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HomeMy WebLinkAboutMiscellaneous - 56 WINDKIST FARM ROAD 4/30/2018 (2)r , I •. M North Andover Roard of Assessors Public Access Page 1 of 1 WMORTM _ North Andover Board of Assessors mox Zroperty Record Card Parra] rr) • )I A/1110 (LMKA-AW111 A 17V.1)(11 1 (.rr,,,,,,,,;f„ . N.,,.*1. A -A–.— Location: 56 WINDKIST FARM ROAD Owner Name: BALOGH/RICO NOMINEE TRUST RAY BALOGH & JOANNE RICO, TR Owner Address: 56 WINDKIST FARM ROAD City: NORTH ANDOVER State: MA Zip: 01845 Neighborhood: 8 - 8 Land Area: 1.00 acres Use Code: 101-SNGL-FAM-RES Total Finished Area: 3847 sqft Total Value: 770,000 770,000 Building Value: 540,000 540,000 Land Value: 230,000 230,000 Market Land Value: 230,000 Chanter Land Value: Price: 1 Sale 04/17/2007 Date: s Length Sale F-NO-CONVNIENT Grantor: BALOGH, RAY Doc: Book: 10713 Page: 136 http://csc-ma.us/PROPAPP/display.do?linkld=1897188&town=NandoverPubAcc 4/24/2012 s I MAP # L © ( LOT # PARCEL # �f� STREET -Y CONSTRUCTION APP 1�- • HAS PLAN REVIEW FEE BEEN PAID? YES NO "\ PLAN APPROVAL: DATE 01% /CJ APP. BY G�%v DESIGNER:STJ /ii(, S el,,-) PLAN DATE W /� 9 CONDITIONS WI ER SUPPLY: WELL PERMIT WELL TESTS: it PLUMBING SIGNOFF COMMENTS: F. f FORM U APPROVAL: DATE ISSUED CONDITIONS: FINAL APPROVAL: TOWN WELL DRILLER CHEMICAL DATE APPROVED BACTER DATE APPROVED BACTERIA II D APPROVED WIRING SIGNOFF APPROVAL TO ISSUE YES NO BY ALL PERMITS PAID WELL CONSTRUCTION APPROVAL SEPTIC SYSTEM CONSTRUCTION APPROVAL OTHER ANY VARIANCE NEEDED FINAL BOARD OF HEALTH APPROVAL: YES NO YES NO YES NO YES NO YES NO DATE: BY: SEPTIC SYSTEM INSTALLATION IS THE INSTALLER LICENSED? ES NO TYPE OF CONSTRUCTION: l ,* ��J REPAIR NEW CONSTRUCTION: CERTIFIED PLOT PLAN REVIEW NOS, CONDITIONS OF APPROVAL S NO (FROM FORM U) 4� ISSUANCE OF DWC PERMIT YES NO DWC PERMIT PAID? YED NO DWC PERMIT N0. INSTALLER: BEGIN INSPECTION YF8 NO: EXCAVATION INSPECTION: -� NEEDED: x PASSED By 2 LONSTRUCTION INSPECTION: NEEDED..` .b, AS BUILT PLAN SATISFACTORY: YES: APPROVAL TO BACKFILL: DATE: `- z l BY r'�^ FINAL GRADING APPROVAL: DATE By f / , FINAL CONSTRUCTION APPROVAL: DATE: c E,er TC6 /t) 4/3� Sawyer, Susan From: Cheung, Eric (DEP) [eric.cheung@state.ma. us] Sent: Monday, October 10, 2011 9:51 AM To: Derek Skillings; Mike Pelletier Cc: Cerutti, Joseph (DEP); Sawyer, Susan Subject: UIC registra#ion. North.Andover_56 Wiiidkist`Farrrl'Roa0-:) Hi Derek and Mike, The purpose of this email is to issue you Underground Injection Control (UIC) registration MAS31A210201-5CL for the installation of 3 closed-loop ground source heat pump (GSHP) wells and system start-up at 56 Windkist Farm Road, North Andover. The wells will be installed by Skillings & Sons, Inc This UIC approval is conditional upon meeting all of the requirements provided in the MassDEP Guidelines for Ground Source Heat Pump Wells. This approval is for the installation of conventional closed-loop wells using high density polyethylene (HDPE) tubing. If you are proposing the use of Rygan HPGX or Kelix well materials you must inform the MassDEP UIC program of your intent to do so prior to installing the wells. Since MassDEP has not completed a detailed review of this proposed installation, you are advised to contact me if you have any questions regarding the requirements that are detailed in the guidelines. The guidelines can be obtained as the 3rd document on the following MassDEP UIC web page: hftp://www.mass.gov/dep/water/drinking/uic.htm If you haven't already done so, a copy of the UIC application must be submitted to the local board of health. Please be aware that the issuance of the above UIC registration number only indicates that MassDEP's UIC Program has received the information that we have requested. There may be other local permits, ordinances, or regulations that apply, including but not limited to board of health permits for well installations and building department regulations regarding trenching work. The issuance of a UIC registration number by MassDEP does not supersede the requirements of any other state or local regulatory entity. A copy of this email has been sent to the local board of health. The board of health should be aware that as of Friday, February 19, 2010, MassDEP significantly reduced the level of effort that goes into the review of a closed-loop UIC registration application for a GSHP well. Specifically, MassDEP no longer requires that the applicant submit site plans and proposed well construction details. Therefore, it is up to the applicant to ensure that all applicable set -back distances are met per the MassDEP Guidelines for Ground Source Heat Pump Wells (August 2010). If you have any further questions you can contact Joe Cerutti at Joseph.Ceruttit Dstate.ma.us, (617)292-5859, or by fax (617)292-5696. Eric Cheung MassDEP 1 Winter Street, 5th Floor Boston, MA 02108 Eric.Cheuna ..state.ma.us ph 617 292-5992 fax 617 292-5696 Please note the Massachusetts