HomeMy WebLinkAboutMiscellaneous - 63 HAY MEADOW ROAD 4/30/2018 63 HAY MEADOW ROAD -
210/1-04.B-0097-0000.0
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�tLE ��PY
PUBLIC HEALTH DEPARTMENT
Town of North Andover
Community Development Division
CERTIFICATE OF
COMPLIANCE
As of: 6/6/2014
This is to certify that the individual subsurface disposal system received a
SATISFACTORY INSPECTION of the:
Repair of D-Box
By: Todd Bateson
At:
63 Hay Meadow Road
Map 104.B Lot 0097
or Andover, MA 01845
Vichele'lGrant
ce of this rt is t shall no' be construed as a guarantee that the system will function satisfactorily.
Public Health Agent
1600 Osgood Street,North Andover,Massachusetts 01845
Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com
• 5^S'fL'Eb'��6 •
•
North Andover Health Department
Community Development Division
ONSITE WASTEWATER SYSTEM CONSTRUCTION NOTES
LOCATION INFORMATION
ADDRESS: 63 Hay Meadow Rd. MAP: 104.B LOT: 0097
INSTALLER: Todd Bateson
DESIGNER:
PLAN DATE:
BOH APPROVAL DATE ON PLAN:
INSPECTIONS
TANK INSPECTION: D-box 6/6/14
DATE OF BED BOTTOM INSPECTION:
DATE OF FINAL CONSTRUCTION INSPECTION:
DATE OF FINAL GRADE INSPECTION:
SITE CONDITIONS
❑ Contractor reports any changes to design plan
❑ Existing septic tank properly abandoned
❑ Internal plumbing all to one building sewer
❑ Topography not appreciably altered
Comments:
SEPTIC TANK
❑ Building sewer in continuous grade, on
compacted firm base
❑ Cleanouts per plan
❑ Bottom of tank hole has 6 stone base
❑ Weep hole plugged
❑ 1500 gallon tank has been installed
H-10 loading
❑ Monolithic tank construction
❑ Water tightness of tank has been achieved by
visual testing
❑ Inlet tee installed, centered under access port
❑ Outlet tee installed, centered under access port
(gas baffle/effluent filter)
❑ inch cover to within 6" of finish grade
installed over one access port
❑ Hydraulic cement around inlet & outlet
Comments:
PUMP CHAMBER
❑ Bottom of tank hole has 6" stone base
❑ Weep hole plugged
❑ 1500 gallon Pump Chamber installed
❑ H-10 loading
❑ Monolithic tank construction
❑ Inlet tee installed, centered under access port
❑ Pump(s) installed on stable base
❑ Alarm float working
❑ Pump On/Off floats working
❑ Separate on/off floats
❑ Drain hole in pressure line
❑ cover at final grade installed over pump
access port
❑ Water tightness of tank has been achieved by
testing
❑ Hydraulic cement around inlet & outlet
Comments:
CONTROL PANEL
❑ Alarm & Pump are on separate circuits
❑ Alarm sounds when float is tripped
❑ Location of control panel: basement
❑ Alarm signal located inside: basement
Comments:
DISTRIBUTION-BOX
❑ Installed on stable stone base Qx "
[� H-20 D-Box
❑� Inlet tee (if pumped or >0.08'/foot)
0ydraulic cement around inlet & outlets
[^]� Observed even distribution
E Speed levelers provided (not required)
Schedule 40 PVC Pipe
Comments:
Commonwealth of Massachusetts Map-Block-Lot
'q�t�`�'`� _• 104.60097
BOARD OF HEALTH
Permit No
North Andover BHP-2014-0640
FEE
$125.00
-----------------------
DISPOSAL WORKS CONSTRUCTION PERMIT
Permission is hereby granted Todd B-ateson
- - - - -----------------------------------------------------------------------------------------
to(Repair)an Individual Sewage Disposal System. b—bo; -
at No HAY MEADOW ROAD
--63--------------------------------------------------------------------------------------------------------------------------------------
as shown on the application for Disposal Works Construction Permit No. BHP-2014-064 Dated June 02,2014
---- - ----------- - - -
Issued On: Jun-03-2014 Ad�O T
le;
I �
Application for Septic Disposal System
'S
Construction Permit — TOWN OF TODAYDATE
NORTH ANDOVER, MA 01845 $25 00-comRepair
Important: Application is hereby made for a permit to:
When filling out ❑Construct a new on-site sewage disposal system*
forms on the
computer,use ❑ Repair or replace an existing on-site sewage disposal system*
only the tab key I� pair or replace an existing system component—What? Ele
to move your
cursor-do not
use the return A. Facility Information
key.
