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HomeMy WebLinkAboutMiscellaneous - 88 ROCKY BROOK ROAD 4/30/2018i LOT & STREET MAP/PARCELI/ CONSTRUCTION APPROVAL HAS PLAN REVIEW FEE BEEN PAID? % 1,1qYES NO nn // PLAN APPROVAL: DATE % APP. BY jU7Z� DESIGNER: �� ��� Not /X) PLAN DATE- Id, 4 x,'7197 CONDITIONS WATER SUPPLY WELL WELL TESTS: PLUMBING SIGNOFF COMMENTS: TOWN WELL DRILLER_ CHEMICAL BACTERIA I �--lv BACTERIA II�``� WIRING S DATE APPROVED DATE APPROVED DATE APPROVED FF FORM U APPROVAL: / APPROVAL TO ISSUE YES NO DATE ISSUE �` a��47 BY CONDITIONS: FINAL APPROVAL: ALL PERMITS PAIDES NO WELL CONSTRUCTION APPROVAL YES NO SEPTIC SYSTEM CONSTRUCTION APPROVAL YES NO OTHER YES NO ANY VARIANCE NEEDED ES qq NO FINAL BOARD OF HEALTH APPROVAL: DATE:u BY: r ; SEPTIC SYSTEM INSTALLATION IS THE INSTALLER LICENSED? YES NO TYPE OF CONSTRUCTION: EW REPAIR NEW CONSTRUCTION: CERTIFIED PLOT PLAN REVIEW _ S NO CONDITIONS OF APPROVAL YES NO (FROM FORM U) ISSUANCE OF DWC PERMIT c. _ES NO DWC PERMIT PAID? -.YES NO DWC PERMIT NO. 40�¢ INSTALLER:} BEGIN INSPECTION YE NO: EXCAVATION INSPECTION: NEEDED: PASSED / //41-/q / BY CONSTRUCTION INSPECTION: NEEDED: AS BUILT PLAN SATISFACTORY: YES: APPROVAL TO BACKFILL: DATE: / 7 l BY FINAL GRADING APPROVAL: DATE BY FINAL CONSTRUCTION APPROVAL: DATE: /3 !Z BY TOWN OF NORTH ANDOVER SYSTEM PUMPING RECORD DATE: (L l SYSTEM OWNER & ADDRESS SYSTEM LOCATION (example: left front of house) i DATE OF PUMPING: 0 V d— QUANTITY PUMPEDALLONS CESSPOOL: NO ES SEPTIC TANK; NO YES NATURE OF SERVICE: ROUTINE —><-/, EMERGENCY OBSERVATIONS: GOOD CONDITION HEAVY GREASE ROOTS EXCESSIVE SOLIDS SOLIDS CARRYOVER SYSTEM PUMPED BY: CO:.INIENTS: CONTENTS TRANSFERRED TO: FULL TO COVER BAFFLES IN PLACE LEACHFIELD RUNBACK FLOODED OTHER (EXPLAIN) f NORTq o � � w 9 SS4CHUSEt Applicant a Site Location Town of North Andover, Massachusetts BOARD OF HEALTH Iti�L.10011 ' • DESIGN APPROVAL FOR SOIL ABSORPTION SEWAGE DISPOSAL SYSTEM Reference Plans and Specs Test No. Form No. 2 Permission is granted for an individual soil absorption sewage disposal system to be installed in accordance with regulations of Board of Health. Fee � Civ '� '4� CHAIR N, BIM RD OF HEALTH Site System Permit No. ge Town of North Andover, Massachusetts F� orm No. 3 kORTN _ BOARD OF HEALTH T(dV , 9 e 3? T. - •e OCL H A �. ,r.. � DISPOSAL WORKS CONSTRUCTION PERMIT Applicant NAME ADDRESS TELEPHONE Site LocationT Permission is hereby granted to Construct ( or Repair ( ) an Individual Soil Absorption Sewage Disposal System, as shown on the Design Approval S.S. No. Jyj /'laIL) CHAIRMAN, BOARD OF HEALTH Fee D.W.C. No. �9 4- LL _L In L 4-% ^1 � Lo ✓ ,_ Or V) s -'q N Q) U rz \ L L Un V rz :3 s U Z o ao ro r LA < U b 0 _ Z m d. rtY N . rt ' Q � Q) frz_ CO w =U L 0 LL 0 0 --N J U= O Q Q W Q O v) Q �0�- J O U N a� � ~ Q n Z w F - D o` Q U p o x0 mLL.3 m oo o F- ) ro _ 3 s o Li U O 0 L) z H N a � x d m U o U 0 E "a Q ° � U C P E U 1 0 Q) N L s •L i Ln w 4J -0 o ro 00 rz N > rV v) o r 0 , O Q CU U x w Az O P-4 z O U �^ fR c� w a o a z U C V w 0 CT, 00 w ro ° c w w o G ch w ° a c: w . o cra cn cn p �T Z ra a 0 O v •r.a co O 0 Z aL CL 0 VA D � �I0 Cm C 0 ■� CO) G '� CD 0 •0 L H= �3 L CD _0 o a CL ga�Q C 0 � C cc C.3 dCD o . C.0 Z CD CL V VJ C C CO) .0 ` c C o C V CD C ` O N C V V •nom d C Cc y � m C D O . R rO+ a CA C 0 m : oL. E c N W mm mm3 z O! - m y 60 m `= O y � C CA p G N m � a�L m �'► N m NO. -cc t = O CD coa N' O p m Om � Z p r.