Secretary of State's office has determined that most emails to and from municipal offices and officials are public records. For more information please refer to: http://www.sec.state.ma.us/pre/oreidx.htm. Please consider the environment before printing this email. Commonwealth of Massachusetts City/Town of q System stem Record DEC `� 201 -rov� Form 4 F 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, Left/ Right rear of house, Left / ' -sl eM� Left/ Right side of building, Left / Right front of building, Left / Right rear of buildin , Address �`—�' • I / � � I �� �_�� Citylrown (O �J State Zip Code 2. System Owner. Name' Address (if different from location) City/Town ' State Zip Code Telephone Number < B. Pumping Record 1. Date of Pumping �2. Quantity Pumped: DateGallons 3. Type of system' ❑ Cesspool(s) eptic Tank ❑ Tight Tank ❑ Other (describe): 4. Effluent Tee Filter present? ❑ Yes o If yes, was it cleaned? ❑ Yes ❑ No '5. Condition of System: 6. System Pumped By: Neil Bateson F5821 Name Vehicle License Number Bateson Enterprises Inc - Company 7. LocatigD-Vere contents were disposed: M0 M M., Zia! t5forrn4.doa 06103 System Pumping Record • Page 1 of 1 Commonwealth of Massachusetts RECEIVE® City/Town of System Pumping Record 3x` Q 12013 Form 4 TOWN OFI=THi DEP has provided this form for use by local Boards of Health. t er 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, Left / Right rear of house, Left Aght si a of oase, Left / Right side of building, Left / Right front of building, Left / Right rear of building, Under deck Address °"" _ j. 6 �3 W) (/� Cityrrown State 2. System Owner. Name Address ('d different from location) Cityfrown B. Pumping Record 1. Date of Pumping 3. Type of system: ❑ Vl4lG Telephone Number Zip Code Date 2. Quantity Pumped: Gallons Cesspool(s) eptic Tank ❑ Tight Tank ❑ Other (describe): 4. Effluent Tee Filter present? ❑ Yes No If yes, was it cleaned? ❑ Yes ❑ No 5. ConditioMofstem: 0 tk')-,i ) 45u� 6. System Pumped By: Neil Bateson F582.1 Name Vehicle License Number Bateson Enterprises Inc Company 7. Locatio ere contents were disposed: C L,,S _ Lowell Waste Water ME M 90 Date t5form4.doc• 06103 System Pumping Recons • Page 1 of 1 Massachusetts Department of Environ Al Protection Bureau of Resource Protection WELL DRILLER Please specify work performed: New Well Please specify well type: Closed Loop _[ Number Of Wells: Well Location In public right-of-way: Yes No Subdivision/Property/Description: Property Owner: RAY BALOGH Engineering Firm: TOWN OF l( _HEALTH D,EPARTIUM Address at well location: Street Number: Street Name: X156 � LWINDKIST FARM�� Building Lot#: Assessor's Map #: L Assessor's Lot#: ZIP Code: E 01845 City/Town: NORTH ANDOVER GPS (GPS for the deepest well) North: West: 42.62670 1 71.09038 Mailing Address: click here if same as well location addr ess .a _. Street Number: Street Name: 56WINDKIST FARM City/Town: State: NORTHANDOVERT1 MASSACHUSETTS ZIP Code: 01845 rn Board of health permit obtained: Yes C: Not Required Permit Number: Date Issued: Gl d Massachusetts Department of Environmental Protection Bureau of Resource Protection –Well Driller Program 'i Well Completion Reports(Geo Thermal) i Well Driller - Geothermal DRILLING METHOD Overburden Mud Rotary ' Bedrock WELL LOG OVERBURDEN LITHOLOGY Loss or addition of From To(ft) Code Color (ft) r�--- 20 ;Organics m _ ;Brown (i'��� Clay L :� -j L. Brown _..___ _ r^.. µ0 �� 'Clay Brown Brown WELL LOG BEDROCK LITHOLOGY From (ft) To(ft) Code ;Granite 14:i 246 Granite (Z'_'� IG to 3-1ti "50(,T,;Granite ADDITIONAL WELL INFORMATION Air Hammerl Comment Drop in Extra fast or slow Loss or addition of drill stem drill rate fluid Fast r Slow r LOSS' Adtii}n` Fast r Slow r Loss r Adcrion rFast fSIOW Etss r Addition I C FasFas r Slow Loss r ; Idi!ion! Date drilling begun 11/9/2011 Date last well drilled 11/11/2011 �j ___0De. Total Well Depth 140 Depth to Bedrock V............�, p GEOTHERMAL INFORMATION Thermal Conductivity (BTU/hr.ft.°F) Thermal Diffusivity (ft2/day) C_ _ Formation Water Temperature (°F) ? DEP UIC # IMAS_IA 31 2-10201 I CASING . F Is Casing above ground?; From To Type Thickness Diameter _ mm� � ;Steel t _ o LOOP MATERIAL From To Type Thickness Diameter �) , __ 1 i4i}� — � _� 115` 1 - .___1 WATER -BEARING ZONES DRY WEL Yield From To .W_—_.._...._, (gPm) r 1270 J 4013 s Visible Rust Staining E Ye r Ye. r Ye FtYe. Extra Large Chips r Ye r Ye. r Ye r Ye Drop in Extra fast or slow Loss or addition of Comment drill stem drill rate fluid r�--- Fast �j&ow r f i Loss r Addition i d iYe Fast Sow Loss r Addition i r Ye: Fas:S o;: — LoAddition Comment Drop in Extra fast or slow Loss or addition of drill stem drill rate fluid Fast r Slow r LOSS' Adtii}n` Fast r Slow r Loss r Adcrion rFast fSIOW Etss r Addition I C FasFas r Slow Loss r ; Idi!ion! Date drilling begun 11/9/2011 Date last well drilled 11/11/2011 �j ___0De. Total Well Depth 140 Depth to Bedrock V............