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HomeMy WebLinkAboutMiscellaneous - 691 FOREST STREET 4/30/2018 691 FOREST STREET t 210/105.D-0173-0000.0 L �Q.�l.�l� �?.(� ��� � , ,^ .'" I MAP # LOT #__.._ J. ._._.-...._........_.._._...._............._._......_.......... PARCEL # - STREET .. CONSTRUCTI ON._,.APPRO HAS PLAN REVIEW FEE BEEN PAID? YES NO PLAN APPROVAL: DATE ;� .7r APP. BY..."_._...._,............... .___ DESIGNER: /L rcd �1L�1Z� PLAN DfITE !D. ._�._._ CONDITIONS I WATER SUPPLY: TOWN =WELL VGA WELL PERMIT .���J _ DRILLER.-............_...........(...... _.//��.5.....___.. ... .. WELL TESTS: CHEMICAL UA I E f.)I`l-1 RUVED__.......... .__... BACTERIA I Df)JE flf'PRUVEU BACTERIA II DATE APPROVEll COMMENTS: FORM U APPROVAL: APPROVAL TO ISSUE EYES NO / ---DY-- --"- DATE ISSUED_ C���Ulr/a ,�[>C� ............... ....._......... _.... .--- CONDITIONS: - ---..___....---- _....._.._...._......_.. ....._.............................. FINAL APPROVAL: ALL PERMITS PAID ES No WELL CONSTRUCTION APPROVAL YES NO SEPTIC SYSTEM CONSTRUCTION APPROVAL=S YES NO OTHER YES NO ANY VARIANCE NEEDED YES NU FINAL BOARD OF HEALTH APPROVAL: DATE: _ . 13y : /l SEPTI_ E.YS-IEM__ N .T9.4.L.Rt�_QN IS THE INSTALLER LICENSED? NO _._ TYPE. OF CONSTRUCTION: LW [REPAIR NEW CONSTRUCTION: CERTIFIED PLOT PLAN REVIEW YES 1,10 CONDITIONS OF APPROVAL YES NO (FROM FORM U) ISSUANCE OF 'DWC PERMIT YES NO DWC PERMIT NO. C�� INSTALLER: �JS� BEGIN .INSPECTION ES NO: EXCAVATION . INSPECTION: NEEDED: PASSED ZZ BY CONSTRUCTION INSPECTION: NEEDED: AS BUILT PLAN SATISFACTORY: APPROVAL TO BACKFILL: DATE:_ By ------- 1 -� ---- FINAL GRADING APPROVAL: DATE BY� FINAL CONSTRUCTION APPROVAL: DATE:_91114�_BY_� Commonwealth of Massachusetts W Title 5 Official Inspection Form - o Subsurface Sewage Disposal System Form - Not for Voluntary Assessment V 691 Forest Street Property Address Scott& Myla Karpinski Owner Owner's Name information is required for every North Andover MA 01845 _ April 19, 2017 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 forms A. General Information ED on the computer, use only the tab 1. Inspector: key to move your 2 cursor-do not George F. Norrisuse MA VER the return Name of Inspector Of RJMEN key. Dlillill .F. Clark, Inc. 'roH��IDEPA �I Company Name --- - - r 22 Mitchell Road, PO Box 265 Company Address Ipswich MA 01938 City/Town State Zip Code (978)356-5638 S14051 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 kVA r FNS 4119111 Inspector' Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board f Health r oo DEP)within 30 days completing this inspection. If the system has a design flow of Y P 9 P Y 9 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.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10t 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 691 Forest Street Property Address Scott& Myla Karpinski Owner Owner's Name information is North Andover MA 01845 Aril 19 2017 required for every p page. CitylTown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E I 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.doc-rev.6/16 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 691 Forest Street Property Address Scott& Myla Karpinski Owner Owner's Name information is North Andover MA 01845 Aril 19, 2017 required for every _p page. Cityrrown 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.doc•rev.6116 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 691 Forest Street Property Address Scott& Myla Karpinski Owner Owner's Name information is North Andover MA 01845 Aril 19, 2017 required for every p page. Cityrrown 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. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/2 day flow t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 691 Forest Street Property Address Scott& Myla Karpinski Owner Owner's Name information is North Andover MA 01845 Aril 19 2017 required for every p , page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal 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.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 17 Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 691 Forest Street Property Address Scott& Myla Karpinski Owner Owner's Name information is North Andover MA 01845 Ar19 required for every April , 2017 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? ® ❑ Were 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): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 660 t5ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 691 Forest Street Property Address Scott& Myla Karpinski Owner Owner's Name information is North Andover MA 01845 Ar19 required for every April , 2017 page. Cityrrown State Zip Code Date of Inspection D. System Information Description: As per design plan 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 Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage d Well water 9 ( Y 9 (gp ))� Detail: Sump pump? ❑ Yes ® No Last date of occupancy: Currently occupied 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.doc-rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 691 Forest Street Property Address Scott& Myla Karpinski Owner Owner's Name information is North Andover MA 01845 Aril 19, 2017 required for every p 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: According to owner, system was last pumped in October/November 2016 Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form s Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 691 Forest Street Property Address Scott& Myla Karpinski Owner Owner's Name information is North Andover MA 01845 Ar19 required for every April , 2017 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: System as-built is dated July 28, 1992, per Board of Health file. Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 1.33 feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: 14 feet Comments (on condition of joints, venting, evidence of leakage, etc.): Building sewer pipe is in good condition. There are no signs of leakage. Septic Tank(locate on site plan): Depth below grade: .66 feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 5'Wx10' Lx4' D Sludge depth: 1 t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 691 Forest Street Property Address Scott& Myla Karpinski Owner Owner's Name information is North Andover MA 01845 Aril 19 2017 required for every P page. Cityrrown 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 28" Scum thickness 0" Distance from top of scum to top of outlet tee or baffle N/A Distance from bottom of scum to bottom of outlet tee or baffle N/A How were dimensions determined? Tape measure& Sludge Judge Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Inlet and outlet baffles are in place. Liquid level is normal. Pumping is not required at this time. Septic tank is in good condition. 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.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 691 Forest Street Property Address Scott& Myla Karpinski Owner Owner's Name information is North Andover MA 01845 April 19 2017 required for every p , page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 691 Forest Street Property Address Scott& Myla Karpinski Owner Owner's Name information is North Andover MA 01845 Aril 19 2017 required for every P 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.): Distribution box("d-box") is 15" below grade. Distribution is equal. There are no signs of leakage or solids carryover. D-box is in good condition with no signs of corrosion. 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.doc-rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments w„ 691 Forest Street Property Address Scott& Myla Karpinski Owner Owner's Name information is North Andover 'MA 01845 Aril 19, 2017 required for every p page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ® leaching trenches number, length: 4 leach trenches each 63' long ❑ 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 absorption system ("SAS") is under the front lawn. There are no signs of hydraulic failure or ponding. Inspected SAS with inspection camera and found it dry. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts u Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 691 Forest Street Property Address Scott& Myla Karpinski Owner Owner's Name information is North Andover MA 01845 Ar19 required for every April , 2017 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 691 Forest Street Property Address Scott& Myla Karpinski Owner Owner's Name information is North Andover MA 01845 Ar19 required for every April , 2017 page. Cityrrown 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 A-1 =4315" Well to SAS = 101' B-1 = 2958" A-2 =4756" B-2 = 3451" A-3 = 51'3" B-3 = 38'3" A-4 =46'8" B-4 =46'10" •Well Garage Water Porch Sewer A B Septic Tank #1 Inlet cover #2 Center cover #3 Outlet cover #4 Distribution Box sw ich, lll� 14 D.F. CLARK TITLE V SEPTIC SYSTEM PROFESSIONALSf r, 9�8) 35b,56��' t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts _ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments w„ 691 Forest Street Property Address Scott& Myla Karpinski Owner Owners Name information is North Andover MA 01845 Aril 19, 2017 required for every p page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope . ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: 8.25 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: April 10, 1992 Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers- (attach documentation) ❑ Accessed USGS database -explain: You must describe how you established the high ground water elevation: Paul Marchionda performed soil testing on Feburary 28, 1992, groundwater was observed in all four holes: T-9, T-10, and T-12 @ 120", T-11 @ 99". According to design plan the bottom of SAS is 4' above the groundwater in hole T-9. There is no new ground water information on abutting properties. At time of inspection a site exam was made, site is level over system and driveway, grade slopes down along the outer edge of property, no surface water was observed, cellar was dry with no sump pump, and no shallow wells were located. