 01845 9-29-12 every page. Citylrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health,will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. 0 Y ❑ N ❑ ND (Explain below): Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments K r 48 Paddock Lane Property Address -- — William and Michelle Holland Owner Owner's Name information is required for North Andover MA 01845 9-29-12 every page. City/rown State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes(cant.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): 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 ' Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 48 Paddock Lane Property Address William and Michelle Holland Owner - information is Owner's Name required for North Andover _ MA 01845 9-29-12 every page. Cityfrown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health(and Public Water Supplier,if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6"below invert or available volume is less than '/day flow ` Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 48 Paddock Lane _ Property Address — William and Michelle Holland Owner Owner's Name — information is required for North Andover MA 01845 9-29-12 every page. Cityfrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis,performed at a DEP certified laboratory,for fecal colfform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ® the system is within 400 feet of a surface drinking water supply ❑ ® the system is within 200 feet of a tributary to a surface drinking water supply ❑ ® the system is located in a nitrogen sensitive area(interim Wellhead Protection Area—IWPA)or a mapped Zone ii of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered"yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304.The system owner should contact the appropriate regional office of the Department. Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 48 Paddock Lane Property Address William and Michelle Holland Owner Owner's Name information is required for North Andover MA 01845 9-29-12 every page. Cityfrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes"or"no"as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as NIA) ❑ ® Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ❑ ® Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ❑ ® Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms(design): NSA Number of bedrooms(actual): 4 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 440 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments •'< 48 Paddock Lane Property Address William and Michelle Holland Owner Owner's Name -- information is required for North Andover MA 01845 9-29-12 every page. Cityrrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: 4 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system?[if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage well _ � Y 9 (9Pd))� Detail: Sump pump? ❑ Yes ® No Last date of occupancy: current Date Commercial/industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments s` 48 Paddock Lane Property Address William and Michelle Holland Owner Owner's Name — information is required for North Andover MA 01845 9-29-12 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date — Other(describe below): General Information Pumping Records: Source of information: Pumped three weks before inspection per owner Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? - Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): 8 Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form-Not for Voluntary Assessments `' 48 Paddock Lane Property Address _— William and Michelle Holland Owner Owner's Name information is required for North Andover MA 01845 9-29-12 every page, City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: System 10 years old per as built plan Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 1'S' feet Material of construction: ®cast iron ®40 PVC ®other(explain): cast iron to sch 40 PVC _ Distance from private water supply well or suction line: 15' feet Comments(on condition of