Address or Lot#
rob R. v
Cityrrmn
I 2--*TYPE OF SEPTI SYSTEM*: SAY 9 2014
➢ ❑ Pump ravity(choose one) TOWN OF NORTH ANDOVER
***If pump system, attach copy of electrical permit to application— I HEALTH DEPARTMENT
➢ E'L,nventional System (pipe and stone system)
➢ ❑ Infiltrator or Biddiffuser(Gravel-Less)(Attach a copy of your certification to install_this type of system.)
➢ ❑ Pressure Distribution S.A.S.(No D-Box)
➢ ❑ Pressure Dosed(D-Box Present)S.A.S.
➢ ❑ Does the system require an effluent filter? Yes No
if yes, does plan specify make and model of filter? YES=(no further info. needed)
NO=(installer must specify brand of filter before DWC issuance)
What is the Make? What is the Model.
2. Owner Information
Name
Address(if different from above)
City/Town State Zip Code
Telephone Number
3. Installer Information
Name Name of Com&WC;ON ENTERPRISES,INC.
R�d, 111 ARGILLA ROAD
Address 01810
City/Town State Zip Code
e Fi5--4703
Telephone Number(Cell Phone#if possible please)
4. Designer Information
Name Name of Company
Address 7 \�
City/Town State Zip Code
Telephone Number(Best#to Reach)
Application for Disposal System Construction Permit-Page 1 of 2
w Application for Septic Disposal System
Construction Permit - TOWN OF TODAY'S DATE
NORTH ANDOVER, MA 01845 $250.00—Full Repair
$125.00-Component
PAGE 2OF2
A. Facility Information continued....
5. Type of Building: esidential Dwelling or❑Commercial
B. Agreement
The undersigned agrees to ensure the construction and maintenance of the afore-described
on-site sewage disposal system in accordance with the provisions of Title 5 of the
Environmental Code, as well as the Local Subsurface Disposal Regulations for the Town of
North Andover. I understand that until a final Certificate of Compliance has been issued by
this Board of ealth, the installed system is not approved.
d-2-/
Name Date
Applicati Approved : (Board of Health Representative)
NZ Date
A kation Disapproved for the following reasons:
For Office Use OniyW�p-.���. — � �_�-,_.�... .�__..�.��.,-_._....-,.�...m.,_._.�. ,.
1. Fee Attached? Yes No
2. Project Manager Obligation Form AtfachedP Yes No
3. Pump System? Ifso,Attach copy ofElectrical Permit Yes No
4. Reviewed approvalletter, all paperwork received.P Yes No
M1SSIng:'
5. Foundation As-Built. (new construction only): Yes_ No
(Same scale as approved plan)
6. Floor Plans?(new construction only): Yes No
Application for Disposal System Construction Permit•Page 2 of 2
j
SEP'xIC SY.S'�EM.INSZ'At:.L- 'RGf E G"I'MANAOfEMENT.OBLIGATIONS
As the North Andover.lic=sed uistaller for the construction for-the septic systetn'for.the prr�perty at
For plans by
(Ad clrest of septic system) (E eer)
Relative to the.application of � N Atid dated
(in'staller's name) U
Dated .s�o�q--1 `7� With revisions dated*
kl-O—CERYS dab;) (Las revise A date)
I understand the following obligations for management of this project:
1. As the installer,I am.obligated to obtain.all per;nits and Board offHealth approved plans. to
;perfortning any work on a site. ;must have,he Vbrovedglans and the permit.on site when any work is
b,Eng done,
2. As tie inS4er;.I must-'call-for-any and in-inspt ctions: I£homeowner,contractor,.project manager,or any
schedules-an inspection and the system is not ready,then
other person not associated with my company
item three-sh4 be applicable.
