HomeMy WebLinkAboutMiscellaneous - 84 BRUIN HILL ROAD 4/30/2018 (2)12
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' MAP # LOT
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` PARCEL # STREET
ON_AP.PQO#AL
HAS PLAN REVIEW FEE BEEN PAID?
PLAN APPROVAL: DATE APP. 8Y
DESIGNER: PLAN DA[E
� CONDITIONS
'
WATER SUPPLY WELL _
WELL PERMIT DRILLER__
WELL TESTS: CHEMICAL�DAlE APPKUVED
ACTE DA|E PPMUVED
PHUVEDACTE�� II DAlE A __._ ......
_.....
__
COMMENTS:
'
\ FORM U APPROVAL: APPROVAL TO ISL3LIEZ YES
--'
DATE ISSUED
CONDITIONS: v,�D
__~_-- -__------_-
FINAL APPROVAL:
ALL PERMITS PAID NO
WELL CONSTRUCTION APPROVAL YES NU
SEPTIC SYSTEM CONSTRUCTION APPROVAL S IIO
OTHER YES NU
ANY VARIANCE NEEDED YES
FINAL BOARD OF HEALTH APPROVAL: DA|E: BY:
A V11
�ISSUANCE OF DWC PERMIT
DWC, PERMIT NO..
.,!.ir,,,,BEGIN INSPECTION C=---Y-ES NO:
NEEDED:
EXCAVATION. INSPECTION:
Em
(---n W�
y
YES
YES NO
INSTALLER:7-/--�13 A
13Y
P A SSE D
CONSTRUCTION INSPECTION: NEEDED:
AS BUILT PLAN SATISFACTORY:
APPROVAL TO BACKFILL: DATE: B Y
B
FINAL. GRADING APPROVAL: DATE 'o Azz y
I
DATE: BY AA
',`,i F I NAL CONSTRUCTION APPROVAL:
"Y1
S -THE INSTALLER
LICENSED?
TYPE OF CONSTRUCTION:
NEW CONSTRUCTION:
CERTIFIED PLOT PLAN REVIEW
CONDITIONS OF APPROVAL
(FROM FORM U)
�ISSUANCE OF DWC PERMIT
DWC, PERMIT NO..
.,!.ir,,,,BEGIN INSPECTION C=---Y-ES NO:
NEEDED:
EXCAVATION. INSPECTION:
Em
(---n W�
y
YES
YES NO
INSTALLER:7-/--�13 A
13Y
P A SSE D
CONSTRUCTION INSPECTION: NEEDED:
AS BUILT PLAN SATISFACTORY:
APPROVAL TO BACKFILL: DATE: B Y
B
FINAL. GRADING APPROVAL: DATE 'o Azz y
I
DATE: BY AA
',`,i F I NAL CONSTRUCTION APPROVAL:
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FORM - U - LOT RELEASE FORM 0
1NSTRUCTIONS: This form is used to venify that all -necessary approval/ permits from
Boards and Departments having juni sdiction have been obtained. This does not relieve the
applicant and or landowner from compliancewith any applicable requirements.
Ock
APPLICANT G e0 fZ:t X C> - 4 '(PHONE 617 69-4 17,475 (W)
i - A
ASSESSORS MAP NUMBER LOT NUMBER
SUBDIVISION LOTNUMBER
STREET Xq3jv,jj, NUMBER T4 bif kii h
loomospoonnounno ..............
All
Room
OFFICIAL USE ONLY
loodoonownwoom mono ......................................................... a
RECONWENDATIONS OF TOWN AGENTS
E.n 0 0 n N 0 n 0 N a a 0 0 a 0 0 a a 0 0 E E a E a o N a N E E M a 0 0
y00- DATEAPPROVED 77
C SERVATION ADNIINIS OR
DATE REJECTED
(16
TOWN PLANNER
CONEVIENTS
FOOD INSPECTOR - BEALTH
SEP'ng,KAEC� - FtAIIT�--__
,;r_1 /
DATE APPROVED
DATE REJECTED
DATE APPROVED
DATE REJECTED
DATE APPROVED
DATE REJECTED
COUNIENTS
PUBLIC WORKS - SEWER WATER CONNECDONS e -C 2 -
DRIVEWAY PERMFr P
FIRE DEPARTNENT
CONMENTS
RECEIVED BY BUILDING INSPECTOR
DATE APPROVED
DATE REJECTED
-0
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Commonweafth of Massachusetts
ExecLAve Office of Environmental Affairs
Department of
Environmental Protectkon,
1i k1-10
VAIllam P. Weld
Argeo Paul Celluccl
U. CK"Mor
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFIFATIPN
Property Addresa:e �jcx-*j�- 6&A&V-rAddress of Owner -
Date of Inspection: (It different)
Name of Inspector-
06A11- 4e,�C�
Compamy Name, Address and Telephone tarnber. BATESON ENTERPRISES, INC.