joints, venting, evidence of leakage, etc.): Pipe looks good in basement Septic Tank(locate on site plan): Depth below grade: feet Material of construction: ®concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1500 gallons Sludge depth: 0 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments J" 48 Paddock Lane Property Address William and Michelle Holland Owner information is Owner's Name required for North Andover MA 01845 9-29-12 _ every page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 34" Scum thickness 0 Distance from top of scum to top of outlet tee or baffle s" Distance from bottom of scum to bottom of outlet tee or baffle 14" How were dimensions determined? measure stick Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank looks normal. Sch 40 tees intact. Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness — --- Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date i4 ' Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments •'r 48 Paddock Lane Property Address William and Michelle Holland Owner Owner's Name information is North Andover required for MA 01845 9-29-12 every page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection)(locate on site plan): Depth below grade: ---- Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No f ! Commonwealth of Massachusetts Title 5 Official Inspection Form b Subsurface Sewage Disposal System Form-Not for Voluntary Assessments J` 48 Paddock Lane Property Address --- William and Michelle Holland Owner Owner's Name — information is North Andover MA 01845 9-29-12 required for _ every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened)(locate on site plan): Depth of liquid level above outlet invert 1.5" Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any 4- evidence of leakage into or out of box, etc.): Box full of seddiment from water softener. Ends of leach pipes clogged with sediment. Jet cleaning the leach lines to remove sediment and distribution box as part of the inspection. Lines working OK after cleaning but water softener needs to be removed from the septic system or it will cause the failure of the leach field. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS)(locate on site plan, excavation not required): If SAS not located, explain why: Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 48 Paddock Lane IV — Property Address William and Michelle Holland Owner Owner's Name information is required for North Andover MA 01845 9-29-12 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: - ❑ leaching chambers number: — ❑ leaching galleries number: - ❑ leaching trenches number, length: ® leaching fields number, dimensions: 1 - 15' x 40' ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: -- Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Area of field looks normal. No ponding, damp soil, or unusual vegetation. Stone in leach field is clean and dry. Cesspools (cesspool must be pumped as part of inspection)(locate on site plan): Number and configuration Depth-top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool -- Materials of construction - Indication of groundwater inflow ❑ Yes ❑ No t3 • Commonwealth of Massachusetts lugTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 48 Paddock Lane Property Address William and Michelle Holland Owner Owner's Name information is required for North Andover MA 01845 9-29-12 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions _ Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): i i Commonwealth of Massachusetts VTitle 5 official Inspection Form Subsurface Sewage Disposal System Foam,-Not for Voluntary Assessments ol4§Paddock Lane_ Property Address Willwneiam and Mlchelle_d -- - -- Owner Owner's Nameme information is -- ---- required for No_ rth Andover ---- - every page, oiry/Town ----------- �__-- MA _01845___ 9-29-12_ _ State— Zip Code Date_of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below- 0 hand-sketch in the area below ❑ drawing attached separately ��dS� Drs'7'A,NcE f �' 1a I.cIC[-•L W T-4&,I, v� 6' 9 �� ► '2.5.x✓. P _t7 f 50 p'nc 13dx 1�� • Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments y 48 Paddock Lane Property Address William and Michelle Holland Owner Owner's Name information is required for North Andover MA 01845 9-29-12 every page. Cityrrown State Zip Code Date of inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water. 