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Miscellaneous - 815 JOHNSON STREET 4/30/2018 (4)
r ; 00 '�I a U ] (n ',b '. CA0 Oa ' ::, r 'i n� (D rt Lot & Street �L,�_CA J6/W5015) c5 - Map/Parcel CONS'T'RUCTION APPROVAL Has plan review fee been paid: __ YES NO Permit# /0/06 Plan Approval: Date: 7 / Approved by:_�/� Designer: ( �IJ�e55f� Plan Date: Conditions: NO Water Supply: Town._ _ _. ____ ._. We1L. Well Permit: -.Driller: Well Tests: Chemical Date Approved Bacteria I Date -'Approved Bacteria H Date Approved Plumbing Sign -Off: Wiring Sign -Off: Comments: NO Septic System Construction Approval? YES NO Form "U" Approval: Approval to -Issue: YES Date Issued By: Conditions: - NO Final Approval: ..All Permits Paid? YES NO Well Construction Approval? YES NO Septic System Construction Approval? YES NO Certification? YES NO Other \ YES NO Any Variance Needed? YES NO FINAL BOARD OF HEALTH APPROVAL: DATE: APPROVED BY: -o -t p I-• SEPTIC SYSTEM INSTALLATION f Is the installer licensed? Type of Construction: New Construction: - ._Certified Plot Plan Review —Floor Plan Review - Conditions of Approval from Form U _Issuance ofDWC permit: — _DWC Permit Paid? DWCPermit # Installer —.----- . r.Begin-Inspection:- -Excavation Inspection: —Needed. _Passed: By: —Construction Inspection: Needed` !, a YES Na_ PAIR YES NO YES NO YES Nn As -Built -Plan Satisfactory: 11117 YES': -- Approval of Backfill: Da te. By; ---Final Grading Approval: Date: By: Final Construction Approval: Date: By: Certificate of Compliance: Approval: Date: r Owner information is required for every page. Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key Its Commonwealth of Massachusetts Title 5 Official Inspection Form 815 Johnson William and Sheryl Appleton Owner's Name North Andover Cityrrown 2 UDDer Unit - Not for Voluntary Assessments MA 01845 State Zip Code 6-14-12 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. A. Genera! Information 1. Inspector: Benjamin C. Osgood, Jr. Name of Inspector none -- Company Name 1R Hillside Avenue_ Unit 3 —. Company Address Amesbury City/Town 978-834-6585 Telephone Number B. Certification MA State 870 License Number 01913 Zip Code 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 1 _ 6-17-12 _ nspect s Signature Date The system inspectr 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. Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Foran Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 815 Johnson Street SYSTEM 2 Upper Unit _ Property Address William and Sheryl Appleton Owner's Name North Andover MA 01845 6-14-12 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: ® 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. 0 Y ❑ N ❑ ND (Explain below): Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 815 Johnson Street SYSTEM 2 Upper Unit Property Address William and Sheryl Appleton Owner owner's Name information is North Andover MA 01845 6-14-12 required for every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) 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 ❑ obstruction is removed ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ Y ❑ N ❑ ND (Explain below): ❑ 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 �Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Y 815 Johnson Street SYSTEM 2 Upper Unit Property Address William and Sheryl Appleton_— Owner Owner's Name Information is North Andover MA 01845 6-14-12 required for every 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 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 ❑ 0 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 . Corhmonwealth of Massachusetts v Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 815 Johnson Street SYSTEM 2 Upper Unit _ Property Address William and Sheryl Appleton _ Owner owners Name information is required for North Andover MA 01845 6-14-12 every 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. ' Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 815 Johnson Street SYSTEM 2 Upper Unit Property Address William and Sheryl Appleton Owner Owner's Name information is required for North Andover MA 01845 6-14-12 every page. Cityrrown 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 NIA) ® ❑ 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): 2 Number of bedrooms (actual): 1 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x # of bedrooms): 220 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments '( 815 Johnson Street SYSTEM 2 Upper Unit Property Address William and Sheryl Appleton _ Owner Owners Name information is North Andover MA 01845 6-14-12 required for every