HomeMy WebLinkAboutMiscellaneous - 50 TURTLE LANE 4/30/2018 (2)OO
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Commonwealth of Massachusetts RECEIVED
City/Town of (y�\ tl `{M}
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System Pumping Record r
Form 4�>> x: s J,s:
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 09Aont of h , Left / Right rear of house, Left / right side of house, Left /
Right side of building, Left / Right front of building, Left / Right rear of building, Under deck
Address F � O
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Cityrrown State Zip Code
2. System Owner. S
Name
Address (if different from location)
City/Town
B. Pumping Record
1. Date of Pumping
3. Type of system: ❑
❑ Other (describe):
Date
Cesspool(s)
stat Code
Telephone Number
— 2. Quantity Pumped
Septic Tank
Gallons
❑ Tight Tank
4. Effluent Tee Filter present? ❑ Yes No If yes, was it cleaned? ❑ Yes ❑ No
5. Conditi o System:
CSS --G�<---
6. System Pumped By:
Neil Bateson
Name
Bateson Enterprises Inc
Company
7. Locati, where contents were disposed:
/G. L, S. Lowell Waste Water
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Vehicle License Number
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Date
System Pumping Record • Page 1 of 1
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SYSTEM PUMPING RECORD
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SYSTEM.OWNER &ADDRESS '• ?' SYSTEM LOCATION
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TO: NORTH ANDOVER, MASS c 7k L 19 7 7
BOARD OF HEALTH
FROM: DESIGN ENGINEER Re: Soil Absorption Sewage
System Inspection
This is to certify that I have inspected the construction of the said disposal system at
�6 7` .3 ?Lt/? TI -6 L ,7/S/ E North Andover, Mass.
SITE LOCATION
The grades and construction are as specified in my plans and specifications dated
19 gas
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Fier/Reg o itarian
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TO: NORTH ANDOVER, MASS c 7k L 19 7 7
BOARD OF HEALTH
FROM: DESIGN ENGINEER Re: Soil Absorption Sewage
System Inspection
This is to certify that I have inspected the construction of the said disposal system at
�6 7` .3 ?Lt/? TI -6 L ,7/S/ E North Andover, Mass.
SITE LOCATION
The grades and construction are as specified in my plans and specifications dated
19 gas
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Fier/Reg o itarian
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TOWN OF NORTH ANDOVER
REPORT OF PERC TEST
/11
NORTH ANDOVER BOARD OF HEALTH
ADDRESS OF SYSTEM /Uf- /C'. �% DATE 9 11-5174
NAME OF PROFESSIONAL EIJGINEER. OR SANITARIAN CONDUCTING TESTS
jo�A Ievh ADDRESS �oJ -, ��
NAME OF LOT OWNE�
SHOW APPRO)M4ATE LOCATION OF PITS ON SKETCH ON REAR OF MS SHEET
J/J517G _.._ Total
Soil Loe: Topsoil Subsoil Depths & Tgpes Water LevP1 Pit Depth
�a`jG Time to Time to
Perc Tes Depth Saturation Time Drop 12t, _ 9ti nrnn 911 _ 61►
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Other Considerations:---� �'��(� ! /4.1or
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Recommendations:
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�a`jG Time to Time to
Perc Tes Depth Saturation Time Drop 12t, _ 9ti nrnn 911 _ 61►
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Other Considerations:---� �'��(� ! /4.1or
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Recommendations:
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Signature _
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SOIL PROFILE & PERCOLATION
Town/CCitit No.&Street TESTf DATA �C� ✓� e e -
I/ ��� Lot No. 3
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Loc . / Subdiv . // 1Plan Owner /r19cZ �
Investigator ccs, Observer
SOIL PROFILES -DAT
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1' E1 v. 2' Elev. 3' Elev. 4'Elev.
o baa 77 0 0 0
2
3
0
5
(\ 7
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0
3
_ 4
5
6
7
8
9
7
3
4
5
6
7
8
9
Benchmark Location
Elevation Datum
Percolation Tests -Date
/-Z-2/,- �7
2
3
4
5
6
7
8
9
Pit Number
1 2 3 4 5
Start _Saturation
3:3 �-
Soak-Mins.
(�
Start Test -Time
p
Drop of 3" -Time
Drop of 6" -Time
411Z
Mins.lst_ 3"Dro
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Mins.2nd '311D -0-p77"_,5'
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Notes & Sketches on Back
Frank C. Gelinas & Associates, North And.
11012-2-17
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