HomeMy WebLinkAboutMiscellaneous - 585 BOXFORD STREET 4/30/2018 585 BOXFORO STREET
210/105.0-00040000.0
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PAGE II STEWART'S SEPTIC TANK SERVICE (CONT'D)
04-22-96 A 31 STONE CLEAVE ROAD 1,800
201 BRADFORD STREET 11000
04-23-96 585 BOX FORD STREET 1,500 HEAVY
A 175 GREAT POND ROAD 2,000
04-24-96 1615 OSGOOD STREET 500 FLOODED
.A 122 OLYMPIC LANE 1,500
A 1116 SALEM STREET 750
04-25-96 A 75 FORREST STREET 11000
04-26-96 550 BOSTON STREET 2,000 2-1,000 TANKS
04-27-96 A 1015 JOHNSON STREET 11000
175 FOREST STREET 11000
350 SHARPNER'S POND. ROAD 1,500
04-29-96 A 18 STEVENS STREET 1,250
A 100 FOREST STREET 11500
A 82 PADDOCK LANE 11500
04-30-96 A 133 SUMMER STREET 11000
A 347 HILLSIDE ROAD 11000
r
TOWN OFNOUH ANDOVER
SYSTEM PUMPING RECORD
DATE eC= G o�bQ 3 ,
SYSTEM OWNER&ADDRESS SYSTEM LOCATION
l�0 Q h
D �rorc�S
N Q.Nde)v er, ma .
DATE OF PUMPING___JA 72 -3 QUANTITY PUMPED fSOy
D.
CESSPOOL NO �= a YDS SEPTIC TANK NO
YES-g
NATURE OF SERVICE; ,R.Qi,1TINE ' :V EMERGENCY
OBSERVATIONS:
GOOD CONDITION_ FULL TO COVER
OOT$GREASE _ BAFFLES IN LACE
LEACHMELD RUNBACK
EXCESSIVE SOLIDS •FLOODED
.SOLID CARRYOVER OTHER EXPLAIN
SYSTEM PUMPED BY
COMMENTS:
CONTENTS TRANSFERRED TO CxiC� JJ
Address
Title of File
Page of
Date File Open: Date file closed:
Doc Document/Action Title Date of Refer to other Purpose of Documernt/Action and notes
action Document/ document/
Num. Action Department
Board of Appeals - Board of Health - Planning Board - Conservation Commission - Building Department
t� G.
WELL DATABASE �>r
ADDRESS:
AGE OF WELL:—(1� WELL DRILLER:CJ, q n
WELL PERMIT T:7 WELL LOCATION:
WCL L PERMIT DATE: l 7" DEPTH OF WELL:
TYPE OF WELL: . DRILLED b. DUG c. UNKj".', -
TYPE.OF WATERBEARLNC ROCK_
WATER ANALYSIS•DATE 3-iZ 9-7/ _
7 HIGH GA�iESE: Y _
s _ -
E MMON Y OTHER CONTAMINANTS: Y N -
WELL DATABASE
ADDRESS: GJ ��
AGE OF WE ., WELL DRILLER:
.WELL PERMIT R: WELL\DU-Gc.
WELL PERtiIIT DATE, ELL:
TYPE OF W�'I.L: a. DRILLED b. UL4 OWN
TYPE OF WATER BEARING ROCK:
WATER ANALYSIS DATE: HIGH MANGANESE: Y N
HIGH IRON: Y N OTHER CONTAINS ANTS: Y N
c
BUAKI) UC ryiAuin
' Town of North Andover,Mass .
Permit # Date : may 1719 88
'APPLICATION FOR WELL & PUMP PERMIT
Application is hereby made ' for permit to drill a well (xx) • Application is
made to install (_) a pump system.
Location: Address Boxford Road, North Andover,- Mass. Lot # 4A . . . .
Owner Maurice Brancato Address68 Cambridge St , Methllpn,MA .Tel .
We 11 Contractor Charles M.Rollins Co.,Inc. A cl d r e s s 129 Depot Read, Boxford, Miss. T e 1 ..887-Z320
Pump Contractor Address Tel . .