page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: Does residence have a garbage grinder? Is laundry on a separate sewage system? [if yes separate inspection required] Laundry system inspected? Seasonaluse? Water meter readings, if available (last 2 years usage (gpd)): Detail: Sump pump? Last date of occupancy: CommerciaUlndustrial Flow Conditions: Type of Establishment: Design flow (based on 310 CMR 15.203): Basis of design flow (seats/persons/sq.ft., etc.): Grease trap present? Industrial waste holding tank present? Non -sanitary waste discharged to the Title 5 system? Water meter readings, if available: Gallons per day (gpd) ® Yes ❑ No ❑ Yes ® No ❑ Yes ® No ❑ Yes ® No ® Yes ❑ No current Date ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 815 Johnson Street SYSTEM 2 Upper Unit Property Address William and Sheryl Appleton _ Owner Owner's Name information is required for North Andover MA 01845 6-14-12 every page. Cityrrown 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 summer 7-14-10 per BOH records 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): PUMP Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 815 Johnson Street SYSTEM 2 Upper Unit Property Address William and Sheryl Appleton Owner Owners Name information is required for North Andover MA 01845 6-14-12 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: Built Seot 1999 Per As Built Were sewage odors detected when arriving at the site? Building Sewer (locate on site plan): Depth below grade: Material of construction: ❑ cast iron ® 40 PVC ❑ other (explain): ❑ Yes ® No 1.5' feet Distance from private water supply well or suction line: NIA feet Comments (on condition of joints, venting, evidence of leakage, etc.): Pioe looks good in basement Septic Tank (locate on site plan): Depth below grade: Material of construction: ® concrete ❑ metal 4" El 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: 1500 gallons (combo pump) Sludge depth: 1" Commonwealth of Massachusetts REMMM Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Tt s 815 Johnson Street SYSTEM 2 Upper Unit Property Address William and Sheryl Appleton Owner Owner's Name information is required for North Andover MA 01845 6-14-12 — every page. City/Town 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 Scum thickness 1" Distance from top of scum to top of outlet tee or baffle 5" Distance from bottom of scum to bottom of outlet tee or baffle 11" How were dimensions determined? measure tape Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank in good condition. Sch 40 PVC tee in 000d condition Grease Trap (locate on site pian): Depth below grade: Material of construction: ❑ concrete ❑ metal Dimensions: Scum thickness feet ❑ fiberglass ❑ polyethylene ❑ other (explain): 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 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 815 Johnson Street SYSTEM 2 Upper Unit Property Address William and Sheryl Appleton Owner owner's Name information is North Andover MA 01845 6-14-12 required for _ every page. Citylrown 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 Dimensions: Capacity: Design Flow: Alarm present: Alarm level: Date of last pumping: ❑ fiberglass ❑ polyethylene ❑ other (explain): gallons gallons per day ❑ Yes ❑ No Alarm in working order: ❑ Yes ❑ No Date Comments (condition of alarm and float switches, etc.): "Attach copy of current pumping contract (required). Is copy attached? ❑ Yes ❑ No Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 815 Johnson Street SYSTEM 2 Upper Unit Property Address William and Sheryl Appleton Owner's Name North Andover MA 01845 6-14-12 Citylrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box (if present must be opened) (locate on site pian): Depth of liquid level above outlet invert a 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 in OK condition. Distribution normal. No evidence of leakage in or out. No solids carryover. Pump Chamber (locate on site plan): Pumps in working order: ® Yes ❑ No Alarms in working order: ED Yes ❑ No Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Pump and pump chamber appear to be in good working order Soil Absorption System (SAS) (locate on site pian, excavation not required): If SAS not located, explain why: • Commonwealth of Massachusetts Title 5 Official Inspection Form t Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 815 Johnson Street SYSTEM 2 Upper Unit Property Address William and Sheryl Appleton Owner owner's Name information is required for North Andover MA 01845 6-14-12 every page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: - ❑ leaching trenches number, length: ® leaching