E�cavatlng - Water & Sewer Unes - Septle Syltemo & Pumping SmIce
I I I Argilla Road 6 Andover, Mass. 0 18 10
0\ 0,
h
Trudy Come
Socrolary
Dev Id 19. Struhs
CornmWloner
TEL- (5091475-14-7-4
FAX: J508) 475-5-131
CERTIFICATION STATEMENT
I certify that'l have pei-sonaffly inspected the sewage disposal system at this address and that the information reported below 6 true, accurate
and complete as of the time of inspection. The inspection was performed based 6 my training and experience in the' proper hinction and
tn.-dntenance of on-sit�. ;m"N%-�agei pogal eyaterrm The system:
Passes
Conditionally Passes
Nee4s Further Evaluation By the Local Approving Authority
FADS
Inspector's Signature! e�)
f Date: Z:> —7/
The Systern Inspector s A1.1 su t a co f this inspection report to the Approving Authority within thirty (30) days of completing this
I jD,
inspection. If the system is it shared system or has a design flow of 16,000 gpd or greater, the impictor and the system owner shall submit the
report to the appropriate regional office of the Department of EnvironmonW Protection.
The original should be sent to the system owner and copies sent to the buyer, if applicable And tho approving authority.
INSPECTION SUMMARY:
Check A, B, C; or D:
A] SYS PASSES -
I have not found any information which indicates that the system violates any of the failure criteria an defined in 310 CMR 15,303.
Any failure criteria not evaluated a" indicated below.
B) SYSTEM CONDITIONALLY PASSES:
One or more system components need to be replaced or repaired. The system, upon completion of the replacement or repair, passes
inspection.
Indicate yes, no, or not determined (Y, N, or ND). Describe basis of determination in &H Insfiinca. if "not determined", explain why.not)
The septic tank is metal. cracked. structurally unsound, shows substantial Irliffirdtion or ex0ration, or taAk failure is
imminent. The system will pass inspection if the existing septid tAA lb r*placed with a ronforming septic tank is ��proved
by the Board of Health.
(revised 11/03/95)
One VAntir Street 0 Boston, Massachusetts 02108 6 FAX (07) SW049 Telephone (617) 292-SWO
Pnnted on Recycled Paper
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: �JOCV'kf\' "IVD14—
Ow-ner. v��(A�bu
Date of Inspection:
91-7
Rl SYSTEM CONDITIONALLY PASSES (continued)
Sewage backup or breakout or high aWic water level observed in the distribution box is due to broken or obstructed pipp(s)
or due to a broken, settled or uneven distribution box. The system will pass inspection if (with approval of the Board of
Health):
broken pipew are replaced
obstruction is removed
distribution box is levefled or replaced
AIL� The PyRtem rvquired pumping more than four times a year due to broken or obstructed pipe(s). The system wW
inspootion it $Willi hpor4oiij t4t ilio n"W'4 0r 'tj4j4jfhj!
broken pipeoq) are replaced
obstruction Is removed
Cl 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 in failing to protect the
public health, safety and the environment.
1) SYSTEM WILL PASS UNLESS BOARD OF HFALTH DETERMINES THAT THE SYSTEM 19 NOT FUNCTIONING IN A
MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THIC ENviRONMIMNIN
— Cesspool or privy Is within .50 feet of a surffice water
— Cesspool or privy is within 50 feet of a bordering vegetated wetiand or a salt marsh.
2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE)
DETERMINES THAT THE SYSTEM 19 FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND
SAFETYAND THE ENVIRONMENT:
— The system has a septic tank and soil absorption system and is within 100 feet to a surface water supply or tributM to a
surface water supply.
— The system has a septic tank and soi] Absorption system and is within 6 Zone I of a public water supply well.
— The system has a septic tank and soil absorption system and is within 50 feet of a private water iupply weft.