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments w„ •' 691 Forest Street Property Address Scott& Myla Karpinski Owner Owner's Name information is North Andover MA 01845 Ar19 required for every April , 2017 page. Cityrrown 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 15ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 D.F. CLARK D.E CLARK, INC. TITLE V SEPTIC SYSTEM PROFESSIONALS INC. April 26, 2017 Mr. & Mrs. Scott Karpinski 691 Forest Street North Andover, MA 01845 RE: Title 5 Inspection 691 Forest Street,North Andover Dear Scott&Myla: Please find enclosed the Subsurface Sewage Disposal System Inspection Report for the above referenced property. As noted on Part B (Certification) of the report, the system Passes the inspection criteria. This inspection is good for the next two (2) years; you may extend the life of the inspection to three (3) years by having the septic tank pumped annually (before anniversary date of inspection). Thank you for allowing us to be of service to you on this project. Please contact us if you have any questions regarding this matter. Sincerely, D.F. Clark, Inc. Xev-e George F. Norris RECEIVED Title 5 Inspector Mv 0 ?U'17 Enclosure TOWN OF NORTH ANDOVER HEALTH DEPARTMENT cc: vNorth Andover Board of Health D.F. Clark, Inc. file PO Boa 265 24A Mitchell Road Ipswich, MA 01938 978-356-5638 Fax 978-356-5500 Toll Free 888-DF-CLARK 43243 Town of North Andover 5/3/2017 ` 691 Forest Street 50.00 i 1 Checking-institution of 691 Forest Street 50.00 NORTH 7861 Town of North Andover `�'••,,;p:: HEALTH DEPARTMENT ,SSACHUStt CHECK#: q 39?y3 DATE: -1 XA �0/� LOCATION: 6 9/ Fo res 6 H/O NAME: CONTRACTOR NAME: C�/G rt- Type of Permit or License:(Check box) ❑ Animal $ ❑ Body Art Establishment $ ❑ Body Art Practitioner $ ❑ Dumpster $ ❑ Food Service-Type: $ ❑ Funeral Directors $ ❑ Massage Establishment $ ❑ Massage Practice $ ❑ Offal(Septic)Hauler $ ❑ Recreational Camp $ ❑ Sun tanning $ ❑ Swimming Pool $ ❑ Tobacco $ ❑ Trash/Solid Waste Hauler $ ❑ Well Construction $ SEPTIC Systems: ❑ Septic-Soil Testing $ ❑ Septic-Design Approval $ ❑ Septic Disposal Works Construction(DWC) $ ❑ Septic Disposal Works Installers(DWI) $ ❑ Title 5Inspector 55 F $ Title 5 Report $ 50 ❑ Other:(Indicate) $ He gent Initials White-Applicant Yellow-Health Pink-Treasurer '5014A i ii L41' -� • # ,-2 2�Y5 2o Y(o J1 _Ise -� •-3: v° rry- $'•8i".f!b'ii;.+ •,�.y, .. ,. }. .. - 1 .. 1 1• - of ry t--- �„ if Z Y(o -71 ,. �t:�v^.<• ice' :."'+'-�-'''..`prr :y� ar�:�.�•.'.� _ •�} ?:.• �� ... ,,.. 5 S, .LLcc.ff RH rl .w n ARF NSKR RES DDJR . North Andover , 1& soachusetts Carroll Designs ' 1 93109 1-13 LM I EL IlRgEHE� U115 TT-1 IMI CITARAGjE ADD I T I ON t 1 . 1 1 1 _ I 1 t 1 1 1 .1 L fit RONL-ELEVAT ION r - Job No. Dwg Nm Carroll RESIDENTIAL DESIGNER KARPINSKI RESIDENCE Alan Carroll 93109 PABox 1957 Andover.WA 01810-0033 FAX 508-474-9354 Designs ' 508-475-1486 NORTH ANDOVER, MA ° A - 1 SEPT 1993 SH 1 OF t i ® mug EIB ILILIL11 EM LU I I REAR EL VA DN l LEFT FL VATIOR Qrwn Job NM Dwq tim RESIDENTIAL DESIGNER KARPINSKI RESIDENCE Alan Carroll 93109 :; -;- A 2 C a rr o I l pOBox 195,.Andover.mA 01810-0033 FAX 508-474-9354 Oat. ® Desi ns _ -1486 NORTH ANDOVER, MA SEPT 1993 SH 2 of g 508 475 IDECK o 00" 6L(DING ' O - � 1 Ln r � FUTURE fROOM - ATTIC 21311 (0"3 3H 21311 - � L n o � � ATTIC �. cv � O - /-a ton P A '� j . 260" 90..aECOND-FLOOR Carroll 1 ��������1�� ���'���� Draw, Job No. Dugrlo. '• rroKAiRPIN%5KIRE61DENCEa�, c arr0>> 9 3109 F ® PAEox 1951,Andover MA 01810-0033 FAX 508-41¢9354 Designs A -4 508-415-148(o NORTH ANDOVER , MA OCT 1993 15H 4 OF a /3�Oli 1011 �r�nGrco"�� -�ounc�a�to,J fOrrn9 I/f --'- __`L= _ -1�-_ --- = _-� -• _ __ -_- GIGO I! -------------------- ! U _ t 4. 1 , I f � Ir 1 ►. 1 1 1 1 I 1, � f , l � '1 '• t � �• � � ,• _Top of Gcr�cr-G>_-�c 1 ' � o r t ►. I 1 / - 1 l 1 rusts 6106 i 1; 8 �te slabr , •� ; tJ , +• 1 Par J l t O , •• + � I --------- ---------------- ---- ---_ -- :--- --- -------------------1 '• O �Dk 1a + I I , -- ------ dp 1 , --------- _, , 1+ -x1'0 •• 1 Deep , ►. , + f .. � - '• I ------------- GA -----EF f - i Ji All d FI NIS14 C pNS ;+►, + ,f 1 1 Ln CRAWL 850 1 and m led t low, ; 6 O 616• M > 3S 10++ 910 die""h: 4& 6'+x rO De ION PLAR Fo-thg Y r-q'd) D,,%m Job No. Dug No. Carrot l RE51DENTIAL DE51C NEIN KAIRPINSKI fRE51DENCE Alan Carroll 93109 P.OJ3ox tWt Andover.MA 01810-0033 FAX 508-414-9,354 Dal, A .� I��s1g�s NORTH ANDOVER , MA OCT 1993 5H 5 OF . f -1 _ I 1 I 1 I 1 1 I . 1 - I m � ili ' '_ ' ' ii111 II men,.bt J- rs are 2 ELF����� R - FRAMING PLAN Carroll, RESIDENTIAL DESIGNER KARPIN6KIRE61DEN °�°� Job NO. �o. ,pQ ROBox M-L Andover,MA 01810-0033 FAX 50 C E Alan C pro 1 I ' •- - - - - �Li�7 1 i 1:1 8-�-14�935� 9 g 508-4B- NORTHD.{. A -(o 1486 OCT 1993 6H6OF T-rcAtcd 2 x 8 0 16" O-G. t' I fit i II I I I I I it '• ([ I I I II • II I I I II II I I I II II III 11 o mQ3 . 08 i LL - o All wxwbare to be Z x 10 9 16' O.G.(1.N.0) FLOOR FRA Drown Job No. Pug No. Carroll fRESII. ENTIAL [DESIGNER KARPIN5KI RE511DENCE Alai Carroll 9310'9 c PABox 1951,Andover,MA 01810-0033 FAX 508-414-9354 � Designs D� r'r;r�.