fields 1 10' x 50' 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.): Area of field is grass and looks normal. No evidence of ponding, damp soil, or unusual vegetation 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 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 815 Johnson Street SYSTEM 2 Upper Unit _ Property Address William and Sheryl Appleton Owner Owner's Name information is required for North Andover MA 01845 6-14-12 every page. citylrown 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.): Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 815 Johnson Street SYSTEM 2 Upper Unit Property Address William and Sheryl Appleton Owner Owner's Name information is North Andover MA 01845 6-14-12 required for 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 n drawing attached separately Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 815 Johnson Street SYSTEM 2 Upper Unit Property Address William and Sheryl Appleton Owner Owner's Name information is required for North Andover MA 01845 6-14-12 every page. City/Town 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: 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: System built 4 feet above estimated seasonal high ground water Before filing this Inspection Report, please see Report Completeness Checklist on next page, Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 815 Johnson Street SYSTEM 2 UDDer Unit ProPedy+ Mftss William and Sheryl Appleton Owners Name North Andover MA 01845 6-14-12 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 -,+ llhtr.�'i.- '€arsxrf r k �7� APPLICATION FOR DISPOSAL WORKS CONSTRUCTION PERMIT DATE: CURRENT INSTALLER'S LICENSE# LOCATION: -:3-/–< _��,, co 5- — LICENSED INSTALLER: SIONATURK;;,—Z��.4�;7 TELEPHONE# CHECK ONE:/ REPAIR. v NEW CONSTRUCTION: IF NEW CONSTUCTION, PLEASE ATTACH FOUNDATION AS -BUILT. 575.00 Fee Attached? Foundation As -Built? Administrative Use Only Yes ✓ No Yes No Floor Plans? Yes No Approval ZO 2/1/2 Date-. /z)/Zz� 07 HEALTH CC r10 aim Town of North Andover NORTH OFFICE OF COMMUNITY DEVELOPMENT AND SERVICES ° h p 27 Charles Street North Andover, Massachusetts 01845 WILLIAM J. SCOTT SSACHusE Director (978) 688-9531 Fax (978) 688-9542 July 1, 1999 - Bill Dufresne New England Engineering 33 Walker Road, Suite 23 No. Andover, MA 01845 Re: 815A Johnson Streett No. Andover, MA 01845 Dear Bill: This is to inform you that the proposed septic system plans for the site referenced above have been approved for a maximum of five (5) rooms. If you have any questions, please do not hesitate to call the Board of Health Office at 978- 688-9540. Sincerely, Sandra Starr, R.S. Health Administrator S S/smc cc: William Appleton File BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 Jun -25-99 09:35A Paul D. Turbide, PE/PLS 508-465-0313 p_O4 June 25, 1999 Sandra Starr North Andover Board of Health Administrator Office of Community Development and Services 30 School St. North Andover, MA 01845 RE: Title V second review for 815 Johnson Street Dear Sandra, I find that the revisions made to the plan dated June 15, 1999 have adequately addressed my concerns outlined in my report dated April 14, 1999. There are however a few minor drafting errors that should be changed (I do not need to review the plans again if these minor drafting errors are corrected.) 4,"C5 The "Pump & Tank Detail' still shows a 6" compacted gravel base. This should be changed to a 6" stone base. L,- Under "Design Calculations", the design per rate was drafted on the plan incorrectly as 10 mpi (it should be 25 mpi). The calculations correctly used 25 mpi. �o In the plan view, the vent pipe was inadvertently left off (it was shown on the initial design plan). If you have any questions or comments please feel free to contact me. Sincerely Carlton A. Brown, PE/PLS Johnson815b.doc PORT ENGINEERING Civil Engineers & Land Surveyors One Harris Street Newburyport, MA 01950 (978)465-8594 MERRIMACK ENGINEERING SERVICES INC. Engineers • Surveyors • Planners 66 Park Street ANDOVER, MASSACHUSETTS 01810 (508) 475-3555 / /�%Fax (508)475--1448 TO A1Ji1%`j %ItMZ WE ARE SENDING YOU ❑ Shop drawings ❑ Copy of letter ❑ Attached ❑ Under separate cover via ❑ Prints ❑ Plans ❑ Change order ❑ [Alfful9n OLS LJ UMLJI UU L1L IL DAT& C� q JOB NO. ATTENTION RE: 5 ❑ Samples the following items: ❑ Specifications COPIES DATE NO. DESCRIPTION THESE ARE NS1VIITTED as checked below: TRA For approval ❑ Approved as submitted ❑ Resubmit ❑ For your use ❑ As requested ❑ For review and comment ❑ Approved as noted ❑ Returned for corrections ■❑ ❑ Submit ❑ Return copies for approval copies for distribution corrected