+ n- G CL p pf G N IS t H m G •O Is 3 a O N F- +O•• ~ N S CD cc m LLU •N C O F.. •E *FL t•C Z C LU CD ca -o v � AD V% O*5 O: _ O ti = _O CL 4 - ra a 0 O v •r.a co O 0 Z aL CL 0 VA D � �I0 Cm C 0 ■� CO) G '� CD 0 •0 L H= �3 L CD _0 o a CL ga�Q C 0 � C cc C.3 dCD o . C.0 Z CD CL V VJ C C CO) .0 APPLICATION FOR DISPOSAL WORKS CONSTRUCTION PERMIT DATE: / CURRENT INSTALLER'S LICENSE# LOCATION: Z,-) % C /6C4>, , z%yr)�(( LICENSED INSTALLER: SIGNATURE: /�� ` ` -� TELEPHONE# b - 2 2� CHECK ONE: NEW CONSTRUCTION: Ll--/ IF, NEW CONSTUCTION, PLEASE ATTACH FOUNDATION AS -BUILT. $75.00 Fee Attached? Administrative Use Only Yes No l d Foundation As -Built? Yes Approval No Date: 6111t1V THOMAS E. NEVE ASSOCIATES, INC. Engineers • Land Surveyors a Land Use Planners 447 Boston Street US #1 TOPSFIELD, MASSACHUSETTS 01983- '(508) 887-8586 t ;C FAX (508) 887.3480 91 TO 130o►rd o� 1-��Q1tl-, IJot }-� Ar�dove< MIS WE ARE SENDING YOU Attached ❑ Under separate cover via ❑ Shop drawings ; Prints ❑ Plans ❑ Copy of letter ❑ Change order ❑ FUTTVIEn @7 DATE S/1-7 J ✓% JOB No. 550 _7_5 ATTENTION SANt>y 5-TARR RE: Lot Z 8 P,61-k13t-oot< 'C2 d� REv SAt-t�-rAMY DtSQoSAL SYS -r -SM -ror Lot. 28 following items: ❑ Samples ❑ Specifications COPIES DATE NO. DESCRIPTION REv SAt-t�-rAMY DtSQoSAL SYS -r -SM -ror Lot. 28 THESE ARE TRANSMITTED as checked below: ❑ For approval For your use ❑ As requested ❑ For review and comment ❑ FOR BIDS DUE REMARKS ❑ Approved as submitted ❑ Approved as noted ❑ Returned for corrections ❑ Resubmit copies for approval ❑ Submit copies for distribution ❑ Return corrected prints 19 ❑ PRINTS RETURNED AFTER LOAN TO US r'e-ac' Sandy Phase �r±nd� enLlosecl 3 orir+t5 of tti+c r"Oeve Feree-iaeak 101,-. 71-,t alor-� ►r,as beer+ re�%sed 90 ne�,.� lo -F lire be�yc� 10+.S i IA c ZA) J As NW j arc a a%JaTC -IL,i ) oi l„ 1¢ $ ag -`F -r- 'fsow, -}l a ..zc,-f)ar-A a S G7oss� ble T'1 -.e ' tesla.-, 4hai-' �l•e -1-1�< �3 o N 1-�as �oi' L..o-}' 1 $ i -+as -I-).� corrcG-1 10+ N'e loc.a+'� D . TL„S lc>+ 1 i^g r-evkg►`o inc tl'c M.,/ COPY TO RECYCLED PAPER: gP Contents: 40% Pre -Consumer -10%1Post-Consumer SIGNED:_ r►. if enclosures are not as noted, kindly notify us at once. r .� • C,C� :� L: 4r Gr1:aJ • (,�t":iJ�Y.• •';. Fr '' GI_d;:,''j M13 JN l` xl; .dam ✓�� 14rr,' . ,.,r:.> .✓" ,:! .f _. ..x +,.j C_. � � .x-J.`«•:.v;?�..• �o t3r^,1e ` -_ f� -� � ._.9` ._ a - �' ! 1,f'1 � y ...:"' ,,. ����.. _ . �.• p�a f'. t.'`.' �i G [ \y p'.''.�: �-�.'?" 1 <�l".C;. ` L'�'�` �.` GY'. 4. r P- p.„ �t�,`3 R r. _ _ "[� __ II +�ti. ,e ��: `ar.,.,� _ i F_> < �F e-� : plc" e'C' _ fi) ".f", ..