�� 508-4 -1486 �0 � �� � � , M Oct' 1993 5H I OF f f le-rs � �TYP� '�.. _ I - ► z-Zx/o � . r l I . I All members are 2 x 10 la16" O.G_ (U.N.O_) -ROOF FRAMING PLANkb No. Carroll RE61C ENTIAL DESIGNMR KAP-,,.. PlN5Kl RE61DENCE- Alan Carroll93 103 D es . - PABox t951,dnclovar,MA 018$0-0033 FAX 508-4'1d-9354 p - - I�esic ns Boa-�-t�-��5� NORTH ANDOVER , MA oc �' 1993 5W 8 OF L21-2A xz-2x 6 sal 1. All dimensions arc to-be field vcrTlcd by the Contractor and any 5. All penetrations (Plumbing,Electrlcal,Heating, etc) thru floors shall stap• adjustments made accordingly_ be completely Ft-e Caulked. j 1 x a 3/4' PIwood 2 x 4 -0 16'O.C.00-T) 2. All work shall be completed in compliance- with all applicable Butiding, 6. All walls adjacent to atalrs shall have Fire Blocking installed adjacent W/lIatro° Plumbing,Electrical and any other local,state and/or federal codes to the stringers. ► that may apply to this project shall be considered as part of the 1- Any liability by Carroll Designs either assumed or implied shall be construction documents. limited to the cost of the Design/Drafting Fee for this project only. 6TEP p O W N D ETA IL 3. All waste materials and debris shall be removed and disposed of properly If thaw drawings are copied and used for any project other than that listed in the title block shall remove C&-roll Designs of all 1_tability- s/e' to' 4. All structural materials shall be Vold of any defects that may diminish there capacity to function in an adequate manner. Structural Engineering or any other profeb6ional serviced, that may be required shall be provided by others under separate contract and terms. Rd Beam others? ROOFING CONSTRUCTION f"O1s Rte°Yarrt ROOFING CONSTRUCTION a.phett/ bargla.s Root7ng Cs o"Lhkx R�a vent Butdhg Pripet - is Bu"P argi�Roo" W Pkjuood �t t!!"Piyu°od 2 x 10 a 16'Oz. t: • _ 2x104156O.C. U R30 Fbar91aa•Inwlatfon �7 i'At space(nW 106vvarha lnq SaM FLOOR CONSTRUCTION with t'g 314 Pkzood t 2 X 10 16'O.C. WALL_ CONSTRUCTION 81dtg to ssetch aaci►thg GARAGE Fi isl-1 CONSTR. j` At Bmkrf�°eod All wood eowz=tad welt and Ca0bg 16'O.C. ;2 xG to hive 5/8' 'X'Fl a Rafael Y FLOOR CONSTRUCTION Rn Fber U"ir»ulatton tlal�oard Sea datad above Y•por 6arrbr 5 W DL{.LAIN Cokwm • 3/4' P�'r°Od � ! � � Vz' tlJaltboand 2X8Q16'OZ., j 4'concrete stab 511_L CONSTRUCTION 4'Concrete slab r .61-2x6 PA,I-2x6 KD. C CRAWL onttiuous 811 Geskat Q W DkL x Le Lg.Aeehor Bolts SPACE - 198'0'O.C.(W4 _ --,FOUNPATiON CONSTRUCTION r 4 Concnets bleb 10'concrats Wall/b'O'Pow 10'Dp x r8'w Coat.FootN _ SECTION - THRU GREAT ROOM 5ECTION-THRU GARAG SAI P � NSK S � Alan Carroll Carroll RE51DE�1tiA�.. pE51C�1���2 � � � � �NC� �� 93109 Job NO. Ho. P.OBox 1951,Andover,MA 01810-0033 FAX 508-414 g X-J354 Date- - es fen's ISOS-��t�-148 NORTH ANDOVER , MA OCT 1993 SN 9 OF P} ti FORM U - LOT RELEASE FORM ' INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable or requirements. *****************************APPLICANT FILLS OUT THIS SECTION******* -,* � I-) - 3400 APPLICANT SC too, �5 � PHONE LOCATION: Assessors Map Number /'U.S PARCEL �J SUBDIVISION LOT (S) STREET �ji % �C1�� SIS s- ST. NUMBER *****************************************OFFICIAL USE ONLY*******'************************** ECOMM ATIONS OF TOWN AGENTS: Ck �,/ � %/4' �;i_l-IT CONSERVATION ADMINIJTRATOR DATE APPROVED l `�l 1 DATE,REJECTED COMMENTS �(`'��I� , I %�ls�� �'I fit I/ !> / ';� v iN TOWN PLANNER DATE APPROVED a� DATE REJECTED COMMENTS FOOD INSP OR-HEALTH DATE APPROVED DATE REJECTED J EP EC-Pd—R-HEA&H DATE APPROVED DATE REJECTED COMMENTS PUBLIC WORKS -SEWER/WATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR DATE FORM U - ICT RELEhSE FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable local or state lav, regulations or requirements. ****************Applicant fills out this section***************** APPLICANT: Phone LOCATION: Assessor' s Map 'Number ®J Parcel 7,3 Subdivision Lot(s) `3 Street St. Number C 9/ ************************Official use Only************************ RECO20NDATIONS OF TOWN AGENTS: Date Approved Conser-ration Administrator Data Rejected • Comments Date Anmroved Town Planner Date Rejec-ed Comments Data Approved I M113 lqz. Healtt agent Data Rejected Comments 7- PP/ Y k�7T �'t�}' �'ll� %'6M Public Works - sewer/water connections - driveway pe=it v' Fire Depar me^. Received by Buildina Ins=ec==r Data PLAN REVIEW CHECKLIST ADDRESS ENGINEERrG/7/Oit Clc� GENERAL 3 COPIES STAMP LOCUS L�F SCALEY CONTOURS PROFILE SECTION BENCHMARK Lim ELEVATIONS 1 SOIL & PERC INFO L," WETS. DISCLAIMER WELLS & WETLANDS WATERSHED DISTRICT DRIVEWAY ✓ WATER LINE r`/ DRAINS v RESERVE AREA SCH40 SLOPE SEPTIC TANK MIN 1500G. . 17 INVERT DROP GARB. GRINDER(+200% EDF) 25' TO CELLAR =f/ MANHOLE TO GRADE ELEV GW D-BOX # OUTLETS FIRST 2' LEVEL STATEMENT INLETJ3� 77 - OUTLET/3V1 _ / (21' OR . 17 FT) LEACHING 100' TO WETLANDS ;._- 100' TO WELLS 325' TO SURFACE H2O SUPP 35' TO FND & INTRCPTR DRAINS 4' TO S.H.GW 2% SLOPE ✓ 4' PERM. SOIL BELOW FACILITY ✓ MIN 12" COVER✓ FILL? (25' if above natural elevation; 101if below) TRENCHES MIN 660 FT2 SLOPE (min . 005 or 6"/100' ) ✓ >3' COVER? - VENT SIDEWALL DIST. 2X EFF. W OR D _(MIN 61 ) _-- IS RESERVE BETWEEN TRENCHES? ,- IN FILL? c/ MUST BE 10' MIN.L 2 BOT , jQq X LDNG . - + SIDE � ��� '��' X LDNG J91D� = TOT (L x W x #) (;d-/—ft (DxLx2x#) ��- DATE "/ A? -- Sheet of . BOARD OF HEALTH TOWN OF NORTH ANDOVER SUBSURFACE DISPOSAL DESIGN REVIEW FEE PERMIT # (� DATE RECEIVED APPLICANT o(J � ASSESSOR'S MAP ADDRESS PARCEL # LOT # 13 i/ ENGINEER STREET ADDRESS �526/Vla��� �lfJ>ZPf,I�� v PLAN DATE `T/l��go�- REVISION DATE CONDITIONS OF APPROVAL: APPROVED ,yDISV�AAPPROVED 1V REVIEW CONTINUED SHEET OF DoT � g Z.BZ �Cr�S S� o � z�• � 7 1 r �FQ oQ°�o� SET R AC KS 3fl 30 o Q a Of �f z., , ROBEFU yo P. /�ee�s; L1101 IRIS e. No. 2215.9 �< Q MAT fw IN N 0 o � o o � r ,/00 o O t MATC ' N C SNF A Grp�o<.�G� �� �� ���.