— The system has a septic tank and soil absorption system and in less tham 100 feet but 60 feet or more &am a private water
supply weU, urdess a weH water analysis for coliform bacteria and volatile organic compounds indicatih that the weh is free
from poUution from that faci1ity and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 6 ppm.
3) OTHER
(revised 11/03/95)
ly
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address:
Owner
Date of Inspection:
D) SYSTEM FAILS -
I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for
this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the
failure.
Backup of sewage. into facility or systern component due to an 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 1/2 day flow.
— Required pumping more than 4 times in the last year NOT dueto clogged or obstructed pipe(s).
Number of tirnes pumped
— Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation.
— 'Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply.
Any portion of a cesspool or privy is within a Zone I of a public well.
Any portion of a cesspool or privy is within 50 feet of a private water supply well.
Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no
acceptable water quality analysis. If the well has been analyzed to be acceptable, attach copy of well water analysis for
coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen.
El LARGE SYSTEM FAILS:
The following criteria apply to large systems in addition to the criteria above:
The system serves a facility with a design flow of 10,000 gpd or greater (Large System) and the system is a significant threat to public
health and safety and the envionment because one or more of the following conditions exist:
— 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 H of a public
water supply well)
The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program
requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information.
(revised 11/03/95) 3
0
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Addrear.
Owner.
Date of Irmpection: SCCA
-7
Check if the following have been done:
/P.ping information was requested of the owner, occupant, and Board of Health.
_LXe1_1 It the sysum 401upe"Onta hAvo bo@n V"_ pod for at Ig!AAt two woke Md the #'"tern )w- b"n tft-sivitia "OYMAI flow MAN
during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection.
built plans have been obtained and examined. Note if they are not available with NIA.
_L,A'e I#cffity or dwelling was inspected for signs of sewage back-up.
=4be m does not receive non -sanitary or industrial waste flow
e2#e-*a9 inspected for signs of breakout.
system components, excluding the Soil Absorption System, have been located on the site.
��e aseptic tank man -holes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or
_L2tees, terial of construction, dimensions, depth of liquid, depth of sludge, depth of scum.
e',7ize and location of the Soil Absorption System on t I he site has been determined based on existing information or
Zapp ted by non -intrusive methods.
e fa�cihty owner (and occupants, if different from owner) were provided with information on the proper maintenance of Sub -
Surface Disposal System.
(revised 11/03/95) 4
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address:
Owner.
Date of Inspection:
FLOW CONDITIONS
Esirm AMMIN A AA."
Design flow: L4 1q.L)-. gallons
Number of bedrooms: 4
—qeQ,:
Number of current
Garbage grinder (yes or no):
Laundry connected to system (yes or no): Yes
Seasonal use (yes or no) �j U r
Water meter readings, if available:
at4-7
LA& date of occupancy:
.4/36-S-ckn� S z- D;6 p4A &�aj
,VA / RC, Z -g'4 9
Q
Q
ck /CA
COMMERCIAL/INDUSTRIAU
Type of establishment:
Design flow:_____gallons/day
Grease trap present: (yes or no)_
Industrial Waste Holding Tank present: (yes or no)_
Non -sanitary waste discharged to the Title 6 system: (yes or no)_
Water meter readings, iY available:
Last date of oecupancy:_
OTHEIL (Describe)
Last date of occupancy:_
GENERAL INFORMATION
PUMPING RECORDS and source of information:
System pumped as part of 1'=,pection: (yes or no)4es
If yes, volume pumped: .110t"�
Reason for pumping: o�j 44w -
TYPE OF SYSTEM
Septic taWdistribution box/sou absorption system
Singie cesspool
Overflow cesspool
Privy
Shared system (yes or no) (if yes, attach previous inspection records, if any)
Other (explain)
APPROXIMATE AGE of all components, date installed (if known) and source of information:
�Ij
Sewage odors detected when arriving at the site: (yes or no) " C.)
(revised 11/03/95) 5
1.
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address:.