prints /❑ FORBIDS DUE 19 ❑ PRINTS RETURNED AFTER LOAN TO US REMARKS /QfJp l I -I rG. t��rh,c�ssEiJ t,t. o� I��rriS r-/cNr"S ^tip well el n2 'r�E Sr�E ,p Jr--' TNS 1-� c�1 Fr --I'LL E 1%ES 16 Prwc rZo IE- 4 Nl e key 6-0�- V -f (qv Z W - ,j COPY TO SIGNED: `_ y ^ if enclosures are not as noted, kindly notify us at once. Town of North Andover OFFICE OF COMMUNITY DEVELOPMENT AND SERVICES WILLIAM J. SCOTT Director (978)688-9531 April 30, 1999 Claire Golden DEP NERO 205A Lowell Street Wilmington, MA 01887 27 Charles Street North Andover, Massachusetts 01845 RE: 815 Johnson Street, North Andover Dear Ms. Golden: to , Fax(978)688-9542 This letter comes as a followup to our telephone discussion on April 30, 1999. Some months ago an upgrade of an existing septic system was completed in the front side yard of this site. The system was designed for 5 bedrooms, and the new owners were informed by the engineer that they could remodel an existing barn/garage area for an in-law apartment for their parents. The existing house has four bedrooms, not five, and there was a problem with ledge that was encountered when the leach area was excavated. In addition, a variance was requested and granted that allowed the installation of the system with a three foot separation to groundwater. After discussion with Dave Ferris, I informed them that they could not increase the flow to this septic system. We then went forward with soils testing in the side rear of the yard for a separate system for the in-law apartment. At the time the deep holes were excavated, it was too wet to run a percolation test. As of yesterday, it was still too wet. The owners' situation has changed somewhat in that the wife's father was diagnosed with cancer in December. It is imperative that this project be moved along quickly because of his illness and because the parents will be forced to leave their home within the month. I am requesting some innovative help to deal with the problem of performing the percolation test, thereby allowing them to start their renovation plans for the in-law apartment. I appreciate any suggestions or direction. Sincerrely, Sandra Starr, R.S. Health Administrator Cc: Wm. Appleton W. Scott File BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 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**** APPLICANT V' IIr. Cly'► �-" PHONE LOCATION: Assesso(s Map Number—j–� 7 PARCEL SUBDIVISION LOT (S) STREET � / % ���^S 5 ST. NUMBERS/J� �--_- -- -- -~ • --_- ^ • •.. ~ • ~ •~ ~~• ~.' *"~'"' 0 F F I C I A L USE ONLY ~.. ~-~-.. ~,.� RECOMMENDATIONS OF TOWN AGENTS: r CONSERVATION ADMINISTRATOR DATE AP PROVED DATE REJECTED. COMMENTS TOWN PLAN COMMENTS DATE REJECTED F000 INSPECTOR -HEALTH DATE APPROVED A /I DATE REJECTED SEPTIC INSPECTOR -HEALTH COMMENTS 1) PUBLIC WORKS DATE APPROVED DATE REJECTED_ SEWERJWATER CONNECTIONS DRJVEWAY PERMIT j FIRE DEPARTMENT' j, til Gv� `J��iril ty A ��YT`�'CCr,' i1,1�� �w — 4,��' R-ECEIVED BY BUILDING INSPECTOR DATE Town of North Andover NORTIy OFFICE OF f , 3? O et t E o a �O COMMUNITY DEVELOPMENT AND SERVICES L ° . A 27 Charles Street North Andover, Massachusetts 01845 �9SSgC,HU5���5 WILLIAM J. SCOTT Director (978) 688-9531 Fax (978) 688-9542 April 21, 1999 Bill Dufresne Merrimack Engineering 66 Park Street Andover, MA 01810 RE: 815A Johnson Street Dear Mr. Dufresne: This letter is to notify you that the proposed septic plans for the in-law apartment at the site referenced above have been disapproved for the following reasons: • Reserve area missing. (310 CMR 248(1)) • This is new construction, not a repair. Perc test missing. • Leach field not a minimum of 900 fete and/or no variance requested. (NA 9.0l (I)) • Interconnecting pipe for ends of distribution lines to be solid. (NA 15.01) • Detail and leach field end section detail disagree as to number of lines. • Proposed gas baffle should be on outlet tee. • Elevation of D -box missing. • Benchmark within 75' of system missing. (310 CMR 220(4)(q)) • Bouyancy calculations required for tank. • Septic tank should be H-20 loading. • D -box baffle requires design specifications on plan. (3 10 CMR 232(3)(a)) • Design specifications for septic tank and outlet baffles required. (310 CMR 227(6)) Please call the office if you have any questions. Sincerely, Sandra Starr, R.S. Health Administrator Cc: S. Appleton File BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 Apr -14-99 08:54A Paul D. Turbide, PE/PLS April 14, 1999 Sandra Starr North Andover Board of Health Administrator Office of Community Development and Services 30 School St. North Andover, MA 01845 RE: Title V review for 815 Johnson Street Dear Sandra, 