WELL CONTRACTOR (To be completed at time of pump test ) X
Type of Well Drilled Well used for Domestic
Diameter of Well 6" Size of. Casing 6„
Depth of Bed Rock 24' Depth casing into Bed Rock 46 , .
Was Seal Tested? Yes (_) No (—) Date. of Testing
Depth 605'- Well Ended in Wha-t. Material Rock
Depth to Water 7' Delivers 81, Gals . Per Min. for 4 hours
Drawdown feet after pumping _hours- at GPM
Date of Completion � �-
Signature Well Contractor
`4 JC iFkn t,!"J"!_!_iC!"!•J•i."''"n iii'C''h%i.%C�n .n..nr.nn .... r.n.... . .. .........ClCnn .n..n nnni.i.i. ..nrini.i.nn n:C'�'n'�.Jit�.'.�•JC*
PUMP INSTALLER (To be-• f•illed in- before installation)
Size & Name Pump :_-_ _ �_: _ ' Pump Type Used
Water Pump Delivers GPM Size of .Tank
Pipe Material Used in Well : Cast Iron (_) CnI.. vnni.zed (_) Plastic (J
Well Pit ( ) or Pitless ,Adaptdr (�)
Was sleeve used to protect pipe? Yes (�) NO(_) 'Type or Name Well Seal
Date
Tj
u:naC1I ?.t� fi. �rr�r,rr,a�r
• �r��tJ��M'��t�M*►M*�t�FtiY�F�4tia�44r�Mti4�r�rti4�ti4tiM�r►4�4ti4�4ti4�M�4i4�'r►�rti4t'rti'rt�t�'rti4Yt,';;c;'-.,,c,csc,c,,..,. ..;;:c.:.:,, .r, , , ,
Date Water analy.si's repor-t• submitted to Board of Ireal'th _
Date release given tD owner of record & Bldg. Insp
Health Inspector
P-0413D of
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FINAL (
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RU4L , APPIRDVA .
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rQ, BISHop
71
_j� >n +t j �a Cil i b EL
AS - BUILT PLAN wl�i�
OF -1"r-I F_� T-0 LAI �''f -,'L� ,T=4
SYST' A �SUBSURFACE DISPOSAL �
LOCATED IN `
AUDOVER HAS S.
AS PREPARED FOR '
B6 B
DATE: qc�0"
SCALE:
MERRIMACK ENGINEERING SERVICES, INC.
PROFESSIONAL ENGINEERS * LAND SURVEYORS • PLANNERS
66 PARK STREET 0 ANDOVER. MASSACHUSETTS 01810 4 TEL, (617) 475.3553, 373-5M1
` TOWN OF NORTH AI`IPOVER/
BOARD OFF' ;1 /
commonwealth of Massachusetts ,
MAY .1..pq�
Executive Offifceof,Envirohl-he taL Affa1 s
Enver®n, eWd1 . Prot Oction
i
Wg11amT.Weld. Trudy.Coxe
6oerrior .8sustary
Ar4ao Paul Celluccl : David B.Struhs
LL Gompor Commbraor+•r
SUBSURFACE SEWAGE DISPOSAL"STEM INSPECTION FOAM
..PART A
CERTIFICATION . .
Property Addreae 13c31!F � S (Ief' . Address of Owner. .
Rate of Inspection: 4// ��fj f g(�, (If different)
Name of Inspaoton Benjamin C. Osgood Jr.
Company Name,Address and Telephone Number: New.England. Engineering Services, Inc.
33 Walker Road, North Andover, . Ma 01845
CERTIFICATION STATEMENT Tel. 508-686-1768 .. Fax. 50.8-685-1099
I certify t6t,l!have personally izispected the,sewage disposal system apt this addreas and that the information reported below is true,accurate
and complete as of the tune of inspection. The inspection was perforated based on my tr&,Wng and experience in the proper function and
maintenance of on-site sewage disposal systems.-The system
Passes
Conditionally Passes
_ Needs Further-Evaluation By the Local Approving Authority
Fails
Inspector'a Signature; �. Data: �9(,
The System Ii speetor shall submit aA2ny.fhisinspection port to.the Approving Authority,within thirty(30)days.-of completing this
inspection: df the system is a shared system or has'a destgn:flow of 10,000 gpd or;greater,the inopector and the system'owner shall submit the .
report:to the appropriate regional office of the'Department'of Env ironmental.Protection.