►� MARCHIONDA & ASSOC. , INC. �p-�- ENGINEERING AND PLANNING CONSULTANTS For—cs+. S-h-c:c- Nor�b Andoucr-, hc� , STONEHAM, MA. 02180 (617) 438-6121 Sco )�a r p i n , SCALE: 1"='S0° DATE: ID (9 ew r -L x, } r, 4 •- 1 � Y ELEVA ;ONS qT TOP OF PIPE THIS IS TO CONFIRMTHAT HAVE INSPECTED TACE CO'4SYRIJCT ON 0� DWE_L'N0 ELE,.. -.i/h.. SAID DISPOSAL SYSTEM ..CCAiED G"d TA\K IN: j'. w, LIQ LtC T .� ?Gi''"' r •��" TANK OU7: tl_,r,�r to-55 7HE GRAC��r.�;�, yi!atw;� �ti S:51�CC;�iE D-BOX IN: FLANS G�BOX Ol.' .� BY MA10,�' F'` rt `SSOG., NC END OF D S ���-t WaY4 D: ' by,�aW{tCiblisilsstY.rW..l1A.Mf.N:WOIPMI":74A194r. AS-BUILT SEWAGE DISPOSAL MARCHIONDA & ASSOC. , INC, SYSTEM PLAN ENGINEERING AND PLANN;'Nv CONSu�T41NTS 62 MONTVALE AVE., 7 . IN STONEHAM, MA. G:: AS P'' _ -ARED FOR _E; �'irt2,p GATE: 17/7.09?_ t•`t t� ~ f'x A FILE No.: -2,151- 05 ~/��' �• .++•.t.W=:n��4i.VF}MP11nMbYuM 4w N?41uL.w.:IA:M+G'-M•..-a-ua.ur.••,•. _-_— �....arrY_ .Harr._—._..-1_,�,�„y�y►ie.41tU I4�. .. 0 o � J TORROMEO TRUCKING CO. , INC. P.O. BOX 308 33 OLD FERRY ROAD METHUEN, MA 01844 (617) 686-5634 OFFICE (603) 642-5564 PLANT June 19, 1992 Ms. Sandy Star Town of North Andover, MA Main Street North Andover, MA 01845 Subject: Double Washed 1 1/2" Stone Please be advised that Busby Construction Co., Inc. of Atkinson, NH, has purchased Double Washed 1 1/2" Stone from us at our Kingston, NH manufacturing plant• I have enclosed copies of our specifications for this stone for your files. If I may provide any additional information regarding this matter, please do not hesitate to contact me directly at(508)686-5634. Sincerely, TORROMEO TRUCKING CO., INC. Brenda E. Geisler BG/pj Enclosures (2) cc: Busby Const CO. Departm%it of Environmental Management/Division of Water Resources WA _R WELL COMPLETION REPORT WELL LO 1 GEOGRAPHIC DESCRIPTION ddress ' ! N S E 00f all " (circle) City/Town Well owner `_ • e (roadl Address /� N T ` � Of !!I ri.rn enrhs) (c le intersect. w/ �r Board of Health permit: yes no no ❑ oadl e WELL USE. WELL DATA �y 1, Domestic R Public❑ Industrial E] Total well depth ! Q� ft. Monitoring[I Other Depth to bedrock—ft. f Water-bearing rock/unconsolidaled aterlat: Method drilled "• Date drilled `/ Description ..+ Water-bearing z es: r CASING 7 Q 1) From To Type 2) From To Lengthft. Dia(.I.D.)__L in. 3) From To Length 'nto bedrock ft. Gravel pack well: dia. Protective wel seal: Screen: dia. Grout.❑ Other Slott length from_to STATIC WATER LEVEL – Static water level below land surface ft. Date — WELL TEST f Drawdown 400ft. after pumping hr. �S7 min:at gpm /– / Howmeasured—Recovery—/–'( ft. after-3hr. min. 0 LOG of FORMATIONS !COM NTS. `r . Materials From To 4 rDriller Mass. Regi str n 7 7*17Do Firm t Addresj City/Towno I ay Si azure or sioleraK5 reistered w dr er n P/esseprint firmly BOARD OF 114EALTH COPY 1)uAj"I) U1' -111:1\L1-1.1 --- -- ------ --- gg ❑ Nort:h Andover ,Mrls p y4. • , L . • : fil).t Tr APPLICATION FOR WELL & PUMP PC MIT 1_i.cation is hereby made for permit to drill. a well _ Application , is c to install ( ) i purnp :y �Lcm'. :tion : Addre�� O •Lot �� • + r z• r1 c1 cl�-c r8� 12 1_ Contradt 1 cA.r"s y��rt= `Te . lid3:.,88ys-Asa Contractor Address Tel . Q; i CONTRACTOR ( 'I'o be co,npl.ctccl at Lime of pump test ) r _ of Well (�� �, =� -==WcJ_J. used for nctcr of We 1.1 Sizc of Casing o :h of Bed PockC Depth casing Ln•to. B'ed. ,Xoc.k„ c ? To f ) n-iCe. of Te's`t d .._• j 1t $S t t r Seal Tc_, t d Yc �C) _ r _ Well .T;nded in What MaC,e.ri:Aa1 ;.. -.h to WI Ler r Delivers, Cal Per Min . 48�--4— .down f.ce L ti f ter pumping ---hours. it C;PM � j5--. �/Aj of Compl.cLi.on 3' $ Signature WcA Gon,.tcratcuax :�::•C:::. .. .. .. .. .. .. .. .. .. .. .. .... :'i;., .. ., .. ., r. ..:. .. •. .. .. .. .. .. .. ., .. .. •. .. .. .. n .. ...'::•:.. .. .. ..:•.'::'::is n.�-.�..V':..�'..n.n..�*\n9�"`'k.*i�iE•�•A•'k. INSTALLi R ( 'i'o 1:)c f-i.J.Tcd i.n before in:� ta7.lat o �� r &. Narnc rump - - -% _ Pu y c sed �" ''` .� r Purnp Dc1. 1-ver:: Matcri:.11. U.-'(2d i.11 lJc 1. 1- : C;:it.0 l. ron ( ) Gnlvnn zcd ( ) Plastic ...... .. . .... C) 'i- t_l.c:..., sleeve used to proLccL j)i.pc? Yc,, (^) 1\10(-) Type or Name Well Seal ,Y)'r��1'ri'()yY',Ye**)P�4���'ri'r�'r�4t'r�'r.'r1't�'rti'r14isS�:Q�1� �CLtitJ'! :nGrtisD����� , '�'74'141rf;1�1141k1�f.1k llaLer an�� l.ys1 rcporL :ubmiCLccl Lo Boar.<i of ,lical'Lh release given Lo o�•:ner of record & i1,1.clg . Insp Health Inspector- i ' I � lr� Ip -41 ' I I i � I I� I I I \Q I I � i I I � I P I i n i -26 _Q 57/ Ev F`7 Ll CC) d 10 OD ---------- Address /5xL=S % Title of File Page of Date File Open: Date File closed: Doc Document/Action Title Date of Refer to other Purpose of Document/ —on and notes action Document/ document/ Num. Action Department Board of Appeals — Board of Health. — Planniing Board — Conservation Commission — Buiiding Department Town of North Andover, Massachusetts Form No.3 NORTq BOARD OF HEALTH Ot� No ,+ ooL 19 O 9 ♦o�.,«SSR:+� "°••..o�R'`� DISPOSAL WORKS CONSTRUCTION PERMIT �SSACMUSEt Applicant at—Al SA:�A� NAME DDRESS TELEPHONE Site Location tomo- t 3 0— ,[lam Permission is hereby granted to Construct ()�or Repair ( ) an Individual Soil Absorption Sewage Disposal System as shown on the Design Approval S.S. No. CHAIRMAN,BOARD OF HEALTH Fee D.W.C. No. 5to k :1houtemoem oeakeataty, Ane. 66 LITTLETON ROAD WESTFORD, MA 01886 (508) 692.8395 FAX (508) 