HomeMy WebLinkAboutMiscellaneous - 91 VEST WAY 4/30/2018 (2)U Stewart's Septic Service 0 Andover Septic ❑ ; Stratham Hill Septic ❑ Roto -Ram
(978) 372-7471 (978) 475-2593 (603) 772.5548 (978) 452-9022
58 South Kimball Street, Bradford, MA 01835
City /C7 /j _�
Special Instructions
Per:
Services Rendered
PAY FROM THIS BILL
0 Completed
O Incompleted Reason:
vay6um. Pumping
Septic Tank
O Drywall
❑ Leech Pit / Overflow
O D -Box
O Pump Chamber
O Grease Trap
O Catch Basin
O Portable Toilet
❑ Other
city:
Size:
O Under 1000 gallons O 1000 gallons ;1500 gallons
0 2000 gallons O 3000 gallons O 4000 g llons
O 5000 gallons O Other
Misc.
0 Digging Charge
❑ Location ft./in,
0 Service Call
O Labor
❑ Waiting Time
* Digging Charge Is Per Driver
Discretion
Description of work
Recommendations
0 Reg. Nature of Service
O N/C O Reg. Maint.
O Emergency
Septic Tank Pumping and Cleaning O Day o Night
"Done the Right Way"
Not Responsible for Covers
or Irrigation Systems
Observations
Drain Cleaning
Good Condition
❑ Main Line
0 Leechfield Runback
0 Toilet Bowl
O Riding High
O Kitchen Sink
(liquid level)
O Bathtub / Shower
O Full to Cover
O Vanity
O Excessive Solids
O Floor Drain
Top / Bottom
O Vent
O Use No Powdered Soap
O Sewer Jet
0 Heavy Grease
O Other
O Roots
Footage:
0 Suggest Electric
Rootering
O Van Called
O Other
0 Backhoe
O Consultion hrs.
O Estimate
O Portable Toilet Rental
O Baffle
❑ Inspection
O Certification: PIF
Reason:
0 Pump Repair
O Repair
0 Chemical Treatment
O Other
r --
Terms of Payment
Parts
Vacuum Pumping Drain Cleaning NET 15 DAYS
Yr. Month Yr. Month Tax
Discount
Terms & Conditions TO Cash O Check 0 Credit
1. Not responsible for damage beyond curb tine.
2. All complaints shall be reported within 48 hours.
Lk ---
Total _ V.— 3. 1.5%per month w{I) be charged to accounts past due./
4. The purchaser agrees to pay all cost of collection. ��
i man '"
Stry ce
jo
Commonwealth of Massachusetts
_ City/Town of North Andover �,
J :may
S'y'stem Pumping Record
FormACV n � W4
w` DEP has provided this form for use by local Boards of Health. i the f9r�rns-may;betusedbut the
t (t� ,
ng
k with your
�
information must be substantially the same as that provided he%;e. 1'3efore uslRecordf t be submitted o
local Board of Health to determine the form
they
aut authority within 14 day fromnh e pumping, date in
the local Board of Health or other app 9
accordance with 310 CMR 15.351.
Important: When
filling out forms
on the computer,
use only the tab
key to move your
cursor - do not
use the return
key.
a
rarcn
A. Facility Information
1. System Location:
Address I Ma 01886
North Andover State Zip Code
City/Town
2. System Owner:
Name
Address (if different from location)
State Zip Code
City/Town" 7 j
Telephone Number
B. Pumping Record 1 �
i0 1� 2. Quantity Pumped: Gallons
s
1. Date of Pumping Date
3. Type of system: ❑ Cesspool(s) id
Septic Tank ❑ Tight Tank ❑ Grease Trap
❑ Other (describe):
4. Effluent Tee Filter present? ❑ Yes&"V\No
5. Condition pf System:
if.yes, was it cleaned? ❑ Yes ❑ No
6. SYstegl Pumped By: "�!1
M.u�Pti��
Vehicle License Number
Name
Stewart's Septic Service
Company
7. Location where contents were disposed:
20 So. Mill Bradford, Ma 01835
Pre-treatment
t5form4.doc• 03/06
Date
Date
System Pumping Record • Page 1
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.
tab
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
91 Vest Way
Property Address
Joseph & Jean Deluca
Owner's Name
North Anover
City/Town
Ma 01845
State Zip Code
4/24/13
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. General Information
1. Inspector:
John DiVincenzo
J1
MAY 2 3 2013
Name of Inspector TOWN OF NORTH ANDOVER
Stewarts Septic Serive HEALTH DEr�a�rnn�n�T
Company Name
58 South Kimball street
Company Address
Bradford
City/Town
978-372-7471
MA
State
S113386
Telephone Number License Number
B. Certification
01835
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
❑ Neeos Further EXaVation by the Local Approving Authority
nature Dat
The system inspector shall s#mit a py of this inspection report to the Approving Authority (Board
of Health or DEP) within 30 dky§_oKcompIeting this inspection. If the system is a shared system or
has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the
report to the appropriate regional office of the DEP. The original should be sent to the system owner
and copies sent to the buyer, if applicable, and the approving authority.