0�'4 �jo'�JJ&
Date of Inspection:
91-7
SEPTIC TANK
(locate on site plan)
Depth below grade:
Material of construction: _�t4nrete —metal _FRP —other(explain)
Dimensions: Now&
Sludge depth:
NAaaeo Oom top of foludoe to bottom of outlet tee or baffle:, C
Scum thickness: 4V 11
Distance from top of scam to top of outlet tee or baffle: 9 1 V
Distance from bottom of scum to bottom of outlet tee or baffle:
Comments:
(recommendation for pumpiR,)conditiQn of ildet and tl t tees or.1 baffles, Pept liquid leyel relation to putlet inve ru integrity,
U
evidence of le4kagq, etc.) !n" &OT Ar
:0��.A_4 C) 1 10
-A-) lc(e JER . �j =&:�*
GREASE TRAP:
(locate on site plan)
Depth below grade:
Material of construction: —concrete —metal _FRP _other(exphdn)
Dimensions:
Scum thicimess:
Distance from top of scum to top of outlet tee or baffle:
Distance from bottom of scum to bottom of outlet tee or baffle:
Comments:
(recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity,
evidence of leakage, etc.)
(revised 11/03/95) 6
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Addreaxey
Owner. FA �' A -
Date of Inspection:
TIGHT OR HOLDING TANK Vj0fV
(locate on site plan)
Depth below grade:_
Material of construction: —concrete —metal —FRP —other(explain)
Dimensions:
Capacity: vallons
Design flow:
Alarm level:
Comments:
(condition of inlet tee, condition of alarm and float switches, etc.)
DISTRIBUTION BOX -
(locate on site plan)
Depth of liqt6d level above outlet invert: 0
PUMP CRAMBER:-
(locate on site plan)
Pumps in working order:(yeg or no)
Comments:
(note condition of pump chamber, condition of pumps and appurtenances, etc.)
(revised 11/03/95)
7
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Addrew 4 �b �A
Owner.
Date of Inspection:
SOIL ABSORPTION SYSTEM (SAS)!
(locate on mite plan, if possible; excavation not required, but may be approximated by non-intruaive methods)
If not determined to be present, explain:
Typo:
leaching pits, number:_
leaching chambers, number:
leaching galleries, number:
leaching trenches, number,length,-
leaching fields, number, dimensions:
overflow cesspool, number:
't�o"\.50
CESSPOOLS: tJ\OV\e
(locate on site plan)
Number and configuration:
Depth -top of liquid to inlet invert:
Depth of solids layer:
Depth of scurn layer:
Dimensions of cesspool:
Materials of construction:
Indication of groundwater:
inflow (empool must be pumped as part of inspection)
Comments: (note condition of soil, signs of hydraulic faflure, level of ponding, condition of vegetation, etc.)
PRtVY: V\Me
(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.)
(revised 11/03/95)
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (oontinued)
�jProperty Addres&- eq BcUA f\ F"
Owner.
"Ate (st Inapepoolu
S —
SEXMH OF SEWAGE DISPOSAL SYSTEM:
include ties to at least two permanent references landmarks or benchmarks
locate all wells within 100'
0"
L4 1c,
A-
10
DEPTH TO GROUNDWATER
Depth to groundwater: feet
method of determination or approximation:
(revised 11/03/95) 9
13
LA
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System Owtier
G,, k
System Location
Contents tionsreirred to i
Date. -
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Tank OUT
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Line 1
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Line 4
AS -BUILT CHECK LIST
and
FINAL INSPECTION
Proposed Elevations
/W/ V, A /
163,71
7/
163,37
/,� -3 , 2,
Bottom of Exc. //0 Iq . I -
Stone OK? L---- D -box checked?
As -Built Elevation
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Pipes cemented? 4--
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
APPLICANT ISU C �CPHCNE 9 2 70 � 7425
coj�
LOCATION: Assess&s Map Number 10q �PARCEL '21610zi- A 0001 E7 '066o_d
SUBDIVISION LOT (S)
STREET Z-11 Byl/io. A Rd - T. NUMSER_g_Z--
USE ONLY***********
RECOMM NDATiONS OF TOWN AGENTS:
CONSERVATION ADMINISTRATOR DATE APPROVED.
DATE REJECTED—
lo
COMMENTS lic� �V,
TOWN PLANNER
COMMENTS
DATE APPROVED
DATE REJECTED
FOOD INSPECTOR -HEALTH DATE APPROVED
DATE REJECTED
SEPTIC INSPECTOR -HEALTH
COMMENTS
DATE APPROVED
DATE REJECTED
PUBLIC WORKS - SEWERIWATER CONNECTIONS
DRIVEWAY PERMIT
FIRE DEPARTMENT
RECEIVED EY EUILDiNG !NSPECTCR DATE
Reviced 9\9"jm
-A
`7
Town of North Andover, Massachusetts Form No. 3
,IORT#f BOARD OF HEALTH
+
19
CHUS DISPOSAL WORKS CONSTRUCTION PERMIT
Applicant
7� —ry.- MA J --AJ VL-�
NAME
Site Location
Permission is hereby granted to, Constructl�-41 or Repair ( ) an Individual Soil Absorption
Sewage Disposal System as shown on the Design Approval S.S. No.-
-2—ZLi—&A r- . , �,j
CHAIRMAN, BOARD OF HEALTH
Fee D.W.C. No.