�, p GEOTHERMAL INFORMATION Thermal Conductivity (BTU/hr.ft.°F) Thermal Diffusivity (ft2/day) C_ _ Formation Water Temperature (°F) ? DEP UIC # IMAS_IA 31 2-10201 I CASING . F Is Casing above ground?; From To Type Thickness Diameter _ mm� � ;Steel t _ o LOOP MATERIAL From To Type Thickness Diameter �) , __ 1 i4i}� — � _� 115` 1 - .___1 WATER -BEARING ZONES DRY WEL Yield From To .W_—_.._...._, (gPm) r 1270 J 4013 s Visible Rust Staining E Ye r Ye. r Ye FtYe. Extra Large Chips r Ye r Ye. r Ye r Ye Massachusetts Department of Environmental Protection ! Bureau of Resource Protection — Well Driller Program Well Completion Reports(Geo Thermal) WELL SEAL Water From To Material 1 Weight Material 2 Weight (gal) Batche Method Of Placement 0i I ;Bentonite Grout 5C ISand 300 24 1S� Tremie WATER LEVEL Date Measured Static Depth BGS (ft) Flowing Rate (gpm) iit:520i" 112 COMMENTS THE ORIGINAL WELL COMPLETION REPORT #446875 WAS INCOMPLETE AND SUBMITTED. WE HAVE SUBMITTED ANOTHER WELL COMPLETION WELL DRILLERS STATEMENT This well was drilled or altered under my direct supervision, according to the applicable rules and regulations, and this report is complete a knowledge. Driller CHRISBERNIEF; Registration # 546 Monitoring [M] Supervising Dri Firm SKILLINGS & SONS, IN ; Rig Permit # 20 Date Job Com NOTE: Well Completion Reports must be filed by the registered well driller within 30 days of well completion. '` 'Commonwealth of Massachusetts City/Town of NORTH ANDOVER, MASSACH,_ System Pumping Record s. -Form 4 OCT 12 2006 b. umping Record- �. 1. Date of Pumping Dat -- 2. Quantity Pumped:----_— -- - Gallons Type of system: ❑ Cesspool(s) n/1septic Tank ❑ Tight Tank ❑ Other (describe): (:4. Effluent Tee Filter present? ❑ Yes [lo If yes, was it cleaned? ❑ Yes ❑ No Condition of System: 6. Sy em Pumped By: ams ;<�'j�" & y Vehicle License Number Company �- 7. Location where contents were disposed: Aw -� Si ature ofHau Date http://www.mas§�gov/d-ep/water/aVprovals/t5forms.htm#inspect t5form4.doc- 06/03 System Pumping Record - Page t of DEP has provided this form for use by local Boards of Health. The Sy�ist�mrPump ng Rec��d mJ,, be submitted to the local Board of Health or other approving authority. A. Facility Information - Important: When filling out forms on the . 1. System Location: -q computer, use VFW only the tab key Address - to move your cursor • do not use the return City/Town ., --'- —_— - State - Zip Code key. 2. System Owner: c rAn— Name .___-_.._... Address (,(different from location) Clty/Town CJ� p de /f��{. MI -ell 72W _ Telephone Number b. umping Record- �. 1. Date of Pumping Dat -- 2. Quantity Pumped:----_— -- - Gallons Type of system: ❑ Cesspool(s) n/1septic Tank ❑ Tight Tank ❑ Other (describe): (:4. Effluent Tee Filter present? ❑ Yes [lo If yes, was it cleaned? ❑ Yes ❑ No Condition of System: 6. Sy em Pumped By: ams ;<�'j�" & y Vehicle License Number Company �- 7. Location where contents were disposed: Aw -� Si ature ofHau Date http://www.mas§�gov/d-ep/water/aVprovals/t5forms.htm#inspect t5form4.doc- 06/03 System Pumping Record - Page t of Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. j ,enm Commonwealth of Massachusetts {City/Town of. NORTH ANDOVER, MASSACHUSETTS System Pumping Record Form 4 DEP has provided this form for use by local Boards of Health. The S,ystera -Rumping_Rec_ be submitted to the local Board of Health or other approving authority.1-0°71l+E,--,D A. Facility Information 1. System Location: Address City/Town 2. System Owner: Name —s6!/! Address (if different from location) City/Town B. Pumping Record • 1. Date of Pumping 3. Type of system: ❑ ❑ Other (describe): 117za State MAR 0 3 2006 TOWN OF N( RTH A% DOVER I TH. Zip Code State Zip C de Telephone Number Dat 2. Quantity Pumped. Cesspool(s)Septic Tank /0— 0 Gallons ❑ Tight Tank 4. Effluent Tee Filter present? ❑ Yes ❑ No If yes, was it cleaned? ❑ Yes ❑ No 5. Condition of System: ` 6. S tem Pumped By: 9��:6 dvjwe) Name Company 7. Loc��e�nts�disposed: i Signature of Hauler http://www.mass.gov/dep/water/approvals/t5forms.htm#inspect Vehicle License Number Date i�/46 t5form4.doc• 06/03 System Pumping Record • Page 1 of 1 TOWN OF NORTH ANDOVER BOARD OF HEALTH CERTIFICATE OF COMPLIANCE DATE OF COMPLIANCE: 8/24/98 This is to certify that the individual subsurface disposal system constructed (X ) or repaired ( ) by Tom Sawyer at 56 (Lot 15) Windkist Farm Road 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. Board of Health Inspector COMMON'WEALTH OF MASSACHUSETTS _ Io EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS 'i DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE WINTER STREET. BOSTON MA 0210£ (617) 292-5500 TRUDY CORE Secretan• ARGEO PAUL CELLUCCI DAVID B. STRUHS Governor Commissioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM 4}1 PART A QUV e f2 CERTIFICATION r Property Address: �"' s / Na�me of Owner Address of Owner: Date of Inspection:l - 0 0 a P Name of Inspector: (Ple nrrt) Ed bil 8(J_5� 1 am a DEP approved system inspector pursuant to Secti 15.340 of Title 5 (310 CMR 15.000) Company Name: /C -;- t��n. S �r�-ye/ c- Mailing Address: r — Telephone Number: CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: A Passes Conditionally Passes t _ Needs Further Evaluation By the Local Approving Authority _ Fails /y Inspector's Signature: /^ Date:U" C/ The System Inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within thirty (30) days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. NOTES AND COMMENTS TC _ C' _. i revised 9/2/98 Page tnlll .. ►. • P!,ted or Recy,Ied Papa r o' SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM d PART A CERTIFICATION (continued) "roperty Address: Jwner: , Date of Inspection: �, G INSPECTION SUMMARY: Check A, B, C, or D: A. SYSTEM PASSES: v� I have not found any information which indicates that any of the failure conditions described in 310 CMR 15.303 exist. Any failure criteria not evaluated are indicated below. COMMENTS: B. SYSTEM CONDITIONALLY PASSES: One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Indicate yes, no, or not determined (Y, N, or ND). Describe basis of determination in all instances. If "not determined", explain why not. The septic tank is metal, unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance (attached) indicating that the tank was installed within twenty (20) years prior to the date of the inspection; or the septic tank, whether or not metal, is cracked, structurally unsound, shows substantial infiltration or exfiltration, or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a complying septic tank as approved by the Board of Health. Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. The system will pass inspection if (with approval of the Board of Health). broken pipe(s) are replaced obstruction is removed distribution box is levelled or replaced _ The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass inspection if (with approval of the Board of Health): broken pipe(s) are replaced obstruction is removed revised 9/2/98 Page 2ofll It SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A (/' ' / (^ CERTIFICATION (contirvied) ,, T Property Address: " r"� / ��/�frJ %G//7I "C+' l Owner: Date of Inspection: V h d v 2r�O B C..FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: -70 Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health, safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES IN ACCORDANCE WITH 310 CMR 15.303 (1)(b) THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. v 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, IF ANY) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and 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 soil absorption system and the SAS is within a Zone I of a public water supply well. The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method used to determine distance (approximation not valid). 3) OTHER 1 revised 9/2/98 Page 3of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: Owner: Date of Inspection: D. SYSTEM FAILS: You must indicate either "Yes" or "No" to each of the following: 1 t ji I have determined that one or more of the following failure conditions exist as described in 310 CMR 15.303. The basis for this 777" TrY `! determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No Backup of sewage into facility -or system component due to an overloaded orclogged SAS or cesspool. Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. _ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. Liquid depth in cesspool is less than 6" below'invert or available volume is less than 112 day flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped _. Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone I of a public well. Any portion of a cesspool or privy is within 50 feet of a private water supply well. Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. E. LARGE SYSTEM FAILS: You must indicate either "Yes" or "No" to each of the following: The following criteria apply to large systems in addition to the criteria above: ajThe system serves a facility with a design flow of 10,000 gpd or greater (Large System) and the system is a significant thre1it to public health and safety and the environment because one or more of the following conditions exist: Yes No the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area - IWPA) or a mapped Zone 11 of a public water supply well) The owner or operator of any such system shall upgrade the system in accordance with 310 CMR 15.304(2). Please consult the local regional office of the Department for further information. revised 9/2/98 Page 4ofII SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: !