692.002$ 1.800,649•TEST Report Number: 0-wps-3882 Report Date: ,lune 09, 1992 Client: Sample Taker At: Wilmington Pump Supply Inc. Flintlock P.O. Box 517 Forest St. Wilmington, MA 01887 N. Andover Lot #3 Sample Taken By:Client On: June 08, 1992 CERTIFICATE OF ANALYSIS TEST PARAMETER; EPA Max RESULTS UNITS Total Coliform (P) 0 0 Per 100ml Calcium No Limit 22.4 mg/L Copper (S) 1.3 <0.01 mg/L Iron (fi) 0.3 # 0.42 mg/L Magnesium No Limit 4.7 mg/L Manganese (S) 0,05 # 0.06 mg/L Sodium " 20 21 mg/L Potassium (S) No Limit 3.9'--J 1118/L Alkalinity (S) No Limit 85.5 mg/L Ammonia No Limit <0.03 mg/L Chloride (S) 250 16.9 mg/L Chlorine (total) Not Spec. 0.73 mg/l, Color (S) 15 10 CPU Conductivity No Limit 240 umhos/cm Hardness No Limit 75 mg/f, Nitrates(as N)(P) 10 0.05 Ing/L Ni.tritea(as N) 1 <0.01 mg/L pH (S) 6.5-8.5 7.7 SU Odor (S) 3 3 TON Sulphates (S) 250 14.9 mg/I, Turbidity 5 2,65 NTU Sediment pos/neg neg NT=Not Tested, #=Value Exceeds EPA STA, TNTC=Tao Numerous to Count *=Background Bacteria Noted, "=EPA Advisory Limit `=Exceeds EPA Advisory Limit (P)=Primary EPA Standard, (S)=Secondary EPA Standard (may affect aesthetica of drinking water i.e. taste, color, etc.) This water sample, as tested, is considered SAFE to drink according to EPA guidelines. However, one or more of the parameters exceeds EPA standards as indicated by the (0) sign. �rlson,' for Massachusetts State Certified Mich, e1P. Testing Laboratory #MA048 Thorstensen Laboratory Inc. JUN 10 '92' rt_;: _h P.2/3 1 .,� Deparancnt of Enviroumcntal Mm,agcn,ortt/Division of Watei Resources WATER WELL COMPLETION REPORT WELL L1 GEOGRAPHIC DtiSCRIPTION ! ddccss _7 N S E= 0 of rr City/Town `y _ rru+,l Well owner � Address N R r (nl.r renins! (r r'r' I / I Board of health Permit: t yes nv iurcrsccr. w/ r a,dr WELL USE WELL, DA rA / i Domestic � t ublic Q lnQu:trial 0 Total well deptli '7e If / ft. t�Aanitoring❑ Other Deptlt to udrock� _ ft. r Water•beanng rocklttnconsolidalod material: r Mathod drilled .._. Ucicriptiots j Date drilled Water-bearing: IV � � CASING 1) FromI._ To 7 Type 2) From To t f Lenglh�2_ ft. Diaf.I.U.) _ in. 31 To ' From Lenqth mo bedrock ��� n Gravel pack well: die._, ProtacUvc we seal: . SCree11: die. Gfout.0 Other Slot r length from—to STATIC WATER LEVEL Stade wotar level below land surfaco� ') It, Data WELL TESTI T _ ! Drawdown /`:V tt. atlor pumping I�.�� tttln.At gPttt I How measurcd. -. Recovery alter-ahr.__ min. 0 LOG of FORMATIONS COM NTS ~ , Mual.h From To � DrillcrT J ,2 Mass, Ftogi n�' �O4 Firm Addres � t City/Town ¢ i s n f . � r�Wr.v w er q req rrnnd di l.r l vr..,.vnnr,worry DRILL' R COPY Commonwealth of Massachusetts City/Town of No Andover System Pumping Record Form 4 Q,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 muStbe submitted to ------ the-local-Boar-d..of Health..or_otber approving.authority within 14 da'vs.#rom thepumpirigdate - - accordance with 310 CMR 15.351. i A. Facility Information N�, Important:When TOWN OF NOk i H ANDOVER ' filling out forms 1. System Location: 1 HEALTH DEPARTMENT on the computer, v t/' f6�es use only the tab "li �J key to move your Address cursor-do not No Andover use the return Ma key. City/Town State Zip Code 2. System Owner: r' 1� CA, (Q Name recon Address(if different from location) City/Town _ State Zip Code Telephone Number B. Pumping Record 16kv l 1. Date of`R+ mping Date 2. Quantity Pumped: Gallons 3. Type of system: ❑ Cesspool(s) 0 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: N a—W Vehicle License Number Stewart's Septic Service Company 7. Location where contents were disposed: Stewart's Pre-treatment Plant, 20 So. Mill Bradford, Ma 01835 Sialme-©l-Hamer—"^° Date Sig ture of Receiving Facility Date t5form4.doc•03/06 System Pumping Record•Page 1 of 1 Commonwealth of'Massachusetts %irCity/Town of .Cliff' System Pumping Record Form 4 AN 1 'Zoll DEP has provided this form for use by local Boards of Health. A9�'I'm. ut the information must be substantially the same as that provided h re. check with your local Board of Health to determine the form they use.The Sys m umping 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 xxtmvt an filing out 1. Systern LocAbon: ns on the UQ aputer,use I Fc)(—(2 r the tab key 'Address nova your North Andover ma 01886 soh-do not Cit yfrown State Zip Code the return ' "2: System Owner. Lou Name Address(if different from location) Cityrrown State Zip Code Telephone Number B. Pumping Record _ 1. Date of Pumping12. Quantity Pumped: - lU 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: O (A 6. tame m Pump tame Vehicle License Number Stewart Septic Service Company 7. Location where contents were disposed: Stew Pre treatment Plant 20 So. Mill St Bradford Ma 01835 Signa auler Date Signature of Receiving Facility Date ym4.doc•MU System Pumping Record•Page 1 of 1 691 FOREST STREET 105.D-0173 Parcel Detail Report Printed On:Tue Aug 12,2003 GIS#: 6622 Address: 691 FOREST STREET Scenic Road: No Map: 105.D District: Scenic View: No Block: 0173 Sewer: Private Lot Size(sq.ft.) Scenic River: No Lot: Water: Private Froutage(ft): 143560 Wetlands ? No Zoning: Subdivision Resource Area: land Use: 101 1(Lot IFEMA Flood Zone Comments:. Parcel ID=210/105.D-0173-0000.0 Sale Date=9251992 Cert= Owners of Record Name Mailing Address Record Date Book Page Tax Id KARPINSKI,SCOTT A&MYLA E KARPINSKI 691 FOREST STREET NORTH ANDOVER,MA 01845 03555 0076 210/105.D-0173- 0000.0 Structures Type of Structure Address UseGroup #of Units #of Baths #of Bedrooms Max Occupancy Tax Id 691 FOREST STREET 2 GeoTMS9 2003 Des Lauriers Municipal Solutions,Inc. Page I of 1 l p D L � NS KR RESLl 1UJ�NCJ� Nor th Andover bho sachuset t s 6, --M Carroll Designs 1 93109 oil HI 1 -- Irm IT IM GARAGE ADDI 7[' II ON ' I ® 1 1 - I - 1 . 