6 feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health-explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: System designed 4'above seasonal high ground water Before filing this Inspection Report, please see Report Completeness Checklist on next page. IL Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 48 Paddock Lane Property Address William and Michelle Holland Owner Owner's Name information is required for North Andover MA 01845 9_29_12 every page. CrtyfTown State Zip Code Date of Inspection E. Report Completeness Checklist ® inspection Summary:A, B, C, D, or E checked ® Inspection Summary D(System Failure Criteria Applicable to All Systems)completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file i i I 17 01/26/1999 13:06 978-688-9575 N ANDOVER DWTP PAGE 02 North Andover Water Trent Plant 420 Great Pond Road North Andover,MA 01845 Nath AdQe ` Lab January 26, 1999 Mrs,Mary Ellen Whalen 48 Paddock Lane North Andover,Ma 01845 Dear Mrs. Whalen: The following are the results of the private well sample collected at 48 Paddock Lane on January 25, 1999.- Total 999:Total Coliform Bacteria 0 per 100m1 6.50 pH 0.15 mg/l phosphate 0 color units 0.02 m4/1 nitrate 0.10 turbidity units 0.042 mg/l iron 6 degrees C 0.001 mg/l manganese 10 mg/l as CaCO3 Total Hardness Comments: The well is free from bacteria,and all the parameters are excellent for a well. The results of these analyses meet the required federal and state standards for drinking water. The only parameter that was slightly low was the pH..A low pH means that the water is more acidic and may cause your plumbing fixtures to corrode. The range for a well pH is 6.5—8.5. The nitrate level is well below the standard of 10 mg/l. The maximum level for well water turbidity is 1.0 turbidityunits and for color 15 color units but naturally the lower the number the better. Your results are well below the maximum level. The well water is also very soft with the range being below 100mg/1 as CaCO3 as an indicator of soft water. If you have any further questions please call us at 688-9574. Sincerely, Kelly Lc9g Senior Water Analyst North Andover Water Treatment Plant Mass Cert.#for Bacteria-MA 21054 07/20/2000 10:46 978-688-9575 N ANDOVER DWTP PAGE 01 North Andover Water'Treatment.Plant R. ' 420 Great Pond Road North Andover,MA,01845 „ July 20,2000 w ` 121 Mr.William Holland — t` 42 Prospect Sftd 02154 a . Waltliatn,Ma - Dear Iv1r. Holland: The following are the results of the private well sample.collected at 48 Paddock T_,aIe on July 10,2000: Ail0 r 100m1 Tota1`Coliform Bacteria per 7.30`�O, 0.11. mg/l phosphate 0.01 mg/0 colo,r.-uniMg/j.nitrate r ilitii 0.085 mg/1 iron, `.. 0'. rut units s: 0.001 mg/l maciganese 20 4` S rng11 as:fiC�3 Total.Hardness ':'The well.is free from bacteria, and all the pamameters are exccllent.fot'a well_ r.,.. i' The results of these analyses meet the required federal and state standards for drinking water_ :,. The nitrate level is well below the standard of l0 ing/1_ The maximum level far well water turbidity is 1.0 turbidity units and for color 15 color units �' but naturally the lower the number the better. Your results'are well below the:maximum <<: level: The well water is also very soft with the range being below 100mg/l as CaCO3 as an indicator of soft water. " If you Have an further questions lease callus at 688-9574. ' y y Q P Sincerely, Kelly. ng ��'.' Senior Water Analyst is North Andover Water Treatment Plant "' Mass Cert. #for Bacteria-MA'21054 North Andover Water Treatment Plant 420 Great Pond Road North Andover,MA 01845 �1 1aAndot W, t Lab January 26, 1999 Mrs.Mary Ellen Whalen 48 Paddock Lane North Andover,Ma 01845 Dear Mrs. Whalen: The following are the