•'l9 i.„J :`Z .:? .lr3 f`+? i :c'�� �«.•��'� ' i¢�_f:V1';r.;.C... �%� '' � ' !\ :,.' J'°';,r C..,.JC.aF� f,""7.,an �! s e.,/,a"'j r-�= ..s'..-.,e a p�C-•1 r__t.;1� e^ �.r T` .._.j -f.: i �',^-.•Y P":..a"�.;,t1«_ ."`3. �:?,� j" `j�! �f �^t� s:i{.ISSid"'t_ _;°`moi! •'1�:_� `;^"•i. '=x]ti..vsF: ..t.•>Y'� _ v;�'� 1'.\ -ty � �. .� ,r 6 .4 .£ CV _i.<-i � }'-''? `, `7.. `�' j .+� 1 sl �i. S .i- �y� � l E� .."`, ° � Ca� lS :." �. � t •� .. a'i 1'-•�4�.'.'j .. �.! `-' +� r` �1:j G' F ; f � I� .`%= �n .� � q. t. 0.+'�"r" i ! 17 s '$ ' (^••.s•''.` i ' :J /"4 {n• _ J ir� f i S-"F. �k'�", ~a'�,g i2�i-- t...s,..vra .1^'bre if.:�4ra"L ? ��. -�•C"� '€'•.-`•.f:.'fiC+:.53=".•?t'.i -y,��'"�'/�`-)._ �'�'Lr-l"}...r?:tS4^.�;? { a I&M No. 550-2A Performed By: Steven J. D'Urso Witnesses By: Sandra Starr 2A - Rocky Brook Road Construction, X Repair, FORM 11 - SOIL EVALUATOR FORM PAGE 1 of 3 1 Date: 11/5/96�;�,����/ , Commonwealth of Massachusetts , igg6 North Andover, Massachusetts�� Assessment for On-site Sewa-ee Diso Date: 4/l/96 Owners Name. Address, and Telephone # Ogunquit Homes, Inc 345 Stevens Street No Andover, MA 01845 (508) 685-6028 Office Review Published Soil Survey Available: No Yes X Year Published: 1981 Publication Scale: 1" =1320' Soil Map Unit:Crc (Carlton) Drainage Class: Well Drained Soil limitations: Moderate (slope, large stones) Surficial Geologic Report Available: No X Yes Year Published: Publication Scale: Geologic Material (Map Unit): Landform: Ground Moraine Flood Insurance Rate Map: Above 500 year flood boundary: No Yes X Within 500 year flood boundary: No X Yes Within 100 year flood boundary: No X Yes Wetland Area: National Wetland Inventory Map (Map Unit): Wetlands Conservancy Program Map (Map Unit): Current Water Resource Conditions (USGS): Month Range: Above Normal: Normal: X Below Normal: Other References Reviewed: DEP APPROVED FORM -12/07/9 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 local or state law, regulations or requirements. ****************Applicant fills out this section***************** APPLICANT: 0tin/��..'f }76�vw�S _41 Phnr�a zgs`."o,7 "r - LOCATION: Assessor's Map Number --- Parcel Subdivision 11a00 0024Lots) c .� StreetoPn n ,� St. Number ************************Official Use Only************************ RECOMI ENDATIONS OF TOWN AGENTS: L,, -Conservation Administrator Comments Date Date Approved Rejected Town Planner Date Approved Date Rejected Comments Food Inspector -Health Date Date Approved Rejected Date Approved Septic Inspector -Health -Date Rejected Comments Public Works - sewer/water connections - driveway permit Fire Department Received by Building Inspector Date 1,3AZDATE % BOARD OF HEALTH TOWN OF NORTH ANDOVER SUBSURFACE DISPOSAL DESIGN REVIEW Sheet of FEE ion PERMIT $C) DATE RECEIVED APPLICANT QCUA,)Qt)1F lloMES ASSESSOR'S MAP ADDRESS ENGINEER &, � ADDRESS PLAN DATE // /* lq6 CONDITIONS OF APPROVAL: APPROVED DISAPPROVED PARCEL T LOT tt a STREET T --;F,C5ctCy REVISION DATE A-CGDt D 1176 7Co 540 CAIe 1<47. a-46 -23z4- ��� /-'a �✓� 6 Av Tris ss� l ' , G* R 5 -919,, c'� /1/651A)6 t✓'6/LJ GSUTGC- T 7 -E� C�/D �-yI1e A: A7(4j/ % ,o �' acG�/T�iti: ov T 5 /X //1% Gl1-s� j CJ G 1A jAe a �eb 6, C�3 /IS �! Nj !