�J l �i� Owner: Date of Inspection: Check if the following have been done: You must indicate either "Yes" or "No" as to each of the following: Y� No _ Pumping information was provided by the owner, occupant, or Board of Health. None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. As built plans have been obtained and examined. Note if they are not available with NIA. The facility or dwelling was inspected for signs of se%ti age'back-up. The system does not receive non -sanitary or industrial waste flow. _ The site was inspected for signs of breakout. revised 9/2/98 Pap. 5of11 All system components, excluding the Soil Absorption System, have been located on the site. J_ The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum. The size and location of the Soil Absorption System on the site has been determined based on: _ Existing information. For example, Plan at B.O.H. _ _ Determined in the field (if any of the failure criteria related to Part C is at issue, approximation of distance is unacceptable) 11 5.302(3)(b)] _ _ The facility owner (and occupants, if different from owner) were provided with information on the proper maintanan".Of SubSurface Disposal Systems. revised 9/2/98 Pap. 5of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION 'roperty Address: Owner: Date of Inspection: /� _ Q L- fi o FLOW CONDITIONS RESIDENTIAL: Design flow: g.p.d./beds?* Number of bedrooms (design): w Number of bedrooms factual):_ Total DESIGN flow ' Number of current residents:_3 Garbage grinder (yes or no):— /� V Laundry (separate system) (yes or no):,�bj If yes, separate inspection required Laundry system inspected (yes or no) Seasonal use (yes or no):4/t Water meter readings, if availpble (last two year's usage (gpd): kl It Sump Pump (yes or no): Lest date of occupancy:_ C C C2( C COMMERCIAL/INDUSTR IA L: Type of establishment: Design flow: gpd 1 Based on 15.203) Basis of design flow Grease trap present: (yes or no)_ Industrial Waste Holding Tank present: (yes or no)_ Non -sanitary waste discharged to the Title 5 system: lyes or no)_ Water meter readings, if available: Last date of occupancy: OTHER: (Describe) Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: System pumped as part of inspection: (yes or no) If yes, volume pumped:gallons ---/^� Reason for pumping: ( l TYPE OF TEM 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) I/A Technology etc. Attach copy of up to date operation and maintenance contract Tight Tank Copy of DEP Approval Other // Avle9edl APPROXIMATE AGE of all components, date installed (if known) and source of information: Y t°y s Sewage odors detected when arriving at the site: lyes or no)_jqV revised 9/2/98 Page 6ofII SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C / fSYSTEM INFORMATION (continued) 'roperty Address: % 1 1'1'9 t `l f �/ / ` / •L / /T� Owner: Date of Inspection: /} l I� 1 v ! r 6ri BUILDING SEWER: (Locate on site plan) Depth below grade: �v Material of construction: cast iron 40 PVC _ other (explain) Distance from private water supply well or suction line Diameter Comments: (condition of joints, venting, evidence of leakage, -etc.) / o /,., T Liao b-'L(r)/ F" SEPTIC TANK:_ (locate on site plan) Depth below grade: / 2,4 4 ' Material of construction: _concrete _metal _Fiberglass _Polyethylene _other(explain) If tank is metal, list age _ Is age confirmed by Certificate of Compliance _ (Yes/No) Dimensions: Sludge depth: Distance from top of sl dge to bottom of outlet tee or baffler Scum thickness: �r Distance from top o scum to top of outlet tee or baffle: i Distance from bottom of scum to bottom of outlet tee or baffle: f 1-/ How dimensions were determined: 12.1-1 � / T C. 'omments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) GREASE TRAP: (locate on site plan) Depth below grade:_ Material of construction: _concrete _metal _Fiberglass _Polyethylene _other(explain) Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of lest pumping: Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) revised 9/2/98 Page 7of11 f SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C / ` ,SYSTEM INFORMATION (continued) ,� 1 'roperty Address: �/ 4%/,7 1 �-1/ s�� f ' A Owner: Date of Inspection: TIGHT OR HOLDING TANK: I 1 ATank must be pumped prior to, or at time of, inspection) (locate on site plan) Depth below grade:_ Material of construction: _concrete _metal _Fiberglass _Polyethylene _other(explain) Dimensions: Capacity: gallons Design flow: gallons/day Alarm present Alarm level: Alarm in working order: Yes _ No Date of previous pumping: Comments: (condition of inlet tee, condition of alarm and float switches, etc.) � S DISTRIBUTION BOX:P (locate on site plan) Depth of liquid level above outlet invert:,Fouj Comments: (note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box, etc.) PUMP CHAMBER:_ (locate on site plan) Pumps in working order: (Yes or No) Alarms in working order (Yes or No) Comments: (note condition of pump chamber, condition of pumps and appurtenances, etc.) revised 9/2/98 Pagv8ofII t SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) 4operty Address: / l S —AP 1V Jwner: Date of Inspection: �� Of