The original should be sent to the system.owner and copies sent to the buyer, if applicable and the,approving authority.
INSPECTION SUMMARY:
Check A, B,C, or A:
A) SYSTEM PASSES,
I have not found any information which ind.lcatas that the system violates any of the failure criteria as defined in 310 CMR 15.303.
Any.failure criteria not evaluated are indicated below.
81 SYSTEM.CONDITIONALLY PASSES;
One of znvre.system components need to be`replaced or repaired.. Tlie;system,upon completion of tha replacement or repair,pass ,x
inspection. "
lndicate yes,.no or not determined(Y, N, or NA), Describe basis of determination in all izwtancee: If."not de.termlued",explain why not)
The mptie'tank is metal,cracked; structurally unsound;shows substantial in3lltrati6ti or exfiltration,.or tank failure is
.imminent. The system will pass inspection if the existing septic tank is replaced with a ponforming septic tank as apprcwed
by the Board'of Health.
(revised 11/03/95) 1
One Winter Street • Boyton,Massachusetts 02108. o FAX(617)656-10,49 a Tolophone(617)292.5540
CIP PfiwW on Rn KIK Paper
SUBSURFACE SEWAGE:DISP08AL SYSTEM;.INSPEC.TIO
N [FORM
RTA ..
CERTIFICArTiON(/oopq.
tfnuod)
#'roPerEY 01F1�
0wtter.
Date of Inapaotion:
:,B) SYSTEM CONDITIONALLY I'AssE9:(wutiaued)
Sewage backup or breakout or high static water lc+vel o3aerved iri thedistributio>�boz,ic due to broken.or obetrttcied pipe( )
or due to a broken u
settled or sieven distribution T
box he system will pass iisapeccion.tf(with approval.of the Board of
Healtth)
broken pipes)are replaced
obetru t ie'ramoved:.
• " distribution box is levelledor rsplaced
The syswm regtured pumping more than four times',a Year,due to broken or obstructed pipe(s). .The system will peas
iaepection if-(with approval.'of the,Board of Health),
broken i (s)are relaced .'
obstruction;is removedJ.'
CI FURTHER EVALUATIOTd.I9°REQUIRED:BY THRBOARD OP HEALTHi
Conditions exist which mquue further,evaluation,by the Board of"Health in order.to;determine if the systezp is fail{ag to protect the
public health safety-and;the.enAronznent.;
I) : BYSTEM WILL'PABS:UNLE88 BOARD OF HEALTH DETERMINES THAt'.T I~'8X9TF.M IS,IVOT FUiVCTIONIN(I INA.
MANNER'FRiCH WILI PROTECT THE PUBLIC HEARTH AND BAPETY"AND THE ENVIRONMENT.
Cesspool or privy is within 50 feet of a.surface water.
Cesspool or:privy is within 50 feet of a bordering vegetated4etland or a salt marsh..
2)' SYSTEM R?TLT:FAIL UNLESS T$E BOARD OFEALTH (AND.PUBLIC WATER SUPPLIER, IF APPROPRIATE)
DETERMINE$ THAT THE SYSTEM IS'FUNCTIONING IN A MANNER•THAT PROTECT•THE PUBLIC.HEALTH A" .
T
SAI?'ETY AND THE ENVIRONMEN,,..
The system has a septic tank and soil absorption system and is'within l00 feet to a surface water supply artributary to a
surfacewater supply
The system has aseptic tank and soil absorption system abd.is within a Zone I of.a public water supply well.
The system
his
eeptio tank and.soil abaorption-system and.is within 50 feet of a private water.supply well.