.`' As•the nst ltr,I atn required to.have.the ptec. ss ry work'tompleted prior;to the.applicable inspectim! as
I irrdgfstand that reaii6t1ngj n jOS2ectig wither;cnm letioit of the ittms in accoYdarice
indicated below�r
Bob= o ' e•beinglevied Qnstmeitid•/or
� el-m�--.- .. . . •• ' : .' ". : :••' •.: '•.• • • . .' . •: . .
a..: Bo'tiotri of3.eti. 'Cneraily,t]iis is the fiCs (1' `ul'speotiom unless.there is a retainin wall,azhch
. : . g
shot�d•be'dtSiiie< rst: The uistall usproq test the ii spec4da but does•hot have to be prtsent.-
b. Vin • :t✓o_ns ttt}.cti'ori.Ifi9pectioti-Eugeer mtis't first clo theifi i�sjecnon for elevations;•ties,etc.
As-bWli of-v.eA?9 OK*(,or e-mail-to: dgp to o 64hando•ver-=ice from the engineer must
be dtibniitied•td.tl2e.Board--of Health,aftet:whi&'mstalter.calls for:iii iiisp'ectipn tune. 'Installer must
be present for d*.inspection, with a pump:System,ail•electrical wotk;musfbe ready and able to
rause puizlp•to arork and alarm".to futition.,
c. din ; installer must request' action whe�i' 11 grading is complt;te., .Installer'does not
have to be•on4ite. ' :
4. As-the installer,•I untie sand that, I tray pedo:m the•caoik(other than jh pk'excavation)and-1 am required
to complete the•installati6n of the system identified in rli •attached applieafign for installation:
gnderstxnd:that work done ►others uiicensedysfems•ia Nnrtli Andover can Eon'stitute
reasons for deival of tht sstern and/.or:lgvocation or siis5 ension o#•mp license•t_o overate in the Town of
North And v�er_siQizif cant fines. allersons.itl'volvetl ire also bible.
5., As the.instyller,rl understand that.I;n�i§t`he on=.sitC during the.perfosmance cf the folowing construction.
steps: :
a: Def�nnirlatiorY that,theproperdlem on ofth'e'ereara on has been reached
b. Inspection ofthe sand snd store-to be used. '
c. FiaW nspectfoa by Bonne(of'ealth staffor consultant.
d Installation,6f tank D-Box pies,stone, vent,primp chamber,retariirrg wall and other .
components.
6. As thg insfal_ler::I uiid rstand that I:am sbldy ressn.ib12 for the installation of the syftem as per the
zpp� p=;,.No instrietims by thehom gtneral contra ,n—r?yyy.o H. r.p rsons absolve
mobe pf this 'Cation.
Undersigned Ucensed ScpticIns.tallet: (Today's
r
.... ... ....'.,,,.. �... • 1. "' lcf.>•v
RECEIVED
Commonwealth of Massachusetts
Title 5 Official Inspection Form LI-1 s 2014
Subsurface Sewage Disposal System Form-Not for Voluntary Assessme t1POWN OF NORTH ANDOVER
HEALTH DEPARTMENT
M 63 Hay Meadow Road
Property Address
Richard Nardella
Owner Owner's Name
information is North Andover MA 01845 6/6/2014
required for
every page. City/Town State Zip Code Date of Inspection
Inspection results must be submitted on this form. Inspection forms may not be altered in any
way. Please see completeness checklist at the end of the form.
Important:
When filling out A. General Information
forms on the
computer, use 1. Inspector:
only the tab key
to move your Neil J. Bateson
cursor-do not
use the return Name of Inspector
key. Bateson Enterprises Inc.