508-465-0313 P.02 Enclosed find the "Checklist for North Andover Septic System Plans' for the above- mentioned site. The following is a list of all the `Problem' areas and deficiencies Port Engineering has found. • The Design Plans are shown as an upgrade of an existing failed system. In my opinion, this is not the case and is in fact new construction (Note that the existing residence and existing appurtenant septic system are not part of the design and will apparently not be changed in any way. What is proposed is to add an in-law apartment with one bedroom to the carriage house, with a brand new septic system.) • In my opinion, percolation tests must be performed in the area of the proposed leaching bed before the plans can be approved. Either the percolation test must be done when the groundwater recedes or some type of dewatering must be performed to allow the percolation test to take place. Since this is new construction and not an upgrade of a failed system, the urgency of performing the percolation testing right away is (in my opinion) diminished. • For new construction, a reserve area must be part of the design. 310 CMR 248(1) • For new construction, the leaching field must be a minimum of 900 SF. NA 9.01(1) • 310 CMR 247(2) states that for a minimum of 2" of 1/8 to 1/2 inch stone is to be placed on the top of the leaching bed. The plan design calls for a layer untreated building paper to be laid on top this stone. There is no regulation that I could find that allows untreated building paper to be laid over the peastone, and therefore I would recommend that the building paper be removed from the design. • The pipe interconnecting the ends of the distribution lines in the leaching field shall be specified on the plan as solid pipe. NA 15.01 • There are two distribution lines in the design, but 3 lines are shown on the Leach Field End Section detail. The detail should be changed to show two distribution PORT lines. IL It ,Theproposal gas baffle should be specified as being constructed on the outlet tee. ENGINEERING • The septic tank and pump chamber detail calls for 6" crushed stone gravel sub -base beneath the septic tank. This should be a 6" stone base. 310CMR 221(2) (The Civil Engineers & Profile correctly shows this 6" stone base.) Land Surveyors • The elevation of the inlet of the dbox is not shown- hownOne OneHarris Street • The benchmark must be located within 50-75' of the system. 310 CMR 220(4Xq) Newburyport, MA 01950 • Bouyancy calculations are required because the tank will be partially in the {978} 465-8594 8r ('The tank will be empty after the routine maintenance of groundwater pumping.) • The septic tank should be designed for H-20 loading because of its proximity to the existing driveway. Apr -14-99 ti I 08:54A Paul D. Turbide, PE/PLS 508-465-0313 P.03 • The bathe in the dbox must have design specifications noted on the plan as per 310 CMR 232(3)(a). • Design specifications of the septic tank inlet and outlet baffle design should be noted on the plan (depth of baffles, 3" air space over baffles, etc). 310 CMR 227(6) If you have any questions or comments please feel free to contact me. Sincerely Carlton A. Brown, PERLS SEPTIC PLAN SUBMITTAL FORM LOCATION: 17 J 0; N� N l nnj) �iu �4 w aloI T NEW PLANS: S 25.0 lan REVISED PLANS: YES $ 60.00/Plan SITE EVALUATION FORMS INCLUDED: IYtES�) NO DATE: 7' S1 -"I I DESIGN ENGINEER: 1 ey'k-j 4k . 9 )< /,A.=hh-Ke- DATE TO CONSULTANT: *If you want your plans expedited, please submit four plans and included a stamped envelope with the correct amount of postage to mail plans to Port Engineering. When the submission is all in place, route to the Health Secretary. TOWN OF NORTH ANDOVER% BOARD OF HEALTH March 9, 1999 �w 11999 Sandra Starr, Board of Health Inspector _ Town of North Andover, Massachusetts Re: Building permit for guest suite at 815 Johnson Street Dear Ms. Starr; I want you to know from the outset that I am very appreciative of your efforts to re -review our application for a building permit to convert our existing carriage house into a guest suite for my parents. Quite honestly, we naively thought the only hurdle would be the special permit and variances needed from the Zoning Board of Appeals. My parents were very excited when the approval was received in November and decided to move forward immediately with our renovation project. Our contractor applied for the building permit in mid-December and my parents put their home in Northampton, Massachusetts up for sale. Life is full of surprises. My father was diagnosed after Christmas with cancer, which has caused great concern and anguish. My father