The"system has a septiq tank and soil absorption system andleaa.than 100.feet bur60 feet or,'more flrom a private water
supply well,uiiless a well water aaalysu for col force bacteiia and volatile organic compounds indicates that the:well is free . .
from pollution from thatfaoihty and thepieaence of ammonia nitrogen and nitrate aitrogea is equsl to or less than b ppm.:
S), 'OTHER f
(rev Ised,11/03%95)
J.
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSF'FC1"tON FORM
•PART A '- I
te,
CERTTFIQATION (oontlnaed)'
Property Address: J 8 O xC) .S�� t�0 `"
Owner
` Date of.[napeotion:
Ul SYSTEM'AILS,
j have deteraunets'that the(system vtolates oae or more of.the-,foUowinB 6a ure cslteria as defined in 910 CMR 16;308 'The`baaie for
:;than determiiiatioa 13.40
below The.Board of N4tb should 1�e'contaated;to determine what wiU be necessary to co
rrect the
'failure..,
Backup of sewage into facility or:system component due to'an'overloaded or clogged SAS.or oeRapooL
Discharge or ponduig of effluent to the surface of the ground.or surface waters;due to an overloaded or clogged SA3 or
cesspool.
Static ligtud level in the dastnbutlon box above outlet invert due to an overloaded or clogged SAS or cesspool
Liquid depth.in cesspool is less than 6'below iaverG or,available volume is lees than 1/2 day Aow•
Required pumping more than 4 iimes in the last year NOT due to clogged or.obstructed pipe(sl
Number of tunes pumped;
s
Ay:nportion of the Soil Absorption System'cesspooi or privy is below the high groundwater elevation...
-.. rtaon of.a cesspool or privy,to mtlun 100 feet of a surface water supply:ar tribuCesy to'a surface water suPP1Y
Pa
Any portion of'a cesspool or privy is vnthin a Zone,I of a pubho well:
Any portion of a cesspool or prsvy is within 50 feetof a Private water supply:well,
Any.portion of a cesspool or}privy is less than 100,feet but greater than 60 feet from'a private water supply well.with no,
acceptable water quality anal sib.;if the well has been analyzed to 66-acceptabls, attach copy of well water ai►e)ysaa for
coUforta bacteria,volatile orgEuuc couipounde •ammonia nStrogeaand nitrate,nttrogen,
El LARGE SYSTEM FAILS
The.foUowing cetera apply to large systems Ln addition to_the criteria above
The vystam serves a facility with a des>ga►'Aow of J'0,000rgpd or greater(Large System}an the rysteast is a significant threat to.publae
health sad safety snd'the environment'because osis or more of the foUowang conditi ca'exist:
the systesa is within 400 feet of a surface:dru>latxg water supply
—,� the irys0em ie.:withia a
200 feat of a trbutary t9 :surface drinldn8 water suPP1Y
the,syfiem is located in a nitrogen sensitive ares,lInterun 9JeUhoad Protection Area(IWPA)or a ntieipped Zone II of a public
water;attPP 1 y well)
The owner or'opeiator of any such system,shall bring the reystem and facility into full compliance with the groundwater treatment,program
uirements of 314.,CMR 5,00 wid 6,00:' Please consult the local regionalreqofllce of the Department for further inFortaation.
<revi;sed :11/03195)
9
a `
}
_ .T
9tBSLWACE:SEWAGE DISPOSAL,:SYSTEM`INSPECTION FORM
PART B
CHECKLIST.
Proporty Addiosa ...�'g5 . Xol'p
Owner S`I Ga CL-':
Data of Inapeotion
e-719 �
Check if'thel6Uo,wi4g have been'doa
Pumping information-was requested of the owner,ocmpaizt, and Board of Health 1
__'None of the.system components hava.been pumped for et least two weeks end the:system:has been receiving normal flow rates
during that period Large volumes cf water have;not We n,introduced into the eystez recently or as part of this inspection.
1
'AAs biult plans have been obtained aam
nd'exined. Note if they are,not available with N(A.
The facility or dwelling was inspected for aigna'of pewage back up.
The eygtem does not receive no.n sanitary or industrial waste flow
.`. .: ;.
y'The':site was inspected fore igns of breakout.