M
LOT
-PLOTAPLAN OF
Scole 0/2�
DANA PERKINS,
CIVIL ENGINEERS 6nd SURVEYORS
READING - TW�-560?-�MASS.
i'-C-rc�uy cerfiiy that the buOding on
Lot 3 ated a -
.is locc pproxim,
ately
as sbown hereon and that i.1 conforms
0
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Of
4"! Lii
of
Dana e X m
J, E
By
yw
No. 30747 -
Is
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V
79.
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To
V
- ----------
May 18, 1992
NORSE ENVIRONMENTAL SERVICES, INC.
3 Pondview Place
TyngSboro, mass. 01879
TEL. 649-9932
Michael Rosati
North Andover Board of Health
Main Street
North Andover, Ma.
RE: Lots 3,4,5,6 Bruin Hill Road
Dear Mr. Rosati;
Enclosed are the revised plans for lots 3,4,5 and 6 Bruin
Hill Road subdivision.
The following changes have been made:
Lot 3
Denotation for Schedule 40 PVC pipe
Top of foundation elevation
Lot 4
Denotation for Schedule 40 PVC pipe
Top of foundation and cellar floor correction
Fill easement from lot 5
Lot 5
Denotation for Schedule 40 PVC pipe
Fill easement on lot 4
Top of foundation
Lot 6
Denotation for Schedule 40 PVC pipe
Top of foundation
Revised system to be 501 from the drain, by eliminating the
third trench and increasing the sidewall area of trenches one
and two. Unfortunately the invert elevation of the drain
line is below the system. Also, the wetlands in the rear of
the lot further limits the area we can use.
Thank you very much for calling these omissions to our
attention.
e yo,
*ter r sen
Norse Environmental services, Inc,
Commonwealth of Massachusetts
Massachusetts
System Pumping ecord
yst�", —O%V,1�1'
01-a��u �� 2A -
Date of Pumping:
Cesspool: No Yes
System Location
V'\
TOVIN 0. "PRT, -I r.oOVER/
0 F T
MAR 1 1 1997
Quahtity Pumped: 45e�� gallong
Septic Tank: No Yes
Sy (em Pumped by: Ferredeff License
s
Contentstransrerrredto: Greater Lawrence Sanitary District
Datle: Inspector:
.1 N 111� ID UT
OW bo
Commonwealth of Massachusetts
Massachusetts
System Pumping Record
$y0tom Owner System Location
)31�V)N MILC
A /,jDo vm
Date of Pumping: 0 -q6 uantity Pu'mped: 0 gallons
CzupDDj: No Yes 5gzk-T=k: No F1 Yes Y
System Pumped by: 64&4" SwAnAu-w License #
Contents transferrred to Greater Lawrence Sanitary District
Date: Inspector:
'FOWN OF ORIN ANDO)
L) A I F, SYSTEM P MplNQ RECO
SYSTEM o"E.-A & AVORESS
Ack
s- V116111-oIJ9
RECEIVED
NOV - 3 2004
TOWN OF NORTH ANDOVER
HEALTH DEPARTMENT
0 T a I tM LOCATION
P—,L
-7 7
.//L/
DATE OF PUMPING:
QUANTITY PUMPED:
CLSSPOOL: NO_ -k
YES— �
S00c I'ank: NO_ YEST
NA rUKE OF SERVICE:
Kou'rINE...)�...
EMERGENCY
013SERVATIONS:
GOOD CONDITION FULL'M covEjR
HEAVY ORMASE BAFFLES IN PLACL
ROOTS LEACKRELD RUNBACK
WeSSIVE SOLIDS FLOODED
SOLI'D CAkRy0V`ERl".. OTHER EXPLAIN
SY&LOM P'Wnpcd by
1-77al
.. .... ..... ....
CUN I hN FS I"KANSYbRALD I'()
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'A
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