has become "driven to get his affairs in order" and relocate he and my mother to North Andover, as I am their only child. I apologize for burdening you with my problems, but felt I needed to let you know the reason for the sense of urgency to find out if we can proceed with the renovations. To complicate matters, a buyer surfaced for my parent's home this past weekend. They are unsure whether to accept the offer while the status of our project is up in the air. Our hope is to use the improved and approved septic system installed by the previous owners to meet Title V regulations. Whether my parents occupy one of our existing four bedrooms or the renovated carriage house (if approved) there will only be four (4) individuals living at 815 Johnson Street and using the septic system. I assume that since the septic system was designed for five (5) bedrooms it will accommodate four individuals. Although this seems logical, I don't pretend to be an engineer and will defer to your judgement. Again, your assistance is much appreciated and the collective "we" anxiously await your professional decision. Please call if there is anything that we can do to help. Sincerely, Sheryl Appleton 815 Johnson Street North Andover, MA 01845 978-682-3137 February 23, 1999 Sandra Starr, Board of Health Inspector Town of North Andover, Massachusetts Re: Building permit for guest suite at 815 Johnson Street Dear Ms. Starr; Per our phone conversation today, we are submitting the following that you requested: • Floor plan of existing house, garage and carriage house • Plans of proposed renovations to existing carriage house for guest suite as submitted for building permit • Plot plan The proposed guest suite for my wife's parents involves the renovation of existing space. The variance that was granted by the Zoning Board of Appeals at their November 1998 meeting was for the renovation of existing space (Carriage House) only. No new addition was applied for or approved. We look forward to meeting with you as soon as you have completed your review. We will call your office next week to see if you are ready to schedule a meeting. If you need any additional information, please do not hesitate to contact us. If it would be helpful to make a site visit, feel free to call us to arrange a convenient time. We appreciate your assistance and guidance in getting this project approved. Sincerely, ��r William and Sheryl Appleton 815 Johnson Street North Andover, MA 01845 978-682-3137 February 12, 1999 Sandra Starr, Board of Health Inspector Town of North Andover, Massachusetts Re: Building permit for guest suite at 815 Johnson Street Dear Ms. Starr; We recently applied for a building permit to construct a guest suite in our existing carriage house at 815 Johnson Street. We were granted the special permit and additional variances required for this project by the Zoning Board of Appeals at their November 1998 meeting. Our contractor informed us that your office rejected this project for a building permit. We are hopeful that this rejection may have been based upon a lack of information that I will attempt to rectify. We purchased this house last year with the intent of constructing a guest suite for my wife's elderly and infirm parents. She is an only child and her parents currently live two hours away. The previous owners were required to upgrade the existing septic system to meet Title V of the State Sanitary Code requirements. Although we were not involved with the engineering design process, we did occupy the property prior to the completion of the improvements. The attached carriage house had been some what altered many years before to facilitate a guest suite. Thus the septic system was designed to accommodate the one extra bedroom if the guest suite was to be completed. The existing home has four bedrooms and the proposed guest suite would be the fifth bedroom. During construction of the Title V improvements we were aware that the contractor ran into some ledge. We spoke with the engineer at a site meeting to express our concerns that if any design changes would be required that they not alter the fact that the system would accommodate five (5) bedrooms. The engineer understood our need and after reviewing the as built drawings, I believe the system installed does accommodate the five (5) bedrooms per the original plans. I am hoping that the rejection of the permit to build the guest suite was based upon the assumption that the completed project would bring the bedroom count beyond five (5) bedrooms. We are hopeful this additional information will clear up any problem with the approval of the