SOIL ABSORPTION SYSTEM (SAS):_ (locate on site plan, if possible; excavation not required, location may be approximated by non -intrusive methods) If not located, explain: Type leaching pits, number:_ leaching chambers, number: leaching galleries, number:_ r t' leaching trenches, number, length: leaching fields, number, dimensions: overflow cesspool, number:_ Alternative system: It Name of Technotpgy: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.) CESSPOOLS: _ (locate on site plan) Number and configuration: / r Depth -top of liquid to inlet invert: Depth of solids layer: )epth of scum layer: Oimensions of cesspool: Materials of construction: Indication of groundwater: inflow (cesspool must be pumped as part of inspection) Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) PRIVY: _ (locate on site plan) Materials of construction: Depth of solids: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) revised 9/2/98 Page 9ofII Dimensions: I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM t _ PART C SYSTEM INFORMATION Icontinued) 'roperty Address: /, , / ,/✓ u �� v lwner: Date of Inspection: �} SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent reference landmarks or benchmarks locate all wells within 100' (Locate where public water supply comes into house) N �1 revised 9/2/98 Page 10 of 11 I F SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) operty Address: .. %/ Jwner: / Date of Inspection: /�� f — rQ . A� NRCS Report name _ Soil Type_ Typical depth to groundwater USGS Date website visited Observation Wells checked Groundwater depth: Shallow Moderate Deep SITE EXAM Slope Surface water Check Cellar Shallow wellsi l. Estimated Depth to Groundwater�Gft Feet 1 Please indicate all the methods used to determine High Groundwater Elevation: bteined from Design Plans on record Observed Site (Abutting property, observation hole, basement sump etc.) Determined from local conditions t Checked with local Board of health Checked FEMA Maps Checked pumping records Checked local excavators, installers Used USGS Data Describe how you established the High Groundwater Elevation. (Must be completed) r It revised 9/2/98 page IIofII a Town of North Andover, Massachusetts Form No. 2 NORTN BOARD OF HEALTH O � , w DESIGN APPROVAL FOR ss,C""SE` SOIL ABSORPTION SEWAGE DISPOSAL SYSTEM Applicant Test No. Site Location �� ca �► ►�d,c�a�� Reference Plans and Specs. r--5 ENGINEER 9 a 711P Permission is granted for an individual soil absorption sewage disposal system to be installed in accordance with regulations of Board of Health. d Fee b CHAIRMAN, BOARD OF HEALTH Site System Permit No. Ilk Massachusetts Department of Environmental Protection + Bureau of Resource Protection Lill WELL DRILLER Please specify work performed: Address at well location: :New Well Street-Num ber- Strget Name: 56 IWINDKIST FARM Please specify well type: Building Lot#: Assessor's Map #: Closed Loop Assessor's Lot#: ZIP Code: Number Of Wells: 3 ... .. _ City/Town: Well Location NORTH ANDOVER In public right-of-way: GPS (GPS for the deepest well) Yes CNo� North: West: 42.62675 71.09038 Subdivision/Property/Description: Mailing Address: 14 click here if same as well location address Property Owner: Street Number: Street Name: RAY BALOGH m 56 WINDKIST FARM City/Town: State: Engineering Firm: NORTH ANDOVER MASSACHUSETTS _ ZIP Code: Board of health permit_ obtained: KYe, C- Not Required Permit Number: Date Issued: Massachusetts Department of Environmental Protection j Bureau of Resource Protection - Well Driller Program Well Completion Reports(Geo Thermal) Well Driller - Geothermal DRILLING METHOD Overburden Air Hammer Bedrock IAir Hammer WELL LOG OVERBURDEN LITHOLOGY From To(ft) Code Color Comment Drop in Extra fast or slow Loss or addition of (ft) drill stem drill rate fluid �0 (--- Choose Code. --- Choose Color - ' r Ye EF:asi S!o41 =Lossf-=A'dIM-tion 2f Choose Code Choose Color r Ye {I r si 5ouv �' Loss adrition _j � i__ .,... !� WELL LOG BEDROCK LITHOLOGY ADDITIONAL WELL INFORMATION Date drilling begun 11/9/2011 Date last well drilled 11/15/2011 j Total Well Depth 400 Depth to Bedrock 146 GEOTHERMAL INFORMATION Thermal Conductivity (BTU/hr.ft.°F) Thermal Diffusivity (ft2/day) Formation Water Temperature (°F) DEP UIC # IMAA 31 i10201' I'll_ _._.. .._...... .. ..... ___, CASING F Is Casing above ground? From To Type Thickness Visible Extra From Drop in To(ft) Code Comment Extra fast or slow Loss or addition of Rust Large (ft) drill stem drill rate fluid Staining Chips --- Choose Code YC C �� F^s Slov� css Addition r Ye Yes ADDITIONAL WELL INFORMATION Date drilling begun 11/9/2011 Date last well drilled 11/15/2011 j Total Well Depth 400 Depth to Bedrock 146 GEOTHERMAL INFORMATION Thermal Conductivity (BTU/hr.ft.