results of the private well sample collected at 48 Paddock Lane on January 25, 1999: Total Coliform Bacteria 0 per 100ml 6.50 H' ; x,_` 0.15 mg/l phosphate N 0 color units 0.02 mg/1 nitrate 010 turbidity u uts 0.042 mg/l iron 4 6 degrees C l 0.001 mg/l manganese 1 L w 10 mg/1 as CaCO3 Total Hardness Comments: The well is free from bacteria, and all the parameters are excellent for a well. The results of these analyses meet the required federal and state standards for drinking water. The only parameter that was slightly low was the pH. A low pH means that the water is more acidic and may cause your plumbing fixtures to corrode. The range for a well pH is 6.5 —8.5. The nitrate level is well below the standard of 10 mg/l. The maximum level for well water turbidity is 1.0 turbidity units and for color 15 color units but naturally the lower the number the better. Your results are well below the maximum level. The well water is also very soft with the range being below 100mg/l asCaCO3 as an indicator of soft water. If you have any further questions please call us at 688-9574. Sincerely, t TOWN OF NORTH ANDOVER/ kA BOARD OF HEALTH Kelly Lcgg Senior Water Analyst — 4 North Andover Water Treatment Plant Mass Cert.# for Bacteria-MA 21054 �'� � I`k � Z�7/� SYs1'�1�1 PlJMP1NU RFC�C7Fc1.. reM C '►�rBR hDU -- _____., SEP — 7 2005 mss — - _....._�,.._....____._.•-___ _- EALT AN ^ H UrzPARTrv,ENT DATE OF f'VkMNq 1 Y P MPEr: - t Yt � ` � UiR r4; 1n rvKt; UM g>:fiY1C KUV'rlNc 0U0D CON01'rio �.NVt �v �'�iti !,Y• RATS 0h58 OXCUMS sOl,lp� `Ei�Crcpi�l p KU►vt3n<:F, SSL ID CA"yQ yUy,'--' r �7�Yi\1 _'( //f• / / )/y�,..fY=�. `yam „41 . Commonwealth of Massachusetts City/Town of 1 ECEMED System Pumping Record MA 2 2 2006 Form 4 TOWN OF NORTH ANDOVER DEP has provided this form for use by local Boards of Health. The Sy u�r`r�u&piagF&6Ejr -m st be submitted to the local Board of Health or other approving authority. . A. Facility Information Important: When filling out 1. System Location: forms the computer.use only the tab key Address to move your cursor-do not use the return Cityrrown State Zip Code key. 2. System Owner: Name Address(if different from location) Cityrrown 46 Zip Code / `7'U Telephone Number B. Pumping Record -C 7>1-c J. Date of Pumping Date 2. Quantity Pumped: Gallons 3. Type of system: ❑ Cesspool(s) eptic Tank ❑ Tight_Tank ❑ Other(describe): 4. Effluent Tee Filter present? ❑ YesNo If yes, was it cleaned? ❑ Yes ❑ No 5. Condition of System: 6. SysV� By -r1�� Name Vehicle License Number Company 7. Locati here content ere di sed:. c )ignnureHauler Date hqp://www.mass.gov/dep/waterlapprovals/t5foans.htm#inspect t5form4.doc•06103 System Pumping Record•Page 9 of 1 1�!N- Commonwealth of Massachusetts RECEIVED City/Town of System Pumping Record OCT 2 4 2006 Form 4 TOWN OF NORTH ANDOVER HEALTH DEPARTMENT DEP has provided this form for use by local Boards of Health. The System Pumping Record must be submitted to the local Board of Health or other approving authority. A. Facility Information Important: When ruing out 1. System Location: � forms on the C\ 1 'CJI J computer,use U only the tab key Address - to move your cursor-do not use the•retum Citylrown State Zip Code key. 2. System Owner: Name ICI Address(if different from location) City/Town State QZI Telephone Number .B. pumping Record `7 1. .Date.of Pumping p g Date 2. Quantity Pumped. Gallons 3. Type of system: ❑ Cesspool(s) R-19—eptic Tank_ ❑ Tight Tank ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes 9-f�0 If yes, was it cleaned? ❑ Yes ❑ No 5. Condition of Sys�l�: 6. System Pum ed y Name::B Vehicle License Number Company .7. Location w e crontents re di ed: Signa)u of a er Date http://www.mass.govidep/water/approvals/t5forrns.htm#in spect t5form4.doc•06103 system-Pumping Record•Page 1 of 1 AS-BUILT UIECKLIST LOT NUMBER STREET NAME ASSESSORS MAP & PARCEL NUMBER `� _✓ LOT LINES & LOCATION OF DWELLINGS LOCATION & DEMENSIONS OF SYSTEM, INCLUDING RESERVE TIES TO LOT LINES& DWELLING, WELLS a. FROM SEPTIC TANK b. FROM LEACH AREA LOCATIONS OF DEEP HOLES & PERC TESTS ELEVATIONS OF DISPOSAL SYSTEM TOP OF FDN ELEVATION V LOCATIONS OF WELLS, DRAINS, WATERCOURSES W/IN 150' OF SYSTEM LOCATION OF WATER, GAS', ELECTRIC LINES, CABLE DISTANCES FROM CORNERS OF HOUSE TO CENTER OF TANK &D-BOX STAMP& SIGNATURE — ✓ IMPERVIOUS AREAS - DRIVEWAYS, ETC. ` NORTH ARROW '✓ FINAL CONTOURS ✓ �/ LOCATION & ELEVATION OF BENCHMARK USED y L� LOCUS PLAN TOWN OF NORTH ANDOVER SEWAGE DISPOSAL SYSTEM INSTALLATION CERTIFICATION The undersigned hereby certify that the Sewage Disposal System ( ) constructed, (✓f repaired: by F P (7.G I LL`3-- qP I k)G located at 4t' PA nQoC.V, L^,Jp-" was installed in conformance with the North Andover Board of Health approved plan, System Design Permit # dated with an approved design flow of 440 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: Engineer Representative Final inspection date: _I1, co rif e,og�lr-i MM►.urX Engineer Representative Installer: Lic.#: Date: Design Engineer: Date: . TOWN OF NORTH ANDOVER SEWAGE DISPOSAL SYSTEM INSTALLATION CERTIFICATION The undersigned hereby certify that the Sewage Disposal System ( ) constructed; ( ) repaired; n by located at ( ,— L a4-\ e. was installed in conformance with the North Andover Board of Health approved plan, System Design Permit# dated , with an approved 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: Engineer Representative Final inspection date: Engineer Representative Installer: ALic.#: Date: Design Engineer: Date: TOWN OF NORTH ANDOVER BOARD OF HEALTH CERTIFICATE OF COMPLIANCE DATE OF COMPLIANCE: 07/06/99 This is to certify that the individual subsurface disposal system constructed ( ) or repaired (X) by F.P. Reilly& Sons, Inc. at 48 Paddock Lane 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 as described in the Design Approval Site System Permit# 1065 dated 03/02/99. The Issuance of this certificate shall not be construed as a guarantee that the system will function satisfactorily. ,q Board of Health Inspector Town of North Andover, Massachusetts Form No.3 • f BOARD OF HEALTH HORTI{1 J� �' O p oo ` 11. # �'`�,,.,o•��"� DISPOSAL WORKS CONSTRUCTION PERMIT . .. ,SSACHUSES Applicant I I tj i.._L' NAME ADDRESS TELEPHONE Site Location �%€'> ' ! C' LN`'�L Permission is hereby granted to Construct ( ) or Repair (� an Individual Soil Absorption Sewage Disposal System as shown on the Design Approval S.S. No. CHAIRMAN, BOARD OF HEALTH Fee was D.W.C. No. Town of North Andover f 40RTh , OFFICE OF COMMUNITY DEVELOPMENT AND SERVICES A 27 Charles Street North Andover, Massachusetts 01845 �9SSACHus�t<y WILLIAM J. SCOTT Director (978)688-9531 Fax(978)688-9542 March 10, 1999 Mary Ellen Whalen 48 Paddock Lane North Andover, MA 01845 RE: 48 Paddock Lane, North Andover Dear Ms. Whalen: This letter is to inform you that the North Andover Board of Health at their meeting on March 9, 1999 granted a variance to North Andover septic regulation, section 5.02 to allow the installation of a leach area 50 feet from wetlands. With this variance the proposed septic plans dated 3/2/99 for the repair of the system located at 48 Paddock Lane have been approved. Please do not hesitate to call the office at the number below if you have any questions. Sincerely, Sandra Starr, R.S. Health Administrator Cc: B. Dufresne File BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 MERRIMACK ENGINEERING SERVICES, INC. PROFESSIONAL ENGINEERS • LAND SURVEYORS • PLANNERS LVI 1 66 PARK STREET•ANDOVER,MASSACHUSETTS 01810•TEL(978)475-3555,373-5721 •FAX(978)475-1448•E-MAIL:merreng@aol.com TQw ibFRTH A DOVE �- March 2, 1999 BOARD OF - 51998 Ms. Sandra Starr Director of Health 27 Charles Street North Andover, MA 01845 RE: Septic Upgrade - 48 Paddock Lane Dear Ms. Starr: We have completed a replacement sewage disposal system plan for the above referenced site. Based on the plan and the existing site limitations it is proposed that the leach field be located 50 feet from a bordering vegetated wetland where 100 feet is required under Local Regulations (5.02). Due to the presence of wetlands and the existing well, it