1 1 Iol i rTn F==� TH . . .offffallilig] Milli - 1 FRONT .--ELEVATION Y - Carroll RESIDENTIAL DESIGNER KARPINSKI RESIDENCE Alan Carroll 93109 ® PABox 1957,Andover,MA 01810-0033 FAX 508-474-9354 Des* igns 508-475-1486 NORTH ANDOVER, MA SEPT 1993 SH 1 OF t" ----------------- rg REAR F FVATIAj Oi� X ! FFT Fl FVATION aJob No. ►+o :.:,. j-;- ® : RESIDENTIAL DESIGNER KARPINSKI RESIDENCE Alan Carroll 93109 Carro PDBox 1957.Andover.)AA01810-03FAX 548-474— ` t• A - 2 Designs NORTH ANDOVER, MA SEPT 1993 SH 2 OF - 41011 - 410 11 DECK o • o71 610" s>_loiNG - � 1 o un 1 r FUTURE ROOM - ATTIC O 1 2131 �1Ci11 21311 O 1 n 1 D-QQ ATTIC i O - J3 1011 /31011 CONK OR PLAN 2610" it 14 !%:�:�' !:��::• Carroll RESIDENTIAL DESIGNER KARPIN6KI Oraw, Job Ho. Dug No. fRE511DENCE Alan Carroll 931 o9 4 i' ® f' P.OBox 19 1 Andover,MA 01810-0033 FAX 508-4'14.9354 :•;•r%'� D Sfg�'18 �OV� 1✓�l�i'V�i NORTH ANDOats DOVER , MA OCT 1993 SH 4 of 1..J. n to <1 n9 `� i J;% ' -i -;•i�-- _ --_ -`-` -- --------1 ------------------ ---- _ , I,; :_- ;r- ;+.►• ; ►. Concr�ste btab on 9rode i r i , 03 /t, 8 Com 8Lb r i -► ; V ; ►' + -. petroof + / "�• , •► , _ by7. / 85 .• t __ _ , . ------ -------- ---------------- () t �1 � r , 1. , •CTS. , _ - - - --__- ------ ', --"U,t,hZ`'b-' Lelry�h„� , •► , U ,I 1 m i �-----------, •► + -------- a 'peep ; , ; ;1 t ►' ►• + Iraq / '� A ; ► ;, ,.n 850 ` ted ------- __ BAWL 5F All to Nood J 5 CONS ; ►• ; i 1_ C /� /�• I (,< <t1I! '� 'o SC's Rand Ca[it� ; '• �+ ; '� - --- r"--L-.r O + / ____ ; �, ; J ►.afad -------------------- t , - ( 1011 -_ ►• / I O 10 I 10 clta — I - ulah Y6'4 rol ION PLAN utiq'� Dr&A Job No. t)u No. KAf;RPlN5KlSII� NC Alan Carroll 93109 i r Carroll fRE61DENTIAL C��51GN P.OBox 1951•Andover.MA 01610-0033 FAX 506-4144 D, . . 508-4 -1406 NORTH ANDOVER , MA OCT 1993 5P 5 OF J • t . r I - t I l oQCIP Z 2x 8 ERAMING-- PLAN 'r�'=r Cam 11 R fES ID EN TIA .. DES IG NEf;R KARFIN6KI Job 90. ows No. RE511DENCE ,flan caroll 93 l09 r; g �g "'ox 1951,A}Fn�^dov,d rr�,MA 001}1810-0/0/33 PAX 5pg..4. -5354 NORTH ANDOVER , MJF 0 1993 5H OF Trratcd 2 x 8 Q ib" O.G. I� FT 1 IIIIIIIII _ it I I 1 II 1 n Il I I 111 o m � og � o — All maribaro to be Z x 10 9 16, O.C.W N.W FLOOR FRA [IAC ' L,� � DraYn Job No. Dug No. Garro l l RESlor=NTIAL DE616NER KARPIN5KI R,,. E5I[DENCE Alan C&To11 93109 r �- 't: � ® PABox t95tiAndovar,MA 01810-0033 FAX 508-4-14-9354 'A NORTHANDOVER MA OCT 1993 5N `1 01= g 508-� -148.6 2- 2Kfa � V 2 - 2x10 09 11 ey I : 2 -2N �ca J 2_2x to a I Z_ZK to I I All members are 2 x 101@ 16" O. ,_ (U.N,O) ROOP FRAMING PLAR Carroll RESIDENTIAL DESIGNER KAIRPIN6KI +' E5IDENCE Alan CarrollJ'SH cj.3 Job ��. 9 3109 P.OBox 1951,Andover,MA 01810-0033 FAX 508-4'{.4-8354 Pots nes gtis 508-415-1486 NOfRTP ANDOVER , MA OCTO1993 S 01= :1-2x 6 sat 1. AI! dimcnslons are to be field vcrificd bg the Contractor and any 5. All penetrations (Plumbing,Electrical,Heating, etca thru floors shall 2 x a 5tap* Pi a adjustments made accordingly. be completelg Fire Caulked. s x0t d 16'O.C.o�.rJ 2_ All work shall be completed in compliance with all applicable Suilding, 6. All walla adjacent to stairs shall have Fire Blockk� installed dd,jacant IU/k""W`°" Plumbing,Electrical and any other local,state and/or federal codes to the stringers. I ' that may apply to this project ehall be considered asart of the p `i. Arxj ilabilitg by Carroll Designs either assumed or implied shall be cortstructlon documents. limited to the cost of the Desigr✓Drafting Fee for this project only. 3. All waste materials and debris shall berl if these draws adre copieand used for any project other than that �� � ���� �� � (�- e removed and disposed of pro p y inglisted in the title block shall remove Carroll Pc5fen5 of all 11abilitg. 4. All structural materials shall be void of any defects that may diminish there capacity to function in an adequate manner. Structural Engineering or any other professional services that may be required shall be provided bg othem under seperate contract and tarns. Rid Baan otharyi ROOFING CONSTRUCTIONCo'ttt"'c"`Ria Vent f ROOFING CONSTRUCTION A�,phaly/ bargla"RoorN ` �P eq*"Roofkg \ Cotthk m Ridge vent d Bu Paper 2x10a16'O.C, tz • 2X10 OAC. t2 Q Ai Spat gn 1nuletSon f At 1' Space(rit, 1'0'0varhs kg Salt FLOOR CONSTRUCTION ; with vadN 3/4'Piynood 2 X 10.0 16'OZ. WALL CONSTRUCTION siding to match extiu g GARAGE FINISH CONSTR. j. At B l&rf aorod Ari Wood cor*Wcted Welk&d Caahg to hwa 5/8't� Y Fka Rated Y FLOOR CONSTRUCTION Rn Fb-r 31a"imulatbn Wlboard t»tai{ed � 3J4' Phpood Sea d � atad above Yapor Bbr 5 i142n D1L Lal1 CoLwm � � � � VY 2X 8Q16'OGv IUaifboand $11 j 4'Concrete slab _L CONSTRUCTION 4'Concrete slab 1- 16 PT,1-2x6 KD. CRAWL ContWous 511 Gaekat W DI&x Le W.Anchor Bolts SPACE 0 8'0'O.c.tW4 _ — --FOUNDATION CONSTRUCTION 4 Cancroto Bleb b'concrsts Wall/bb'Pow b'Dp x 1.8'W Corti.Footixg _ SECTION THRU GREAT R00M &ECTION THRU GARAC� Draw Job No. Ho, Carroll Sin N-r«�. n sj N KARPINSKI RE51DENCE Alan Carroll 13310'3 � P.Omox 1951,Andover,MA 01810-0033 FAX 508-414-9354 q �- NORTH ANDOVER , Dataets508-41 148(o OCT 1993 514 9 Or ly 451 r - 74 N 4--9 r f l / Tye v r ELEV;.TION :i TOP OF PIPE THIS IS To CONFIRM THAT I HAVE ' INSPECTED THE CONS`RI C`10f—_ OF THE uYvEl„LCLL SYSTUil i_0 AT` I K IN: (�a'w, �� LOT ' rt4���"'�� TANK OU T. l'a �'a HE C�'f�V?