�`, c` N) -D 7w / 5 tii itis 57TE/Lt mu5r L ccvEe 7::76.e .� N1 /ti/A40M 0 r- T(3/D CAIS /67, a3 LAC', / ,,oD.x"55 CSF owAJ94 �PPLfC/4.u7' iu6 , C,/j�'. > , oa g J PLAN REVIEW CHECKLIST ADDRESS �ar,��/ ,�,� ENGINEER��� GENERAL 3 COPIES ,(,� STAMPS LOCUSNORTH ARROW Li SCALE CONTOURSt� PROFILE D SECTION BENCHMARK SOIL_& PERCS ELEVATIONS WETS. DISCLAIMER L-- WELLS & WETS k WATERSHED?JZL DRIVEWAYy(Elev)"WATER LINE FDN DRAINL� SCH40 ✓ TESTS CURRENT ✓� SOIL EVAL SEPTIC TANK MIN 15001G .17 INVERT DROP ✓. 10' TO FDN r4:::� MANHOLE ELEV_ D -BOX I Z b6-7 # LINES INLET 1,9% `% 3 -.OUTLET 53 = , Z GARB. GRINDER_.#Q (2 comps +.200) GW 6& # COMPS. GBk FIRST 2' LEVEL STATEMENT (2" OR .17 FT) TEE REQ'D?.,da LEACHING MIN 440 GPD? RESERVE AREA ---4' FROM PRIMAR'�? 20 SLOPE 100' TO WETLANDS X100' TO WELLS4' TO S.H.GW /--� (5'>2M/IN) 20' TO FND & INT.RCPTR DRAINS L,-----400' TO SURFACE H2O SUPP 4' PERM..SOIL BELOW FACILITY MIN 12" COVER4-`FILL?15') BREAKOUT MET? TRENCHES MIN 440 gpd SLOPE (min .005 or 611/100, )__. SIDEWALL DIST. 3X EFF. W OR D (MIN 61) �RESERVE BETWEEN TRENCHES'? cq'� IN FILL? ~ MUST BE 10' MIN. 4" PEA STONE? :VENT? _ate.(>3' COVER; 'LINES >50' BOT 4q + SIDE 61 X LDNG p x TOT 4.4 r" (L x W x #) (DxLx2x#) (G/ft2) Copyright © 1996.by S.L. Starr PITS MIN 440 LEACHING MIN 1 (13'x16') PIT: MANHOLE/PIT GW MIN 4' BELOW BOTTOM EXC 2x EFF W ORD 12"-4$" STONE BOT + SIDE x LOAD TOTAL (L x W x #) (2x(L+W)xD x #) (G/ft2) CHAMBERS MIN 440 LEACHING GW MIN 4" BELOW" _ COVER >3'-FT_7!:.__VENT Or - MANHOLES 12."-4.8" STONE SPLASH PADS SLOPE .005 BED/TRENCH (Bed max. 60' X 601) MIN 13' X 16' PIT BOT. + SIDE X LOAD = T.OT.AL. (L x W x #) (2 x (L+W)xD x #) (G/ft2) FIELDS MIN 440 GPD 900 ft2 BED GW MIN 4' BELOW BOTTOM OF FIELD ----�> PIPE ENDS JOINED? L/ 4" PEA STONE?.e_� DIST LINE SLOPE .005? L/ >3'COVER-VENT. SCH 40 i�-' MIN 12" COVER RATE �?M /10 ( X !) X = TOTAL L W LDG DOSING TANKS AND PUMPS DIMENSIONS. X. X = PUMP CAPACITY L W D Vol. gpm. DISCHARGE SIZE DISCHARGE RATE DISCHARGE TIME gpm MANHOLES TO GRADE ALARM SEP. CIRC. GW (Min. 1' below inlet) HWL LWL CHECK VALVE BLEEDER HOLE • MANUAL OP. SWITCH ENUF STORAGE? TDH WEIGHTED? Copyright 1996 by S.L. Starr THO January 22, 1997 Ms. Sandy Starr, R.S. Board of Health 146 Main Street North Andover, MA 01845 Re: Lot 2A Rocky Brook Road Dear Sandy: EVE INC. We are in receipt of your disapproval letter dated January 6, 1997 for the above -referenced lot. Please find enclosed three prints of the revised design for this lot. The following revisions have been made to the plan which coincide with your comments: 1) The plan has been designed for trenches 2) Gas deflector added to septic tank detail 3) Access manhole added to septic tank (see profile) 4) N/A 5) Note added that outlet lines from d -box to be laid