ILEI Company Name
111 Argilla Road
Company Address
Andover MA 0
Citylrown State Zipp Code
978-475-4786 S115
Telephone Number 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 of the time of the inspection. The inspection
was performed based on my training and experience in the proper function and maintenance of on site
sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of
Title 5(310 CMR 15.000).The system:
® Passes ❑ Conditionally Passes ❑ Fails
❑ Needs urther valuation by the Local Approving Authority
6/6/2014
Inspect is Si nature U 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.
t5ins•3/13 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 1 of 17
46
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
63 Hay Meadow Road
Property Address
Richard Nardella
Owner Owner's Name
information is
required for North Andover MA 01845 6/6/2014
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:
® 1 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:
After permit from B.O.H., install new d-box, inspection from B.O.H. , septic system now passes Title5
Inspection.
I
B) System Conditionally Passes:
i
❑ 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.
❑ Y ❑ N ❑ ND (Explain below):
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17
4
Commonwealth of Massachusetts REC 1 WED
s Title 5 Official Inspection Form Ju2
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
i 4
TOWN O+NRTH ANDOVER
' M
63 Hay Meadow Road HEALTH DEPARTMENT
Property Address
Richard Nardella
Owner Owner's Name
information is
required for North Andover MA 01845 5/27/2014
every page. City/Town State Zip Code Date of Inspection
Inspection results must be submitted on this form. Inspection forms may not be altered in any
way. Please see completeness checklist at the end of the form.
Important:
When filling out A. General Information 64
forms on the
computer, use 1. Inspector:
only the tab key
to move your Neil J. Bateson _
cursor-do not Name of Inspector I�
use the return
key. Bateson Enterprises Inc. _
Company Name — — —----
111 Argilla Road
Company Address
Andover MA 01810
01�T� Cityrrown State Zip Code
978-475-4786 SI 15
Telephone Number 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 of the time of the inspection. The inspection
was performed based on my training and experience in the proper function and maintenance of on site
sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of
Title 5 (310 CMR 15.000).The system:
❑ Passes ® Conditionally Passes ❑ Fails
❑
Needs Further Evaluation by the Local Approving Authority
5/27/2014
Inspe tor's Si nature 1 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.
t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17
Commonwealth of Massachusetts
W Title 5 Official -inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
63 Hay Meadow Road
Property Address
Richard Nardella
Owner Owner's Name
information is
required for North Andover MA 01845 5/27/2014
every page. Cityrrown 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.
❑ Y ® N ❑ ND (Explain below):
t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17
Commonwealth of Massachusetts
w
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
63 Hay Meadow Road
Property Address
Richard Nardella
Owner Owner's Name
information is
required for North Andover MA 01845 5/27/2014
every page. City/Town State Zip Code Date of Inspection
B. Certification (cont.)
❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if
pumps/alarms are repaired.
B) System Conditionally Passes (cont.):
❑ 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
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
63 Hay Meadow Road
�M
Property Address
Richard Nardella
Owner Owner's Name
information is
required for North Andover MA 01845 5/27/2014
every page. City/Town 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 fecal
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.
�4-- or !
3. Other: `j /�9 � ,'L
D-Box needs to be replaced.
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
t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
;M 63 Hay Meadow Road
Property Address
Richard Nardella
Owner Owner's Name
information is
required for North Andover MA 01845 5/27/2014
every page. City/Town State Zip Code Date of Inspectioli
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 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
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.
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
M 63 Hay Meadow Road
Property Address
Richard Nardella
Owner Owner's Name
information is
required for North Andover MA 01845 5/27/2014
every page. City/Town 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?
® El available
as built plans of the system obtained and examined? (If they were not
available note as N/A)
® ❑ Was the facility or dwelling inspected for signs of sewage back up?
® ❑ Was the site inspected for signs of break out?