is not possible to meet both requirements. We hereby request a variance from the required 100 foot wetland setback to 50 feet and propose to meet the required 100 foot well setback. We will be happy to discuss this request in more detail at your next Board of Health Meeting. Very truly yours, MERRIMACK ENGINEERING SERVICES William Dufresne Project Manager cd Enclosure Mar-04-99 10: 22A Paul D. Turbide, PE/PLS 508-465-0313 P.02 March 4, 1999 TOWN OF NORTH ANDOVER/ BOARD OF HEALTH Sandra Starr North Andover Board of Health Administrator CLIA — Q Office of Community Development and Services 30 School St. North Andover,MA 01845 RE: Title V review for 48 Paddock Lane Dear Sandra, Enclosed find the"Checklist for North Andover Septic System Plans" for the above- mentioned site. The following is'a list of all the`Problem' areas and deficiencies Port Engineering has found. • The groundwater separation has not been adjusted to highest existing grade over the leaching bed. Test Pit Tl has an existing grade elevation of 83.7', but the highest grade over the leaching bed is about 85'. If we assume that the groundwater under the leaching bed is 4' below the existing grade(ESHW was 4' in TP T1)then the ESHW under the leaching bed would be at elevation 81'. The bottom of the proposed bed is elevation 84' and thus there would only be 3' of groundwater separation. Either the bed should be raised a foot, or a local upgrade waiver should be requested to be only 3' to groundwater. • 310 CMR 247(2)states that for a minimum of 2"of 1/8 to%s inch stone is to be placed on the top of the leaching bed. The plan design calls for a layer of untreated building paper to be laid on top this stone. There is no regulation that I could find that allows untreated building paper to be laid over the peastone, and therefore I would recommend that the untreated building paper be removed from the design. • The septic tank detail should that there is to be a 3-inch air space above the inlet and outlet tees(227(4)). The following minor points are noted: • The profile correctly shows 6" stone base beneath the septic tank,but the Septic Tank Details incorrectly shows a 6"compacted crushed stone gravel base. The septic tank detail should be changed to show a 6" stone base. • 220(4xq)states that the benchmark must be 50 to 75 feet away from the facility. The benchmark shown on the plan is about 107 feet away. (For this site,it may be that the benchmark on the top of foundation is adequate and another closer PORT benchmark is not needed, but I leave that up to you.) it I • A minor drafting error is that in the Design Calculations,under"leaching area ENGINEERINGrequired", the end of the equation says"647 GPD"when it should say"647 SF". An observation is that a local upgrade waiver from the NA regulation 5.02 is requested Civil Engineers& to allow the upgrade leaching bed to be 50' off wetlands rather than 100'. I find this to Land Surveyors be a reasonable request. One Harris Street If you have any questions or comments please feel free to contact me. Newburyport,MA 01950 (978)465-8594 Sincerely Carlton A. Brown,PE/PLS Mar-04-99 10: 22A Paul D. Turbide, PE/PLS 508-465-0313 P.01 Facsimile Cover Sheet To: SANDRA STARR Company: NORTH ANDOVER BOH Phone: 978-688-9540 Fax: 978-688-9542 From: Carlton A. Brown Company: Port Engineering Associates, Inc. Phone: (978) 465-8594 Fax: (978) 465-0313 Date March 04, 1999 Pages Including This Cover Page: 2 Comments: Enclosed is the review for 48 Paddock Lane(map 107d lot 98) Thanks, Carlton : Town of North Andover, Massachusetts Form No.2 • NORTh BOARD OF HEALTH • Of� ��o i�,'1' nn q� • s DESIGN APPROVAL FOR ss"C"°5`` SOIL ABSORPTION SEWAGE DISPOSAL SYSTEM • Applicant Test No. g 9� Site Location -I8-i9060(21-< Z19A.0 Reference Plans and Specs. /)-)&"/m'PCz ENGINEER DESIGN DATE Permission is granted for an individual soil absorption sewage disposal system to be installed in accordance with regulations of Board of Health. _ CL/1/CJ CHAIRMAN,BOARD OF HEALTH Fee /-4 Site System Permit No. /D�� I MERRIMACK