°F) Thermal Diffusivity (ft2/day) Formation Water Temperature (°F) DEP UIC # IMAA 31 i10201' I'll_ _._.. .._...... .. ..... ___, CASING F Is Casing above ground? From To Type Thickness Diameter i, ilii Choose Type -- Choose Thickness -- 2n sU _- Choose Type -- i hoose Thickness -- 46 4t; Choose Type -- L Cho ose Thickness -- LOOP MATERIAL From To Type Thickness Diameter 400 � � Choose Type --- WATER -BEARING -- WATER-BEARING ZONESr DRYWELI Yield From To -..� -- (gPm) WELL SEAL From To Material 1 Weight Material 2 Weight Water(gal) Batche Method Of Placement _ ,� i r Choose Material ) --- C� hoose Material --- j� i -- Choose Placement -- Ilk Massachusetts Department of Environmental Protection Bureau of Resource Protection — Well Driller Program _ Well Completion Reports(Geo Thermal) i i WATER LEVEL Date Measured Static Depth BGS (ft) Flowing Rate (gpm) COMMENTS WELL DRILLERS STATEMENT This well was drilled or altered under my direct supervision, according to the applicable rules and regulations, and this report is complete a knowledge. -__—_-,,,,.... Driller Registration # Monitoring [M] Supervising Dri Firm_ Rig Permit # �Date Job Com NOTE: Well Completion Reports must be filed by the registered well driller within 30 days of well completion. Massachusetts Department of Environmental Protection Bureau of Resource Protection —Well Driller Program Well Completion Reports(Addendum) WELL DRILLER - ADDENDUM FORM WELL COMPLETION ADDENDUM FORM MONITORING WELLS Well ID GPS Coordinates (WGS 1984) Degree Decimals North: 42.62675 West: 71.09031 North: 42.62677 West: 71.09026 NOTE: Well Completion Reports must be filed by the registered well driller within 30 days of well completion. T-511 1 3'4" 1 y'-0" 1 3-3" 1 13'-1" 1 61-211 C9 w 09 w N w 7 713 w_7N w QO -13 W L.- I .- I ^/\A KoxcTTlne; WINPK15T FAVM5 Of - 15 %u' PAZ: err; �/ 16"-I'-0" 2/ 25/ 98 :1�T TfiL�; i�.'AWN BY; PLJIL-I�Fp OF FINF HOMF-5 F1F5fFLOO1?PI.AN TOW HOOIPFp �/ W d b 6-'011 w a--------------------------- _ < i � 1 LL i I o b I 1 C-) O NZ \ r- �O "-O d 71�S _ 7s 7- i 'j-o W-011 V a 0 N X I 5' 51/4" T-0° 1 4'-(2v fj� n 10�„Qu LAUNn1;Y yl -on Q 0 Int v, b 9 1 0 w QUI. -L - D i� l���"�" r'to>�crnn�: WINPK15f FAP\MS �0f-l55CU�, 11 VAt: err: �/ 16 I 0 2/ 25/ 98 17G�NM BY: � o PuIL r� OF r HOMF-S �T111 ; I� FIN S�CONn �I.00p t'I.AN -�,��� ����� p Jt r-------------- 4 ---,FIR � I p I � I I I i I 1-----------------1 7KI � I b W d b 6-'011 w a--------------------------- _ < i � 1 LL i I o b I 1 C-) O NZ \ r- �O "-O d 71�S _ 7s 7- i 'j-o W-011 V a 0 N X I 5' 51/4" T-0° 1 4'-(2v fj� n 10�„Qu LAUNn1;Y yl -on Q 0 Int v, b 9 1 0 w QUI. -L - D i� l���"�" r'to>�crnn�: WINPK15f FAP\MS �0f-l55CU�, 11 VAt: err: �/ 16 I 0 2/ 25/ 98 17G�NM BY: � o PuIL r� OF r HOMF-S �T111 ; I� FIN S�CONn �I.00p t'I.AN -�,��� ����� p APPLICATION FOR DISPOSAL WORKS CONSTRUCTION PERMIT DATE: 3 t�? — `�'� CURRENT INSTALLER'S LICENSE# LOCATION: / LICENSED INSTALLER: SIGNATURE:_ CHECK ONE: REPAIR: TELEPHONE# NEW CONSTRUCTION: !/ IF NEW CONSTUCTION, PLEASE ATTACH FOUNDATION AS -BUILT. $75.00 Fee Attached? Foundation As -Built? Administrative Use Only Yes No Yes No Floor Plans? Yes �� No Approval C Date: 7 Rib Town of North Andover, Massachusetts Form No. 3 t MORTM BOARD OF HEALTH 44 9 7P 'tGHUS E< yam DISPOSAL WORKS CONSTRUCTION PERMIT • SS Applicant NAME A DRESS Site Location t % TELEPHONE - - Permission is hereby. • 411 granted to Construct or Repair ( ) an Individual Soil Absor tion Sewage Disposal System as shown on the Debi n A p S Approval S.S. No. : ��� •, 7er : CHAIRMAN, BOARD O T� Fee / D.W.C. No. �� c y C � d y C7 CD n Z CA Cl)L "0• r =?o C. :q. y O � 0 v CD CD O CLQ CD Sr CD O CD C CD ra CL v y co CD I S v y10 O CD Z O O 71 O � CD O CD PL s O Oq C 0 d�0 dcm CA »m o o yma� 3, O CV Im - N � .. = 0-00 T maim m C W H P y � O 3E m �a 7 C C O _ : CJ O CO) 0 aOW: =r 5,0 a „� ;�•.. O O W H "m o W CL0 W GO CV CO) `y. Ccr W m m H H Q O CD -CD O � . CIM moo: CD 0 CA w: r n r E \ V� W W .1 C JU W dm: . a=.: -AA nom: 0 "., • 3 �3: 7 o ~" gym: LW O r, z \?�p G ,\, �'1 p ::r- p o w G G 0 o 'O p CA 0 N W r rD M M 0=3 0 9 0 c CD V 5083723960 APG PO1 TOWN OF NORTH ANDOVER SEWAGE DISPOSAL SYSTEM 24STALLATIQN CERT'IF'ICATION The undersigned bacbv certify that the Sewage Disposal System 'eonstrected; i .) repaired-, by �r located at e - - - was installed is cvafo==ce wins tl t North Audovcr Board of Health approved plata. SY stain Dec►ga Permit a !,l, duod�iz 7j P . with an approved design flow of G1 to gallou per dsy. The matalts Used were in cot *M=ce with those specified on the apprvvcd plan, the S s= wan installed i:s'accordance wit** provisions of 310 C?vM 15.000, Title 5 and loeai reguladom and the Baal grading agrees snbssd iany with the approved plmr Ali work is acoaratcly represented ora the As -built which has been submitted to the Board of Health Installer: Design r Lic. Date: , c APR 3 0 TO" OF NORTH ANDOVE?, UA 11 SYS'T'EM PUMPING RECoRL Trico f oVce N0. qlvd )j/) q, DATE OF PUWNQ, NA rVKU OF SeRVICE: KounNe._ SYSTEM LOCATIO C) of _QUANTITY PUMPED: SOP'jc Tank: NU, (s. RECEIVED OUSEAVAMN3: JUN 0 3 2005 OOOD OONVITION .,.....,FULL Tyj COVER KRAVY 0M3B BAES IN PLACL .TOWN OF NORTH ANDOV E R'tom LEACKFIELD KLNBACK..HEALTH DEPARTMENT 5XCUMVE SOLIDS FLOODED SOLID CAKRYO yv-R_OTHER EXPLAIN �Yltvm Pump"d by s- cro eZ?' 177a VUMMENTS. rKANSYbKKB[) I'L) Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. 