® ❑ 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): 4 Number of bedrooms (actual): 4
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form- Not for Voluntary Assessments
63 Hay Meadow Road
Property Address
Richard Nardella
Owner Owner's Name
information is
required for North Andover MA 01845 5/27/2014
every page. CityTrown State Zip Code Date of Inspection
D. System Information
Description:
Number of current residents: 2
Does residence have a garbage grinder? ® Yes ❑ No
Is laundry on a separate sewage system? (Include laundry system inspection Yes ® No
information in this report.)
Laundry system inspected? ❑ Yes ❑ No
Seasonaluse? ❑ Yes ® No
Water meter readings, if available last 2 ears usage d Yes
9 ( Y 9 (gP ))�
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:
t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
4'M
63 Hay Meadow Road
Property Address
Richard Nardella
Owner Owner's Name
information is
required for North Andover MA 01845 5/27/2014
every page. City/Town 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 2013, owner
Was system pumped as part of the inspection? ® Yes ❑ No
If yes, volume pumped: 1200
gallons
How was quantity pumped determined? Measured tank
Reason for pumping: Inspect tank&tees.
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):
t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
�M
63 Hay Meadow Road
Property Address
Richard Nardella
Owner Owner's Name
information is
required for North Andover MA 01845 5/27/2014
every page. CityTrown State Zip Code Date of Inspection
D. System Information (cont.)
Approximate age of all components, date installed (if known) and source of information:
Tank original, d-box& pits installed 6/16/1986, plan at B.O.H.
Were sewage odors detected when arriving at the site? ❑ Yes ® No
Building Sewer(locate on site plan):
Depth below grade: 2.4
feet
Material of construction:
® cast iron ® 40 PVC ❑ other(explain):
Distance from private water supply well or suction line: feet
Comments(on condition of joints, venting, evidence of leakage, etc.):
4"Cast iron through wall, 3" PVC in house, no leaks visible
Septic Tank (locate on site plan):
Depth below grade: 1.4
feet
I
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
8' x 5'x 4'
Dimensions:
�
Sludge depth: 3..
t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17
f..
Commonwealth of Massachusetts
f Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
63 Hay Meadow Road
Property Address
Richard Nardella
Owner Owner's Name
information is
required for North Andover MA 01845 5/27/2014
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
31"
Scum thickness
1"
Distance from top of scum to top of outlet tee or baffle
8"
Distance from bottom of scum to bottom of outlet tee or baffle
14"
i
i
How were dimensions determined? Tape Measure
Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
Pumped septic tank.lnlet tee ok. Outlet tee ok. Depth at outlet invert. No evidence of leakage.
Center cover has riser to grade in driveway. Outlet cover under hot top driveway. Camera outlet tee
through inlet of d-box.
I
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
t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17
s
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
�^M 63 Hay Meadow Road
Property Address
Richard Nardella
Owner Owner's Name
information is
required for North Andover MA 01845 5/27/2014
every page. City1rown 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:e El 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
t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17
i
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
63 Hay Meadow Road
'9M
Property Address
Richard Nardella
Owner Owner's Name
information is
required for North Andover MA 01845 5/27/2014
every page. City/Town 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 0
Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any
evidence of leakage into or out of box, etc.):
D-box badly corroded, has holes in side. Sand in d-box. No liquid in d-box. Evidence of leakage&
carryover. D-box needs to be replaced.
rY P
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.):
* If pumps or alarms are not in working order, system is a conditional pass.
Soil Absorption System (SAS) (locate on site plan, excavation not required):
If SAS not located, explain why:
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17
Commonwealth of Massachusetts
W Title 5 official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
'9M
63 Hay Meadow Road
Property Address
Richard Nardella
Owner Owner's Name
information is
required for North Andover MA 01845 5/27/2014
every page. Cityf town State Zip Code Date of Inspection
D. System Information (cont.)
Type:
® leaching pits number: 2
❑ leaching chambers number:
❑ leaching galleries number:
❑ leaching trenches number, length:
❑ leaching fields number, dimensions:
❑ 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.):
Soil ok. Vegetation ok. No sign of ponding to surface. Camera inside of pits through outlets in d-box,
no liquid to inverts
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
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System.Page 13 of 17
A
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
63 Hay Meadow Road
Property Address
Richard Nardella
Owner Owner's Name
information is
required for North Andover MA 01845 5/27/2014
every page. City/Town 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 Ian):
Materials of construction:
Dimensions
Depth of solids
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
i
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
63 Hay Meadow Road
�M
Property Address
Richard Nardella
Owner Owner's Name
information is
required for North Andover MA 01845 5/27/2014
every page. City/Town 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:
® .hand-sketch in the area below
❑ drawing attached separately
`
Ar
It
pY��-
I �
I i
t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Fora,
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
M
63 Hay Meadow Road
Property Address
Richard Nardella
Owner Owner's Name
information is
required for North Andover MA 01845 5/27/2014
every page. CitylTown 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: '4
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. 12/9/1976
Date
❑ Observed site (abutting property/observation hole within 150 feet of SAS)
® Checked with local Board of Health -explain:
Design plan
❑ Checked with local excavators, installers- (attach documentation)
❑ Accessed USGS database-explain:
You must describe how you established the high ground water elevation:
Test pit data on old design plan
Before filing this Inspection Report, please see Report Completeness Checklist on next page.
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
;M 63 Hay Meadow Road
Property Address
Richard Nardella
Owner Owner's Name
information is
required for North Andover MA 01845 5/27/2014
every page. City/Town 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
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17
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 LocationPi
/Right ont bf hou e�eft/Right rear of house, Left/right side of house, Left/
Right side of builLeft/Right ro- 5uilding, Left/Right rear of building, Under deck
Address "� � " u� '�� � •— .� � ,- ��,''��
Cityrrown/ State Zip Code
2. System Owner.
Name'
Address(if different from location)
Cityrrown ' State /I Zip Code
F
'7
Telephone Number
B. Pumping Record
1. Date of Pumping Date 2. Quantity Pumped:
Gallons
3. Type of system: ❑ Cesspool(s)
Tight Tank
❑ Other(describe):
4. Effluent Tee Filter present? ❑ Yes 9-110 If yes, was it cleaned? ❑ Yes ❑ No;
5. Condition of System: n ;
6. System Pumped By:
Neil Batesbn F5821
Name Vehicle License Number
Bateson Enterprises Inc
Company
7. Location where contents were disposed:
ISign
S. Lowell Waste WaterC
Haul paw `
t5form4.doc•06/03 System Pumping Record•Page 1 of 1
Summary Record Card generated on 5/12/2014 2:42:33 PM by Maureen McAuley Page 1
Town of North Andover
Tax Map # 210-104.B-0097-0000.0
Parcel Id 16420
63 HAY MEADOW ROAD
NARDELLA, RICHARD
63 HAY MEADOW ROAD
NORTH ANDOVER, MA
01845
Class 101 Single Family Property Type 1 Residential
Zoning2 1 Residential Zoning3 1 Residential
Size Total 1.04 Acres
FY 2014
UB Mailinq Index
Name/Address Type Loan Number Active/Inact. From Until
NARDELLA, RICHARD Payor
63 HAY MEADOW ROAD
NORTH ANDOVER, MA
01845
UB Account Maint.
Account cco t N o Cycle Occupant Name Active/inactive
Y P
Bldg Id. 18096.0-63 HAY MEADOW ROAD Last Billing Date 4/2/2014
3180124 03 Cycle 03 Active
UB Services Maint.