ENGINEERING SERVICES, INC. PROFESSIONAL ENGINEERS • LAND SURVEYORS • PLANNERS 66 PARK STREET•ANDOVER,MASSACHUSETTS 01810•TEL(978)475-3555,373-5721 •FAX(978)475-1448•E-MAIL:merrengCaol.com March 2, 1999 Ms. Sandra Starr - Director of Health 27 Charles Street North Andover,MA 01845 v RE: Septic Upgrade-48 Paddock Lane Dear Ms. Starr: We have completed a replacement sewage disposal system plan for the above referenced site. . Based on the plan and the existing site limitations it is proposed that the leach field be located 50 feet from a bordering vegetated wetland where 100 feet is required under Local Regulations (5.02). Due to the presence of wetlands and the existing well, it is not possible to meet both requirements. We hereby request a variance from the required 100 foot wetland setback to 50 feet.and propose to meet the required 100 foot well setback. We will be happy to discuss this request in more detail at your next Board of Health Meeting. 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I -�� — M1 if.tr�iltrr��1!►�e Per'''gi- 'u l 1\ 4 t DATE: LOCATION. vt — ENGINEEF - BOH VVITNESS: PERCOLATION TEST BO i 0M DE TH •r PARC T EST: TIME OF SOAK: _ 7 fat least mirutes Icnc) TIME A' i 2" i. TIME AT TIME A T E / CVEP,NIGH,T S0, K ' T IME ST=.-TED NESTD,''-,Y � (.-,t iees; mini esi Sui-�r�: TIME AT %° TIME T TIME AT S'° FORM 11 - SOIL EVALUATOR FORAZ Page 1 Data.... , Commonwealth of Massachusetts J0_ , Massachusetts f oil S iMhility Assessnzertt On- * Se=U Divosal Perfomed By: ........... ......191V. ....... Witnessed BY:.....� ...: t(22�.. :.� �w :.. :::::::..........._..................................M . . wit /r/ /"`h A&M.r0 8 I(K /0 TtM�lr�e Ajo •/l7�lbf!*�7Li �4 Ol1xfs T` 6I,-'v New Construction ❑ Repair d� Office Review Published Soil Survey Available: No ❑ Yes Year Published ... .. Publication Scale l..•: s � Soil Map Unit _K� Drainage ClassSoil Limitations ..... .................................................................................:�'�.".............. ..... .......... Surficiai Geologic Report Available: No Lam' Yes ❑ Year Published Publication Scale ...............••• Geologic Material (Map Unit) ......................................._........W..........................................._........................................................ .. .. ,C�u ,,�. . e/ ...................................... ?.................................. Landform ................ .. ....._.................... f*7 Flood Insurance Rate Map: irL'� (oma Above 600 year flood boundary No ❑.,/ . Yes Within 600 year flood boundary No Lam" Yes ❑ ❑ Within 100 year flood boundary No Yes Wetland Area: National Wetland Inventory Map (map unit).............:..............................._.................__............................................. Wetlands Conservancy Program Map (map unit)..............................................................._.................................. Current Water Resource Conditions IUSGSI: Month .....•.......••.•• Range : Above Normal ❑ Normal ❑ Below Normal ❑ Other References Reviewed: a4AS a,,Nd t• v 1 ' FORM 11 - SOIL. EVALUATOR FORM Page 2 • nh._kite Review ' �� ........_. Deep Hole Number ._1..-�_... Date:.•Z 7Y Time:.• .O... Weather r♦ Location (identify on site plan) ....................................................................................__............ w_...__�.._......__ Land Use .L /LESS Slope(961 ��- ,0 Surface Stones ............................................_....__................ j _. ...._... ..._... ..... ___ .............. _..................... ............ .. _ .Vegetation rr...................... ............ Landform ......_lam..._. � � ................_......................................_...................................... Position on landscape (sketch on the back) ----PON= �c --. ' ' ..........•-..........................-___........_.�___.......__.._. Distances from: , Open Water Body ! ' feet Drainage way_ feet, Possible Wet Area _:_�?? feet Property Una. feet Drinking Water Well feet Other_•••••••••••••••••-••••••• MON HOLE LOU DEEP A Depth from SuFfaM Soil P.Oftn SON Texture Sol Color 'Boll Motdkv 000 gnoheel (USDA) (Munsell) t8tniotul.