4:1 �aaxn Commonwealth of Massachusetts City/Town of NORTH ANDOVER, MASSACHU System Pumping Record Form 4 DEP has provided this form for use by local Boards of Health. The System Pumpin�Rebrd must be submitted to the local Board of Health or other approvino-autbortty. / A. Facility Information �MM 2. Syste Name Address (if different from location) City/Town B. Pumping Record 1. Date of Pumping Date OCT - 5 2007 N OF NORTH ANDOVER State Zip Code State 0?, Vit. odee Telephone Number 2. QuantityPumped: Gallons 3. Type of system: ❑ Cesspool(s)Septic Tank ❑ Tight Tank F1 Other (describe): (((���"' 4. Effluent Tee Filter present? ❑ Yes ,fit- No If yes, was it cleaned? ❑ Yes ❑ No 5. Condition o/f�S V 6. Systerp-Rumped By:,,,. Name Company 7. Locaj4gLwheCe-,contents were disposed: Signature of Hauler http://www.mass.gov/dep/water/approvals/t5forms.htm#inspect Vehicle License Number A-11,0 Date t5fonn4.doc• 06/03 System Pumping Record • Page 1 of 1 _ _ r } r t ��+ flr�Jd��J'+•�;1�;,,. _ `� �.:ry 4i•,Cr:;j',%.{!c:f':.•,•', �•.•; ,,.� ly ,r 1, ran•E3 <tt!i;'il t4 COVE d' Recor o1 ,w+y�'!)�,''� )�yy,',llr a y��r,,.::,',,,. ApH o 2a�8 ..� rrl q' �, ,i, rl Ja^!.'•'l., l j l•�' ✓''� j' •'l !!r::,•'' . :I. ,1,(p;r i,ly# y�•'''•'�•�1,�%!i�(�rl��1v1Jv.A,(,• •Jl+r +n,l%;y�:'�V:l'ijf, }; ptar t rlr,'r17,.,! F,',y,,v,wVi;l,?f•, r •' T� OF h i provided �hli form for use b TOWN ry y local Bo rd#VA NO P " be:ubml(�ed to the.local't3oar th a rko aq�l�q �e.� e Pum In Recor . d of Heal or other pp a P 9 c m. A; Faclllty Infor ttlon ,. J,r'fi1,�a-cut ',1;. System Location' Ori y the tab kay to move your :.. yr,.::: l ' ,04/T wn 'r a rotum ,Stac 7� v'','''ly�,y�I���yAll'�i'4'/,�Y:r'i,�:y�1:�ll�i,l �lr�g1 ,.•i, '/�rr'1 "^,'1.(;i�. a .,�•' r uP C�a r.it�i•'.... i•J'fV.,;�`1id�:iL'!•;i.'.Ji�:Qvelen.�/1;r,.,....',�.lir,r! r.i.; � .. 1•I•rj��.i� �iY:H:itl�l�:J,?C,?•3r;r!!8i�ilr:�lG'•,'t ati+l�;�t'l"�ri..�•.: X ���/irvCll� r.,,a!•; N&M# :��. ji•:;''Y.}�yM;71'7!•r.v'1i.r,'.', '!,�':,,'i/Y.,,.r,,�� •.'', �\%ri/C../ � . "Add(aas pldlnerenl from louWn) , i':Gk4rRown Stete ... ,,;•. ,, ,,i�,,',�,,.',.• :1;, 'v� 1,. ZID Code Tolephono Number \7:, :'j �. ;:/'�f:y l%lir ;,; �'••; •. ,4/:;: •. �'' ;,� ; . Pum.ping:.Reg:ord,r, i J',:.',1. .;.,Ir:i%!�5>I�I:IFt:c�'ti" r'i�ir„r fidi4' 6/'`'• D8,0; of Prim q``l�'" pf�.,, Dale 2r QuantltY Pumped: / TYpe pl,oystem; ,r•'' '❑ cesspool(s) 2eptic Tank :•,.,1 �• ❑ Tight lank :,`:.Other(dascllbe1; , .. .', • 'ir'1;�; •'+"H:ti11,1v11;'•*J•ryr�;�+rr�'r.il",:r,�•�,,,rr 4 ,•.r •t„ . . '':"•.,r ;; k., 1, .1i/p,l y:'�i.i'II�;�I�ha,tJ�,.r. .: v• • �1Uent e Yes +Is:l : Y: ,,�:• ,(,p' , ,. ❑ o • If yes, was It cleaned? Yes ❑ rr 5:•r. �y; , , i l , aye i Ir, lr. 1 W • ' ..•.. �i,,. ��.:'�'.�,�tr�;n, 'V 1. Y,�• �,:.. / :''':}:r• r!'Sf�i/!;Pr.�r:611}'lC,o�tOon.Qf.'3 iT�•�,.i.,i:G,: .. ..,.a�.li{•:y.�.�,y,;.%iY�Nitry}+t•�fJ'ri •�r�l•'�i �if Lr.. j,nrti I Jrl:� '}r.l� • r..>.0 ':., •'; r�`;,, Y 6 5i1 :>;i• dl IY,�'1}',;.6'rtj 'i3' 1 • �'''r'"' �7 .. ,, .•1,;y ,. ..r 11•,r��', •'1 \I�� 1. .1� ..I ,fir.:.,.•,\. ' .. '•'r,' ; 1 t: �;N ir'I T1,•� '+1Si'SAti�'Il .�.;,'r�.-•;.!',,; � 6,,,,:Sy ]A,j'm} P,�mped ..;,i.,.•;• at..•<.�'l�Y,tii+�l; 1'1 .i o�!;� ',�j•,���''li;�,, ••, 1 VehICJ f6Nurftb <�i�r>.�r,, r; �:��`�;vJ-�e';1���� ,r�• .�x%• ��fi� '.'f 'ST: e U�can/� er . g3ic't'`in'.il��'r:i7`:` 1 yr�yw'�''� S'I'r II�t111iti'>l•ra,: 1''>' J ' ";,�:;,•�Yr'''/�i�,►"I�!c,• t�f � l'�1','lT'•°{'�, ttl• • �' i�1'' ri�'"(� •- ':r:�;on.Where co !� :: :,::.;,:;'.:y;<;,:,>:�;+�t. •{,.,y;r,<,• :,ln nts µ!ere.dl;iposed: ��\... r,.:., �;.. •,f :i' CI /�,.r' :'IYl'1 y1,11,'/ IjY I' , 1 � b , / ' ' 4: '''. '.r.i r'r ;,.�+, i•;1�'tt. •ei,{ t' i,!. rlbrr. �j',,•� :r: r... r, r ter,; � •' 1' •v4 1 '',�.''..'r'•:%:i.'i(r'r'/l�r�f'�,`•�:�i.:l`.'!•r,;.l(t,';, �r�,':��'�;,;r��r'��l+,rli'.'(.�'�:•�tis::7'�1. i. \' ... 'Yi"•r'•i'l:, l'; +'•',,, u. eii�..'•:� •Ir• ••:)1(�'i. '.Y T ' '', �'.1 ?''111.i7.t``;v:'••iirdl i;�i i r,' r .•e"t t°/J l/'.,'1 ,f .. •:,., .. :Y'. �i=�';',.... .�,,' �Aub . k 4"'� rJ,:;. ''tP•i!.' r.i.41r>;:. .. D `:':� �` i>'%��'3i:��'•�.f�-:��!',i��'? 31pnr<luri of Haub(;j� ;,1/os'Y•,;,.�..it• .. r J•' J�dl+, r •rr � Dole : htt�Jhw�v,massr9oV/deplwa(er/approvaJs/t6(orms,htm#Inspect ' t5fartn4.doa; o6/QJ .. , , ;.. SWIM Pum in D 0 Record Popo ! . . 04/06/1997 15:02 5083736611 STEWART/ANDOVER PAGE 01 !JD,n St gi rg8 S2= um Sffi�iIGL N• r� A nca/.� 47 READ gfpmp r MA 01835 Uwu i L !G1 -op µ 978-372-7471 r -M z,: - s SVr nnctn ar- o73 -7 Cor/ fan lar e, 10 5 Rack,, �raot� t ►� lane, ,6'7 O -A /0h ro(m ane -on tOr- t U RCL �a vcrr7 1G}/�, X35 dond t es 15 Lon ire �TA �Cs dx1el h T� Lcrn enc fODp ho Porn ►j 1Qd m