Account No. 3180124
Service Code Rate Charge Multiplier/Users
MISCFEEADMIN FEE 0.635/8 7.82 1/
WTR WATER 01 ALL METER SIZE 45.60 /1
UB Meter Maintenance
Account No. 3180124
Serial No Status Location Brand Type Size YTD Cons
13242296 a Active 00 METE METE w Water 0.63 0.63 1706
Date Reading Code Consumption Posted Date Variance
3/14/2014 2381 aActual 12 4/11/2014 -80%
12/16/2013 2369 a Actual 64 1/17/2014 -69%
9/13/2013 2305 a Actual 198 10/15/2013 234%
6/14/2013 2107 a Actual 56 7/24/2013 426%
3/20/2013 2051 a Actual 12 4/22/2013 -61%
12/13/2012 2039 aActual 27 1/9/2013 -82%
9/19/2012 2012 a Actual 163 10/15/2012 71%
6/18/2012 1849 a Actual 92 7/16/2012 755%
3/20/2012 1757 a Actual 11 4/14/2012 -41%
12/19/2011 1746 aActual 19 1/17/2012 -95%
9/16/2011 1727 a Actual 375 10/13/2011 447%
6/13/2011 1352 a Actual 65 7/20/2011 491%
3/15/2011 1287 a Actual 11 4/13/2011 0%
12/15/2010 1276 a Actual 11 1/12/2011 -91%
9/16/2010 1265 a Actual 126 10/15/2010 202%
6/14/2010 1139 a Actual 39 7/15/2010 220%
3/18/2010 1100 a Actual 13 4/14/2010 3%
12/14/2009 1087 aActual 12 1/12/2010 -80%
9/16/2009 1075 a Actual 65 10/15/2009 -46%
6/10/2009 1010 a Actual 104 7/20/2009 860%
3/18/2009 906 a Actual 12 4/29/2009 17%
12/15/2008 894 aActual 10 1/20/2009 -90%
9/15/2008 884 a Actual 109 10/10/2008 -1%
6/10/2008 775 a Actual 100 7/16/2008 809%
3/14/2008 675 a Actual 11 4/11/2008 -10%
12/17/2007 664 aActual 13 1/22/2008 -74%
9/14/2007 651 a Actual 46 10/12/2007 119%
6/21/2007 605 aActual 24 7/20/2007 -42%
3/16/2007 581 a Actual 40 4/16/2007 232%
LOTS 4, 51 ]_1'`& 12• Tucker Farm
j 242-280 95
NACC hereby finds that the following conditions are
Therefore,the y
necessary,in accordance with the Performance Standards set forth in the regulations, to protect those inter-
ests checked above.! he NACC orders that;ill work shall be performed
in accordance with said conditions and with the Notice of Intent referenced above.To the extent that the lot-.
lowing conditions modify or differ from the plans,specifications or other proposals submitted with the Notice
of Intent, the conditions shall control.
General Conditions :
1. Failure to comply with all conditions stated herein,and with all.relatod statutes and other regulatory meas-
urea,shall be deemed cause to revoke or modify this Order.
2. This Order does not grant any property rights or any exclusive privileges; it does not authorize any Injury'
- -- -
'to private property or invasion of private rights.'
3. 'This Order does not relieve the permittee or any other person of the necessity of complying with ail •'
other applicable federal,state or local statutes.ordinances.by-laws or regulmtlons.
4. Tha work authorized hereunder shall be completed within three years from the date of thts Order unless
either of the following apply:
(a) the work Is a maintenance dredging project,as provided for in the Act;or
(b) the time for completion has been extended to a specified date more than ttIree years,but less than
five years, from the date of Issuance and both that date and the special circumstances warranting
the extended time period are set forth in this Order,
5. This Order may ee extended by the Issuing authority for one or more periods of up-to three years each
upon application to the Issuing authority at least 30 days prior to the expiration date of the Order.
8. Any fill used in connection with this project shall be clean fill,containing no trash,refuse,rubbish or de-
bris, including but not limited to lumber,bricks.-plaster,wire,lath,;,paper.cardboard,pipe, tires,ashes.
refrigerators,motor vehicles or parts of any of the foregoing.
7. No work shall be undertaken until all administrative appeal periods;turn this Order have elapsed or,If ,
such an appeal has been flied,.until all proceedings before the Department have been completed.
8. No work shall be undertaken until the Final Order has been worded in the Registry of Deeds or the Land.1,
• Court for the district 1n which the land is located,within the chain of Atte of the affected property.In the
— case of recorded land, the Final Order shall also be noted in the Registry's Grantor Index under the name t'
of the owner of the land upon which the proposed workis to be doge.In the case of registered land.the
: Final Order shall also be noted on the Lan Certificate of Title of the owner of the Ian N ponOwhicll
the proposed work is to be done.The recording information shall be submitted to,the AC
on the form at the end of this Order prior to commencemept of the work.