level for a minimum of 2' 6) Address of owner/applicant has been added to the plan If you have any further questions or concerns please do not hesitate to contact me. We look forward to receiving an approval from you for this lot. Thank you for your time and effort regarding this matter. Very truly yours, THOMAS E. NEVE ASSOCIATES, INC. '7� %�e�Gt n John Morin, E. 1. T. Civil Engineering Consultant JM/km Enclosures • ENGINEERS • • LAND SURVEYORS • 447 Old Boston Road U.S. Route #1 (508) 887-8586 #550 BREEN.WPS • LAND USE PLANNERS • Topsfield, MA 01983 FAX (508) 887-3480 January 6, 1996 Thomas Neve Neve Associates 447 Old Boston Road Topsfield, MA 01983 Re: Lot 2A Rocky Brook Road Dear Tom: This is to inform you that the proposed plans for the site referenced above have been disapproved for the following reasons: 1. According to 310 CMR 15.240(6) trenches are to be used whenever possible. Why are they not proposed on this site? 2. Gas baffle missing from outlet tee. (3 10 CMR 15.227(4)) 3. Manhole needed on tank for access within six inches of final grade. (3 10 CMR 15.228(2)). 4. I recommend a larger D -Box if this remains a field system. 5. Outlet lines from D -Box must be level for a minimum of 2 feet. (310CMR 15.232(c)) 6. Address of owner/applicant missing. (N.A. 6.02g) If you have any questions, please do not hesitate to call the Board of Health Office at the number below. Sincerely, Sandra Starr, R.S., Health Administrator SS/cjp Town of North Andover OFFICE OF COMMUNITY DEVELOPMENT AND SERVICES WILLIAM J. SCOTT Director. January 6, 1996 Thomas Neve Neve Associates 447 Old Boston Road Topsfield, MA 01983 146 Main Street North Andover, Massachusetts 01845 Re: Lot 2A Rocky Brook Road Dear Tom: This is to inform you that the proposed plans for the site referenced above have been disapproved for the following reasons: 0 1 . According to 310 CMR 15.240(6) trenches are to be used whenever possible. Why are they not proposed on this site? 2. Gas baffle missing from outlet tee. (3 10 CMR 15.227(4)) 3. Manhole needed on tank for access within six inches of final grade. (3 10 CMR 15.228(2)). 4. I recommend a larger D -Box if this remains a field system. 5. Outlet lines from D -Box must be level for a minimum of 2 feet. (310CMR 15.232(c)) 6. Address of owner/applicant missing. (N.A. 6.02g) If you have any questions, please do not hesitate to call the Board of Health Office at the number below. Sincerely, Sandra Starr, R.S., Health Administrator SS/cjp BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 FORM 11 - SOIL EVALUATOR FORM Page 2 of 3 Location Address or Lot No. Lot 2A - Rocky Brook Road On-site Review Deep Hole Number: 96-3 Date: 4/1/96 Time: AM Location (identify on site plan) See sanitary disposal system design Land Use: Residential Slope (%) 8-15 Surface Stones Vegetation: Wooded Landform: Ground Moraine weather: Fair Position on landscape (sketch on the back) See sanitary disposal system design (locus map) Distances from: Open Water Body