�J 1�)�� G'A*s";SPCCI IEE IHE � FLANS „ tvr A!IONS DA tF l DI-8,1,)X OU)T� c�,. R'r' MA.Rq'4`ifOiN Ar''gC tiSS C,, INC END OF G15 :;� x� r,1 , t h - D7. 1 �� � (p•� 1 �;��,,s�'� ��' ��' ;a�j:: '^� .fir_ � C: A +lic HIT - nr�ac nwMwe�lxM,w4hb0��A>•F�L a+nwY^-��w-�cS(1L�'�aYK�aY k]rY:tAe1..fY.l'W.11�e.Y:.NALtl�tiv<[wMM@�GM:M4rAfTN{ I 1 AS-BUILT SEWAGE DISPOSAL MARCHIONDA & ASSOC., INC, I SYSTEM PLAN ENGINEERING AND P' ANNlNG CONSULTANTS 62 MONTVA:LE AVE:, S10I-E IId STONEHAM, MA. 0218C- I IN tC:7�.� i 1 i�� G (617) x,36=6121 tX AS P" ARLD FOR � LE: y`tr 7.C., DATE: : k FILE No,, ";l C� �4r . - Tp•�,,,, ...��.,- : : Town of North Andover, Massachusetts Form No. 1 NORTH d BOARD OF HEALTH O� ,SLED 6 m Ap °°° •w,°°�" '` APPLICATION FOR SITE TESTING/INSPECTION 7�ADRATED SSACHUS� Applicant VLA,�1C�C.�Z.. _.t1t �• C3 • ,( -53 (o •�" NAME I ADDRESS TELEPHONE Site Location # A��" ' ,5 E by -P� T SA— Engineer `v 1 Q,-_k:A O Y\ C' NAME ADDRESS TELEPHONE i Test/Inspection Date and Time E pJ CHAIRMAN,BOARD OF HEALTH Fee Test No. S.S. Permit No. D.W.C. No. C.C. Date Plbg. Permit No. t GRAIN SIZE DISTRIBUTION -- AGGREGATE GRA11vU Boring No. : N\A Project : KINGSTON MATERIALS Q.C. All Sample No. L91248A Project No.: 10180.01 MILLER ENGINEERING & TESTING, INC. Tested by FB Location: N\A Date : Fri May 17 1991 Filename L91248A - U.S. STANDARD SIEVE SIZE 4„ 2., 11, o.s ya #10 #20 N4o #6o #100 #200 J400 0 100 10 90 20 80 30 = 70 w w 40 Q r 60 M 50 O_ Z Z 50 U 60� LJ F- 40 70 Q-1 30 0_ 80 20 90 10 100 0 50 10 0.05 0.01 0.005 0.001 1000 500 10o 5 1 0.5 0.1 GRAIN SIZE IN MILLIMETERS GRAVEL SAND SILT OR CLAY COBBLES COARSE FINE COARSE ME-------------- DIUM FINE Remarks Classification ASAP Visual)Description FiaUfe 1 1\2 STONE qri Kay 17 07:45:59 1991 Page 1 GEOTECHNICAL LABORATORY TEST DATA Project : MGSTON MATERIALS Q.C. Fllaname : 1,91248A Project No. : 10180.01 Depth : N\A Elevation : N\A Boring No. N\A Test Date : 5-17-91 Tested by : FB Sample go. :,L91248A Test Method : ASTM Checked by : BC Location : K\A Soil Description : 1 1\2 STONE Remarks : ASAP COARSE SIEVE SET Sieve Sieve Openings Weight Cumulative Percent Mesh Inches Millimeters Retained Weight Retained Finer (lb) ('b) (8) 2" 2.000 50.80 11.70 11.70 100 1.5• 1.500 38.10 12.10 12.10 99 1" 1.000 25.40 28.20 28.60 46 0.751 0.752 19.10 23.50 40.40 9 0.51 0.500 12.70 14.10 42.80 1 0.3751 0.375 9.52 11.80 42.90 1 #4 0.187 4.75 11.80 43.00 1 Total Weight of Sample - 43.2 Tare Weight a 11.7 (• D85 : 34.2585 mm D60 : 28.2309 mm D50 : 26.1280 mm D30 : 22.4286 mm D15 : 20.0092 mm D10 : 19.2622 mm Soil Classification ASTM Group Symbol : N/A ASTM Group Name : N/A AASHM Group Symbol : N/A arcmnn Group Name : N/A fIkN�+i� E �h�N qy i '� + t G � 1 f t I !' " . .� � � • f1 ��1it.•+Jk� lf:'2�i`��i'� �,� # L.._,r ��,P ``'l,'- ,r7 � � ` _.. _ rl.. J'A4`r``` f, 7' +r1�,dr..`7f �iF ,St i+ ,t•�'` 1� L'f !it t r } "h 1• r . 4 �aA• `1 t YI� iai 1 /is yt.fi+ to��,, t ' 1 '•1 ,i' 4 Lt ?Cti:, �R�`j t Jf 1 ! il�" h ty. <,,j3 • , rt t�•. fir, .� ­:, TOWN OF NORTH ANDOVER r t 4 SYSTEM PUMPING RECORD _ a �'t t �T� rT�•�,,r�*r�A,l !"T Sr a .. ,is �Rf•/wd�,kaah fer�>rQS�j j + +:'' .T R ;SXS1'EM OWNER&ADDRESS SYSTEM LOCATION ieft•froot of house) 4V' � �kLiFN 1, r ..,t rig �' � %��%� �+ ,,• r�t'�t11;p 1-W-jrrr�'"tsw.�� �,iay�n..c•4+wi j,`,: +,±; a ». _ h , f ��f � F kjJMING► �/ QUJTITY PUMPED_ GALLONS '� +•r} 7,1 ,� �>rL Y k2 r���yy�,�,x�J,,h t a;Nr Y� �.�I� �J d , YES SEPTIC TANK: NO YES t ��A ^ "i ~* �S�"+�s��i����rt*,i7�S�,�•�ti� fir,5,� i 4 a" 1"�:4, i .:l t � +,�A u .. •. . SERVICE: ROUTINE; '...R, EMERGENCY tri.._.. w 15 '.! t•t GtI � ru• :, _ •�� y w i °���i �dq+� i�'•fjtL,� `CF^ " b`�!r j c _ v �1 L 1'rR , r x r•�� i 'a: 'GOODCONDITION y h '...��j ��]�(���j GREASE. TO COVER ` t ���+ r,• Lrtt�' '�+I:/ii♦ i M4YrK'iVL' .: ^,^„_, . BAFFLES IN PLACE _ ROOTS LEACHFIELDRUNBACK P EXCESSIVE SOLIDS FLOODED SOLIDS CARRYOVER OTHER OWLAIN) ��� 4fi�,�at�•t�l�.,+�a��, Ley. ` rl + , i '. .� }- w �,"i; r J ,fir'�{l+�P :�•�� t , �tI , � ` 1 t �t1+frJS�d7�!,t�i"R� P t , .;"�i��'.�., ^,�,�".dtf�''•.f�F•41a`'� -t ,J r ,r� a t r X 1 ',> s-,i r �. . . •J �. ,•( ��i!�1',.;��ir4rt�tx;l:a$•� 1 .;L �.. i� si••' t , i'3%A'i�,k .,r .. - ti.. Zo� ' ) k 1�p•j R � �4 .��t , ..j� (•h ir1..�1 �1 1. fVJ 1 ' vfY} �(1 Yt'7Yhi'�i4'�.';�f-+ Y,yb' ;,i• // ./ o J Yr - � Y �rr�l�l� ���, Yr� ilr))ir •1C� JV tJalli t �`fllr ,Illc1 lyl ( 1�Z�7V� l �( N' .___ _._. V. Is cof + '{V I�v� (��. �� `'�,(�!\1,� �j r, 1.f In(``�t�tV,i\r� �IL + �I i ^r)''I \ll., •,/�'J V . 1 rel I (�F u ; WANTITY .YS Se('TIC' TANK : rvG -� uKE;oF:S�ft:YLCei ' ROUTINE. .I rUUU,O C,U,NU� I ..I.Q� LL 'TU CUY f I FZ,U,0-T ,1.{<< ` ' I „ l FaCHFIC!D Zvr; ll� r `,::CXC:SSSI�Y� �9:�1•IQS :,�.' F1;0,0.DEDl � ----- Sn IIQI�, ,CRY�YR �'I Q`�f� (1 � I\ - Yy4 r T_ "U.2 k'11' rt`� �i' � / / 1 , / r I_,^ � b u� I I % FCi 1.l;'NQ I.vI