building permit for a guest suite. If you need any additional information, please let us know. We appreciate your patience in reviewing this request. Sincerely, William and Sheryl Appleton 815 Johnson Street North Andover, MA 01845 978-682-3137 TOwBOAR OF HEALTH NORTHANDVER 1219990 Town of North Andover, Massachusetts Form No. 2 of roR*M BOARD OF HEALTH C . w g A 40 DESIGN APPROVAL FOR Ss�cHus SOIL ABSORPTION SEWAGE DISPOSAL SYSTEM Applicant 1�M�l���E TCS. 9(7� Test No. Site Location__ Reference Plans and Spec�-3fG(✓3U % ENGINEER DESIGN ATE Permission is granted for an individual soil absorption sewage disposal system to be installed in accordance with regulations of Board of Health. Fee { / Q�5 CHAIRMAN, BOARD OF HEALTH Site System Permit No. /0'66 Q EXISTING BARN B EXISTING 5 BEDROOM DWELLING I 815 JOHNSON STREET A EXISTING DISTRIBUTION BOX -- EXISTING PUMP CHAMBER - EXISTING 1500 GALLON SEPTIC TANK 9,77 38 92,40 98,2 z� z r r r*) M z ru w -►� (A9 ,4 97.47. , 0 97,31 97,63 8,1 9 95.11 95.10 95.1 97, -99.14 JOHNSON STREET ED HORIZONTALLY RAGGS, INC. 'HOWN ON THIS CEMENTS OF P.O. 1027 NMENTAL CODE. CONCORD, MA 01742 (978) 369-1100 PREPARED FOR: AS -BUILT PLAN FOR SEPTIC SYSTEM W. & C. MOODY A SEN 815 .JOHNSON ROAD 815 Johnson Street 4 DIOTALEVI N. ANDOVER, MA 01845 s. No. 942 Q North Andover, MA <,S -T DATE: 8125198 SCALE: 1'= 20' 815 JOHNSON STREET, NORTH ANDOVER BOARD OF HEALTH NORTH ANDOVER, MASS. 01545 APPLICATION FOR SOIL TESTS TEL. 688-9540 4M OF NORTH ANDOVE0 B9ARD OF HEALTH MAR 2 2 M DATE: 3 - LOCATION OF SOIL TESTS: 915- J®Wov�ti 7?z--ee,7— Assessor's map & parcel number. m /v -t I— 2-7 OWNER: 94,z- ,4!°1�i�� TEL. NO.: lo8z ��3 ADDRESS: V! 5 c, vx0y5ew ST ENG I N E ERPeretoi r/G TEL. NO.: CERTIFIED SOIL EVALUATOR: 124" !2K � ;Ve Intend '� of'I�n : sidential subdivision, single family home, commercial R it testing Undeveloped lot testing N. A. C rvation Commission Approval: g& THE FOLLOWING MUST BE INCLUDED WITH THIS FORM: 1. Proof of land ownership (Tax bill, deed, or letter from owner permitting tests) 2. Plot plan 3. Fee of 1275.00 per lot for new construction. This covers the minimum two deep holes and two percolation tests required for each disposal area. Fee of $75.00 per lot for repairs or upgrades. GENERAL INFORMATION 1. Only Certified Soil Evaluators may perform deep hole inspections. 2. Only Mass. Registered Sanitarians and Professional Engineers can design septic plans. 3. At least two deep holes and two percolation tests are required for each septic system disposal area. 4. Repairs require at least two deep holes and at least one percolation test, at the discretion of the BOH representative. 5. Full payment will be required for all additional tests within two weeks of testing. 6. Within 45 days of testing, a scaled plan (no smaller than 1'-100') shall be submitted to the Board of Health showing the location of all tests (including aborted tests). 7. Within 60 days of testing coil evaluation forms shall be submitted. I CD 0 Z Q J a W N le I i7 lira > POS ✓ I CD 0 Z Q J a W N le I 62 61 p 2? > POS ✓ Oil • «► t, Q' y ►+! lve W0 S! �� •►' ��,t 1.114, 1i 0 �1 41 • � 4ell t� �,•ZSG .epi All Pro *3'es' VO ` t 44 • S � 14 ae• a • a' �3 225 +6° Q^ 11 4. or Y- Y G T It, Ab � , R e c1 `�, ► `� ♦ i 1 t wo AV , C�` �� y► 2�b �� � .� A6 Nbt• � A ►� F4ti Sv V ►► ��G 4� t ` Z h^ AA ^Y 1� tA%b 6 5. sse `� �'S✓ �•�sa es � ►' �Oti c me • tit. td$ „aP t 84 "= N� <� v IN ✓ tot t4G ' y X01 4 uK Y S. �, �a K ld ;� t� • �, fvy JAI � 4 b Mi q.• ss qt'J •c 25 ea � � ��! g1 8 7 9D 2ao 1� 9� 62 61 p 2? FORM 11 - SOIL EVALUATOR FORAZ Page 1 Data... z Commonwealth of Massachusetts 1)6 Massachusetts PerformedBy:._...1 J............ov e'u'..�1`�:................... ........ _.... ............................ Witnessed By: ... ..............................................................._......__.........:..:::::...:....:.:.:::::::............................................� .. tat 7;o la New Construction ❑ Repair Published Soil Survey Available: No ❑ Yes E Year Published ...f���� Publication Scale,C,YA- Soil Map Unit ..%(%.. DrainageClass ..........� ........ Soil Limitations................................................................................ Surficiai Geologic Report Available: No Yes ❑ Year Published................... Publication Scale .................. GeologicMaterial (Map Unit)................................._......._................................................... Landform......................................................................................................... .......................................................................................................... Flood Insurance Rate Map: Above 600 year flood boundary Within 600 year flood boundary Within 100 year flood boundary Wetland Area: No❑,/ Yes Lam" No Yes ❑ No Yes ❑ National Wetland Inventory Map (map unit) ....... .._................................................... __............................................. Wetlands Conservancy Program Map (map unit) ..............