N/A ft Drainage way N/A ft Possible Wet Area N/A ft Property Line 45 +/- ft (from left lot line) Drinking Water Well N/A It Other DEEP OBSERVATION HOLE LOG* Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface (inches) (USDA) (Munsell) Mottling (Structure, Stones, Boulders, consistency, %Gravel) 011-3611 Fill None 3611-4611 A F/S/L lOYR None Organic matter, fibric 2/1 4611-6411 Bg F/S/L 5Y 5/2 Redox @ Gleyed 46" 64" - 112" C1 L/F/S 5Y 6/3 None Some silt loam MINIMUM OF 2 HOLES REQUIRED AT EVERY PROPOSED DISPOSAL AREA Parent Material (geologic): Glacial till, basal Depth to Groundwater: Standing Water in the Hole: 64" Estimated Seasonal High Water: 46" DEP APPROVED FORM -12/07/95 Depth to Bedrock: None Weeping from Pit Face: None Location Address or Lot No. Lot 2A - Rocky Brook Road Method Used: FORM 11 - SOIL EVALUATOR FORM Determination for Seasonal High Water Table Depth observed standing in observation hole 64 inches Depth weeping from side of observation hole inches Depth to soil mottles 46 inches Ground water adjustment feet Index Well Number Reading Date Index well level Adjustment factor Adjusted ground water level Depth of Naturally Occurring Pervious Material Certification Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? Yes If not, what is the depth of naturally occurring pervious material ? I certify that on 11 1?4 (date) I have passed the soil evaluator 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 Z�e►'1� / Date �/ S DEP APPROVED FORM -12/07/95 Page 3 of 3 ,Qep ,h�� p/oYldrd {hl�Ylolrn for ��o ;,',' ,o.; of Boar 00 IVbllll(Iod.lo �i ►ocll 8circ c'1 nvulln � CI Or n C i .InoIIry A' Faclllty ln(or,�l�Ilon '� "'ll Y'11 l'�'l :/'•1' ",.' 1, %i.l' Ir ' ��,.. y, ,,� 1 Slll • 1. �'1''Ii1111'1. �•,.l ' " I'll(Y!Vr '". '': ( � ., i-... ' �•.;', .�,;'��'Y2',,�ffI���Sralem Owner"',�.,�,'., .h r ; • , �'.�%,t •gilt ��)��lf, l:�i'1'1''' I..1,.` Il..ry���: '".•.� ';''�'� ,'�',il fryl'14�'y y, 'i'''I�r1�,I. 11:,P1/ � - '; µl d IlJnl rain lowVon� i, Oale 91 Pvmp1A, ..,' .Q Q'�10�;I' I,1•.I,',1�: Isr.l le. r '.' ° I ;,tri,►.�m�e�J; ree FlAf f or) r? r � ,;'t? "•'•'+ ' '' t'MAE ., .•^ I ;I I,,/1`iilYon Q✓sr)oil 1,f'- . •.�,..y;,•'•`r.�;•1(11'IYI,;r" rl 1�'4 �� tr, � '�� �� ,t� rel• II � �� ru.. I ), ., 'A✓ '�' ;; � �/I'lilj� Irl ', y'�U { I I ' '',�`''�''', I�'��' �I� �(,, 1,� I ''roc'}�•;'� I�`' .,,, ►�� 1;,�'l0 N +{ I�rl< � k�'I �, ��il,�t t�;r lr•' Y/)li/ljM4 n e i n rTvf l _ r N R TOWN OF XTH ANDOVER L) A SYSTEM PU FPINQ RECORI.) SYSTEM OWNER 8t -ADDRESS � l X16 DATE OF PUMPING:/ -- /0- / 0 y 0 1 tM LOCATION -QUANTITY PUMPED:.../- .5- CLSSPOOL: NO-.... . YES.. S00c Tank: NOYES NA rUKE OF SERVICE: Rou'rINE....-. EMEROENCY -EC �El V �ED NOV - 3 2004 TOWN OF NORTH ANDOV HEALTH DEPARTNiEN' OBSERVATIONS: (WD CONDITION /FULL'IYJ COVER HEAVY ORF-ASEBAFFLES IN PLACE .ROOTS LEACKFIELD RUNBACK BXCESSIVE SOLIDS.-- FLOODED SOLID CARRYOVER OTHER EXPLAIN ...... SY&tvm Pwnpod by aim; 177a. C'UMMENTS. ........... L.UN FEN I'S 1'KANS.FbPUL) I -Cl 2