✓All ovwm.components excluding the Soll Absorption System, have been.located.on the site.
' The septic.tank manholes were uncovered, opened,and the interior of the septic tank was inspected for condition of ba8les or
T material of couAr=lou,dimensions;depth cf liquid,depth of sludge;depth of'a';=.
` The size and,,loco of the Soil Akisorption Syetem,on the site has been determined based on existing inforcnaeion or
f .�aPpiozitnated°by noti:iiztrusIve methods,'
✓The'faczlity owner(and occupants, if different from owned were'pzrovided with lnformation,on the proper maiatenauce of.Sub
Surfue,Dispoaal System,
(revised 11/.03/95). 4
9zv r� �
SUBSURFACE SEWAGE DISPOSAL:9YSTEM.INSPECTION FORM
j PART C _
r
*STEM INFORMATION
Property Address SBS k"
n46 S�t �Jd .►wt+1 c o(1C'�'t'
�:Dato of.Inapeotion:
l 5 l4)
FLOW CONDITIONS
' RESIDENTIAL
Design slow ons ,:' ,
;`Number of bedrooms
Number of cursout residents,;�`
Garbage.gnndar. (pes or to)
I.sundry_commecu to system(yea or no). ,
Seasonal use(yes or no ./(/ ,J /
Water meter readings iS Avatlahle C�lz G G ocy cAY�p Q/u' S� f'iL
Last date of oocupancy: ielZ!!/
COMI1�EItCIAL/INDUBTRIALi . ,
Type of establishment
,Doeigiialow,_,__,gallons/day .
Gr :,trap'present:'(yes or.no).
Industrial Waste Holding Tank p'resent:;(ves or no)____
Non sanitary waste dLecharged,to the Ti IQ 5 system;"(yes or no)_ '.
Watier,ineter;readings, if available: .
Last date of,occupancy;
}
01'SER: (Aescribe)
L st date of oociipancy
G ENE RAL':I NFO RM ATI O N
PUMPING RECORDS and source of Wormation
�
System Pumped,as.part'otanspectioa. (yea.or nq) < .
If yea,volume pumped. /J (R?�,�aUons
Reason.for"P=pmg 4-1 `r_G' '.4�:ffyl�OvK G'/L..=
.Septic'tanlc/distribution,box/soil;`absorptiou syetein
s. .�oeas. :P09
Overilow cssepool
Prtvy,
Sbsrgd'ayRtem. (yea or.no)" (if yes,:attach;previoui inspection records,tf any7.:
Other(explain) ,.,
APPROXIMATE"ACiE of all components:date installed(if lmown):aad source of information;
Sewago odors detected when arriving at the 81w:(yea or no)
:{rev.ised 11/93Y95>
kt��•'N
SUBSURFACE SEWAGE DISPOSAL SYSTEM iNSPECTION FORM
ow
'-PART G•,
9Y9TEM,I NFO"RKATION-(ooa iia uod)
ProportyAddroax g5 :. dXO�fl. OVEN
Owoer: r G l2:
-Date of Iaapeotlon!
PTIG'TANK.
(locate on grte plea) _ ,
,Depth be'"low giada
Material of.'canetfuetion:^concrete.metal FILP, other(explain)
Dimeneions. P x .' .r:
Sludge
Distance"from top of sludge to bottom of outlet tee or bafTle:, :
Scion thYcknesat ,,,�
"Distance:from top of south to top of outlet tee or baffle:
Distance from.bgttom":of scum to;bottom of,outlet tee`ar baf#le;
Comments:
(recommendation for puniputg,condition of inlet;and outlet gees or baffles,depth of liquid level iii,-relation t0 outlet.invert",Rtructtiral-integrity,
evideuce';:of leakage
etc) n G �o r ,': cl C Q. o
QRW E"TRAP;�
;(locate`on s
lie".per)
Depth below grade
77—
Material of crnaetructioa::' concrete;„_,metal FRP mother(mplain)
77
j.