--.............. Current Water Resource Conditions (USGS).• Month Range : Above Normal ElNormal Below Normal ❑ Other References Reviewed: U S6 5- amo, YORM 11 - SOIL EVALUATOR DORM Page 2 On-site Review Time:.. s�o ,8� Weather Deep Hole Number .��".•• Date:• x�''�� - r" Location (identify on site plen) _.. . ! !^.............."........."."........."...."....."..............................."...._"..".........._ _... ""......" Land Use %1ilr." _ . __"..� ". slope 1961''. Surface Stones ...... ........... .... _ "..........". j vegetation it `"...... .......... �................................ ........."".........."..._:............. ...... """."...... ..... "......... .............. Landform .... sketch on the back) ..:"........."_.""........."........".."_"...."..""..."_"".".._"..". position on landscape 1 Distance$ from: '�'� , Open Water Body .. feet Drainage way".•".:!feet c Possible Wet Area �n feet Property Una ...P feet Drinking Water Well7M° -'--. feet Other ...•.••••••...... .................."••• 4. L .• 1-1 yam" Parent Material Igeologicl-"w".T.�.L4 .:.................._.............................................._............. Depth to Bedrock: Death to Ground Standing Water in the Hole:�l,Sr........ Weeping from Pit Face:...... " .I Estimated Seasonal High Ground Water:.�� • FORM 11 - SOIL EVALUATOR 1?ORM Page 2 On-site Remkw _..__. Oete• 3?' �?' Time:.©�rg�,u Weather Deep Hole Number'2 Location !identify on site plan! ...... -:_............. _......... _.................. ...... _.......................... ".........____.. _...._ __...�...._....__ :�`• Land Use -s �2.fn••_..____-_... slope !961-�? Surface Stbnes _ �_ ............__ Vepbtation....... ....... C -%..._......_._..._._... .._.................................. �_....................__............... _._ ._...._... Landform •• position on landscape !sketch on the back! Otstenos.s from: Open Water Body ?� feet Drainage Way-.. feet, .`.... feet Property U e ... .. feet Possible Wat Area Drinking Water Well '' .. feet Other .... _••••••••-•••••• Parent Material (geologic) ....M... .................... ......... _..._........................................................ Depth to Bedrock. _ eenth to Groundwater: Standing Water in the Hole: -r-0-11 Weeping from Pit Face:......••••••••• U 4,1Estimated Seasonal High Ground Water:...... Z.. 4 Ll'il.r V�►7i`iA r is a. avis cava.,:...... �. Dap* hom surtaos llnohssl SOU HOW= Sol UAW$ WSOA! sol COW IMunsslq 601 I�MttUnp - IStnraurs, .8oulpsrs. Orwe Z•Sr�/3 Parent Material (geologic) ....M... .................... ......... _..._........................................................ Depth to Bedrock. _ eenth to Groundwater: Standing Water in the Hole: -r-0-11 Weeping from Pit Face:......••••••••• U 4,1Estimated Seasonal High Ground Water:...... Z.. 4 WORM 11 - SOIL EVALUATOR FORM Page 3 ❑ Depth observed standing in observation hole ................. inches ❑ Depth weeping from side of- observation hole ......... ..— inches r� (5-ze, zDepth to soil motiles ........ `.` inches) ❑ Ground water adjustment ._- feet Index Well Number Reading. Date Index well level Adjustment factor .___......._.. Adjusted ground water level _.....�..__...�_� ___......._.._..__.. Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? VOW If not, what is the depth of naturally occurring pervious material? artification I certify that on (date) I have passed the examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with the required training, expertise and experience described in 310 CMR 15.017. Signature Date tto DATE: 4 _x ENGINLEE � BOH WITNESS. NESS. V PERCOLATION TEST r.= BO i i Ofvl DEFTH OF PLRC TEST: TIME OF SOAK: _ (At (East Z minutes Icnc) TIME AT 12" TIME AT _ TIME AT 55 CvE: ,NIGHT 50,=.K T I1vIE STA.F.TED NE; T D, -•Y SOAK: TME AT 1 TIME AT �.Ai ieaS i _ .., Inl- I DATE. 6 -- C D LOCATION: `NGINEEF.��/ BO. , WIT NESS. PEE7:�\COLnT10N TEST- _ L v� EO i 0(vI DEPTH Or PLrtC TEST. WE OF SOAK.: Z _ -,L iEcSi TI(l'lcS �CrC� T IME— i 2 l TIME AT 73 UJJ I I I ULU liff I Q -5 C7 Ci W& .w �.�py SW�}Fk� �' � t i i,9... � n � � a � ' 9i; ��3 �}w hi � r � n �b r � �� � ��r � w�o 1E 1 4� .� T 1��H ��jF�� � > � r a Y i , � � �. t'9'7 ���s {�'t(7�i�i S hf g; ''; n :, . s �