$miw.Qre open. etc C, -v. aqr,,�d C evo.. p 1sY ohk SY G/s f1 L� ............ Depth to Bedrock: Parent Materiel(geologic) _...._.._.................._..._................_. Deoth to Groundwater: Standing Water in the Hole: .!•.07"QWeeping from Pit Face: ....k-00 k� Estimated Seasonal High Ground Water: ... g�� FORM it - SOIL. EVALUATOR DORM Page 2 On-sig Review -7� Z�6l Time:./o:`cv��w� Weather 3Ss' Deep Hole Number Oete:............:�. ••••• ••••••••----- Location (identify on site pisn) ...._...__ ,E' '....v..........._..................-....._....................................._...._....._..___._... _�...._...-_ _. L Sr Slope 1961 '8 Surface Stonae .11 '! __...._.� LandUse ... ._....... ____...._.... jVegetation '`'-...�...... - ......................__...w.� ..........................r................................................................_....___...............- Landform..............(eee .... ___. ... ...._......_.....--r.... w_.......c ...........................................__..........._..........._..._...._........ Position on landscape(sketch on the back) -......- -Distances from: Open Witar Body M— .• feet Drainage way-2;!7'- •'• feat, Possible Wet Area _ � feet Property Lina. ��. feet ' Drinking Water Well (. .. feet Other.................................. papth from Swfaco Soo Hoon Sol��ra S'oM SoN Mpulinp ISquapr�.�.BaMor�. unahol font4i arwe -75 Y& t L S. Z.sY6/C, 000rl ''� lc�„s•� X� ........_...._....-..._.. ............. Depth to Bedrock: Parent Material(geologic( •�•• • ••••••-•••-••••�•N weeping from Pit Face: ./�•�� ......... penth to Groundwater: Standing Water in the Hole: ...... ........... Estimated Seasonal High Ground Water: ....- 1 YoRM ii - SOIL EVALUATOR FARM Page 3 .or Seasonal Hi Watff TIM method Used_ ❑ Depth observed standing in observation hole.••...•••..••.••••• inches ❑ Depth weeping from side of,observation hole...............•• inches Q/ 4 .,e.� V4v—Z, L/ Depth to soil mottles .Zak, inches ❑ Ground water adjustment.....••.••..... feet Index Well Number Reading_Date ...•__•..••_-•• Index well level Adjustment factor Adjusted ground water level ...........�_...�.._�_.._. .._.__�__. Qeoth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? If not, what is the depth of naturally occurring pervious material? I certify that on Natal I have passed the examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with the required training, expertise and experience described in 310 CMR 16.017. Date Z Signature • FORM 12 -PERCOLATION IM COMMONWEALTH 'OF MASSACHUSETTS Massachusetts percolation Test Date: Z"�. � Time: .. r0:b:9;8rv,a=t1On=8Deptf Perc ?� FEW Pre-soak 12, 1� Ere-soak �f at 12" at g" r Z! c at 6" P Time l9"•6'1 Rate Mindinch Site Passed Site Failed ❑ Performed By: '� Witnessed By: / cp(b 40 Comments: .............................................................................................................................. ................................................................ RIi1WAtti1►`�'!h?:f$�"'h"(S'i't!P+:,.��h:;.$fs*".N,11f.'s?';+,v',•;:<rov?-?.;,¢.r-...e. ,, ss;�.:"v,„a:aw...:.,. , - .. ,., .. ,. . . .. • tr•r� _F��f_l �. f L A 1_o-r d•A • � � S, r t v 44 f t a _ G1 ' �1 Q FA P P �O ISL-F-N ° -ir I a NAS. 1 o ,r _ t. r� 17 o S f t►'t♦/ nL`J i- 1 D '.A.�� 5 Ge,t_tt•� 40 DAT G i D rCC.. Z9� 1 of a 1 F P�rs B G G E.L-1 N AS A S ac t o-t-ES � �=lit C-�l f♦1r�L:�S�: Al2G.!-1 fTf�=GT C� .t STT Jor�tN Pao �j w,4sH- ST 57ACetii41111A al9 pj_.�f<'s AAG FitiIOAZ�— 3> G��r�r2 TOWN OF`NO$TH ANDOVER SYSTEM PAING RECORD DATE 11-13-o-7 +. SYSTEM OWNER&ADDRESS '' SYSTEM LOCATION .11-17 DATE OF PUMPING_ -03 QUANTITY PUMPED S D O CESSPOOL NO YES SEPTIC TANK NOS NATURE OF SERVICE;;,RQjTI'INE EMERGENCY OBSERVATIONS: GOOD CONDITION FULL TO COVER HEAVY GREASE BAFFLES IN LACE ROOTS LEACHFIELD RUNBACK EXCESSIVE SOLIDS FLOODED SOLID CARRYOVER OTHER EXPLAIN SYSTEM PUMPED BY v COMMENTS: CONTENTS TRANSFERRED TO