Dunanaions
Scum thu]mes�
DtRtance from,top of ecum-to top of outletaee oribaftle
Distance from bottom 9f 8=to bottom of outlet toe"or baffle:
Comments,,
(recommendation forpumpiag,condition of inlet anis outlet teen or baMis, depth of liquid level•in relation to outlet Inver structural integrity;
evidence of leakage,etc.)
_ I ,
(revi"sed 11/03/95) 6
a
� r
SUBSURFACE Sgyv. QE DISPOSAL BXBTEM INB,PEt7TiON FORM
9YSTEM`INFO
RMATION(ooat`iriugd)
PropertyAddreea TS$S ao.XFo eio 1f0./
Owner. G�� :
DaQ a of Inapaotlon:
TIGHT.OR.HOLDINQ TANK:
(locate oa site:pian) , . . .
Depth below grade:
Materiel of cc?ietructioa: wacrete Imetal FRP_other(explai3t)
Dimensions•
Capacity . ' ;_gallons
De!xign flow
Aicvm
leveli
Coniznenta
(ooluati6r of ialat tee,Wo&tion oi alaxra:ond-float erntcheeto)
DISTRTBiTMON BOX ,
(locate on site plan)
Depth bf hquid level above outlet invert: Q
(notcri leve!and distnbution is equal evidence sohds carryover,;evideace of.leakage:into or out of box, etc) `
'BN C I?u 5 O it 7"•�r <-�'w iC'..'Q/j -/"�Uw- .
PUMP;CHAI4SBER: .. ,
tlocste on site.plaa)
Fumps is working order;(yes or no)
Co
mmettts
(note-co to of pump_chamber;condition of pumps and appurtenances,etc.)':'
(revs"sed 11/03/95): 7
f
�w-
SUBSURFACE-SEWAGE DISPOSAL SYSTEM INSPECTION FORM
SYSTEM.INFORMATIO,N (ooatinuod).
Property Addre+s . 5� .� XFOiPQ � lffp
Owner. :
r.
Dawl o1 Inapootion: SING
SOIL ABSORPTION SYSTEM(SAS)
(locate on axis`plan if poas�bie ezcavation,not required bube
t a roximated
pP by son-iatruslve methods)
If notdetertnined;'to be present,"ezpla�n, ; 1, 4
Type
leaching pita,nuruberi
aeaching'clsambere, number
eaclung galleries;aumben,,,;,,,,_
l built:trenches,ntnnber leagth
leac2uug;Selds;•pumber;.diaeaaioba:
overtYow;ceaspool;number.;. ?
Cbmmeata (note aoadituau oC soil signs-.0th ydraulic 8a:lure,level of ponding,conditioA of vegetation,eta)
�L `L rc z h�..: �! r t3�i`:Q o re:.
cEs�hooLs .
(locate on site plan)
Number and configuration: .
Depth top.of liquid to inlet invert:
.Depth of golida••layer. . ,, . ..
Depth of;scum layer:
Dimen ions'of cesspool:
Mateaals;of constiuctwn
Indieation�of groundwater- '
inflow(cesspool iuust be pumped aa`part of inspection)
Comments: (note conditioa'of soil,signs of kydraullc we"level of ponding,condition of vegetation
PATVY:
(locate-on site plan)
Materialof construction Dimensions:
Depth of solids.:
Conunents: (note condition of soil, signs of hydraulic failure,:level of ponding,condition otr vegetation,:etc.)
sed
(revi1... .
1103/..4S> g
i
tel
:
SLMSURFACE.SEWAGE DISPOSAL SYSTXMINSPECTION I+ORM
$Y9TEM INFORMATION(oontinuod)�
Property AddMe W: S 0x Fo lek��� lV �K'a4V(^Z.r� k 4r
Dato of Inspmotiow. 'lv
' IR �al�O
SJMMH OF SEWAGEDISPOSALSYSTEM
uzclude ties to at ieast two permanent refereaces dmarka'or benclunarke
to,all weiis'wtthin 10(1'•
m
a
j.