_ 9. A sign shall be displayed at the site not less than two square feet or-more than three square feet in size
bearing the words,"Massachusetts Department of Environmental Quality Engineering.
Fie Number 242-280
10.Where the Department of Environmental Quality Engineering is requested to make a determination and
to issue a Superseding Order, the Conservation Commission shall be a party to all.,agency proceedings :
. i
and hearings before the Department. ti
- -
11. Upon completion of the work described herein. the applicant shall forthwith request in writing that a .
Certificate of Compliance be issued stating that the work has been satisfactorily completed.
• 12.The work shall conform to the following plans and special conditions:
. • t. '
5-2 F
L-0 5�
1T
15
� p
Y-.
r
TO: NORTH ANDOVER, MASS ' 36 19 7F
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
#X -bo cti North Andover, Mass.
SITE LOCATION
The grades and construction are as specified in my plans and specifications dated
19
coM�,o2�
5 � F
eg. P irlg. itarian
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7-14 A l;14 J%r
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P�eDPOSED SL/BSURFAGE 5E=WACvE b1SFS4� SYSTEM
,Q�t1D
Aeo oo6ED ZoT alCAD/ti/C,
,SCALE . / =� ATE - �IfI�C
+4 /7 1?77
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TES N � �� �,; �a�` • ,} �' �'
b6S/C,AI DATA =
TYPE OF gale-61414:
GARAGE f( CELLAR PLUMB/A/U FAC/G/T/ES !✓O%'�
SElU,4C6E FLOW EsT/MATE= 6C)O �•.-D t=.
SEPI-IC r4,Vl< /DOD v%L L O,',1
,4BsoeP r/o�v AREA : 900
Q5PERCo6Ar10AJ 767S7S
DATE 12- LZ, ,
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BOTTOM ELEVArioN
\ TESTS CavDaC rED BY J3--c- PA -S &tqQP_.,AtrfttLCi k:�, .
�, TE.STs W17-NESS,-_,D BY
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APP.-?OVTD --DATE DISAPPROVED DATE r-,XCAVATION OK
P -ONG:
F,A
I L 0 K
Dis"aface To:
T�,.,!etlands
Drains
Well
L- 2. 1- ester Line Location
i I e
4. Septic Tank
Tees Length & To Clean Gut Covers
;Pi0 0 Gn Both Sides of Tank
T-
Dis, t1I0trft0-x Le,
Y,
Cover P", Box
All Lines Flo, in- En-,,i.al Amounts
!,To Back Flow
r. Leacq Field or Trench
Di_inens-ions
S' Depth---e Depth
L
Capped Ends
Clean Double 'V,lashed SII.one
7. Leach Pi-'!-,.,;
Dime'asions
Stone Dept h
Splash.,,Pa:dS
Tee,s- '
`ei
-Pit - Both Sides
Pipe to
-�.,-ent Pi1
Cle-an Double V!, sled_ S-11-one
3. No Ga-'-,afre Disposal
Final Tnsi)ect.ion
10. j':)arrac.--- 3in- Co-,.,e--. edSvst-em
C-
11 . As - Built Si'111-J.,iit ted
Lot Loca-(-,-J*-on
D'JT!,1e1Isioi)s of Sys-'Gem
Location -v;ith Regard 1_-.o Pere Test
Elevations
raker Table
r
i
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,old C74ZO�4G� J1SAD.--AG / - - -4- -. x• DA rE
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dIW d ' ✓ �� AND , Pyo E.16
WArER TABLE JILIL-
GocA rioN � 1
20
i1,4 BOTTOM F/FVArlav Is NT
> - ME +�I A D TESTS COAIDUC TED BY : 3o�c P4
` ~�- cR TESTS W/rNEs5E,b BY :
PZ-4,U e 06Ste, Cof
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