DEPTH TO GROUNDWATER '
Depth td groundwater b feat j,
zpotl►od,of determinatwn-qr approsu: tiop: L? c'y q` v.�..s' d! e-� {^49 p S tyW
r---- --
trevtsed 11(03/95) 9
:
/.v�cn �s�G�s
�N � �� � � �
CAMERON-BISHOP
t(NANCIAL SERVICES, INC. tSai IJLJ(J�
! Lakeside Office Park LETTER
WAKEFIELD, MA 01880
(617) 24644 D`79—0733 Date
VVV Subject
l�,r;% 5`/3
.y
Fllv'o Z41yrtIr Roe 7/)/(E
/ f £_ S%G/G� Cl7IJiN CTEV U T
O� Div FU rc/9 L
SIGNED
[IPlease reply No reply necessary
1_ .
S/0'39 ZO �' p�1 op ,2 6 0- -40
1Z Iz
'10 It
7AL
1 /�4' ��---- -�_ , S• ill I ,
� - o I � a• -a S 32• � / �
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" 10302 ¢` PLAN OF REV/SED DISPOSAL SYSTEM
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STEVENS ANALYTICAL LABORATORIES, INC.
38 Montvale Avenue, Stoneham, MA 02180, (617) 438-6114
FAX (617) 438-0173
LABORATORY NUMBER: 12372 SAMPLE DATE: 3/22/91
DATE RECEIVED: 3/22/91
SUBMITTED BY: ROBERT & LAUREN SEGEE
31 PATRIOT STREET
N. ANDOVER, MA 01845
COLLECTED BY: CLIENT
SAMPLE SOURCE: 585 BOXFORD STREET
N. ANDOVER, MA 01845
REFERENCES: 1) STANDARD METHODS - FOR THE EXAMINATION OF WATER
AND WASTEWATER, 16TH EDITION, 1985.
2) METHODS FOR CHEMICAL ANALYSIS OF WATER AND WASTES
EPA/600/4-79-020, REVISED MARCH 1983 .
PARAMETER CONCENTRATION
Total Coliform 0 per 100 ml
pH 8. 06
Chlorides <5. 0 mg/l
Hardness 7. 3 mg/l
Manganese <0. 01 mg/l
Sodium 48 mg/l
Iron 0.046 mg/l
Nitrate <0. 1 mg/l
Nitrite <0.01 mg/l
COMMENT: The results of these analyses meet the required federal
and state standards for drinking water. However, the
sodium concentration exceeds the recommended
Massachusetts standard of 20 mg/1. If you are on a
sodium restricted diet or have a problem with high blood
pressure, I recommend you keep in mind the sodium
concentration.
Water quality can vary significantly from time to time
due to various local conditions. It is advisable to
have your water tested every six to twelve months to
determine any change in water quality.
Authorized by:
Alan P. Stevens, Laboratory Director
Commonwealth of Massachusetts
City/Town of NO. ANDOVER NOV 12 Q1z
TOWN OF NORTH ANDOVER
a System Pumping Record HEALTH DEPARTMENT
Form 4
M
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 within 14 days from the pumping date in
accordance with 310 CMR 15.351.
A. Facility Information
Important:
When filling out 1. System Location:
forms on the
computer,use 585 BOXFORD ST.
only the tab key Address
to move your NO.ANDOVER MA 01845
cursor-do not City/Town State Zip Code
use the return
key. 2 System Owner:
tab CHARLES BROGAN
Name
Address(if different from location)
CitylTown State Zip Code
Telephone Number
B. Pumping Record
1. Date of Pumping 10/20/12 2. Quantity Pumped: 1500
Date Gallons
3. Type of system: ❑ Cesspool(s) ® Septic Tank ❑ Tight Tank ❑ Grease Trap
❑ Other(describe):
4. Effluent Tee Filter present? ❑ Yes ® No If yes,was it cleaned? ❑ Yes ❑ No
5. Condition of System:
6. System Pumped By:
JAMES H. CURRIER H79 406
Name Vehicle License Number
J's SEPTIC&DRAIN
Company
7. Location where contents were disposed:
GLSD
10/20/12
Signature of Hauler Date
Signature of Receiving Facility Date
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