****This report only describes conditions at the time of inspection and under the conditions of use
at that time. This inspection does not address how the system will perform in the future under
the same or different conditions of use.
t5ins • 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 1 of 17
Owner
information is
required for every
page.
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
91 Vest Way
Property Address
Joseph & Jean Deluca
Owner's Name
North Anover
City/Town
B. Certification (cont.)
Ma 01845
State Zip Code
4/24/13
Date of Inspection
Inspection Summary: Check A,B,C,D or E / always complete all of Section D
A) System Passes:
® 1 have not found any information which indicates that any of the failure criteria described
in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are
indicated below.
Comments:
stem is 30 vears old. passes all title 5 criteria.
B) System Conditionally Passes:
❑ One or more system components as described in the "Conditional Pass" section need to be
replaced or repaired. The system, upon completion of the replacement or repair, as approved by
the Board of Health, will pass.
Check the box for "yes", "no" or "not determined" (Y, N, ND) for the following statements. If "not
determined," please explain.
The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally
unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass
inspection if the existing tank is replaced with a complying septic tank as approved by the Board of
Health.
* A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of
Compliance indicating that the tank is less than 20 years old is available.
❑ Y ❑ N ❑ ND (Explain below):
t5ins • 3113 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 2 of 17
Owner
information is
required for every
page.
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
91 Vest Way
Property Address
Joseph & Jean Deluca
Owner's Name
North Anover
City/Town
B. Certification (cont.)
Ma 01845 4/24/13
State Zip Code Date of Inspection
❑ 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
❑ 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
t5ins • 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 3 of 17
Owner
information is
required for every
page.
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
91 Vest Way
Property Address
Joseph & Jean Deluca
Owner's Name
North Anover
CityrFown
B. Certification (cont.)
Ma 01845
State Zip Code
4/24/13
Date of Inspection
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 'h day flow
t5ins • 3/13
Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 4 of 17
❑ ® 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
Commonwealth of Massachusetts
❑
Title 5 Official Inspection Form
❑
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
°M
91 Vest Way
❑
Property Address
Joseph & Jean Deluca
Owner
Owner's Name
information is
required for every
North Anover Ma 01845 4/24/13
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 • 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 5 of 17
6
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
^M 91 Vest Way
Property Address
Joseph & Jean Deluca
Owner Owner's Name
information is
required for every North Anover
page. City/Town
C. Checklist
Ma 01845
State Zip Code
4/24/13
Date of Inspection
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
been determined based on:
this inspection?
®
❑
Were as built plans of the system obtained and examined? (If they were not
approximation of distance is unacceptable) [310 CMR 15.302(5)]
available note as N/A)
®
❑
Was the facility or dwelling inspected for signs of sewage back up?
®
❑
Was the site inspected for signs of break out?
®
❑
Were all system components, excluding the SAS, located on site?
® ❑
Were the septic tank manholes uncovered, opened, and the interior of the tank
inspected for the condition of the baffles or tees, material of construction,
dimensions, depth of liquid, depth of sludge and depth of scum?
® ❑
Was the facility owner (and occupants if different from owner) provided with
information on the proper maintenance of subsurface sewage disposal systems?
The size and location of the Soil Absorption System (SAS) on the site has
been determined based on:
® ❑
Existing information. For example, a plan at the Board of Health.
® ❑
Determined in the field (if any of the failure criteria related to Part C is at issue
approximation of distance is unacceptable) [310 CMR 15.302(5)]
D. System Information
Residential Flow Conditions:
Number of bedrooms (design): 4 Number of bedrooms (actual): 4
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x # of bedrooms): 600gpd
t5ins • 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 6 of 17
1 1 1
Commonwealth of Massachusetts
_ - Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
91 Vest Way
Property Address
Joseph & Jean Deluca
Owner Owner's Name
information is
required for every North Anover Ma 01845
page. City/Town State Zip Code
D. System Information
Description:
4/24/13
Date of Inspection
Number of current residents: 2 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 years usage (gpd)):
Detail:
Sump pump?
Last date of occupancy:
Commercial/Industrial 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
occupied
Date
❑
Yes
❑
No
❑
Yes
❑
No
❑
Yes
❑
No
t5ins • 3/13 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 91 Vest Way
Property Address
Joseph & Jean Deluca
Owner Owner's Name
information is North Anover
required for every
page. CitylTown
D. System Information (cont.)
Last date of occupancy/use:
Other (describe below):
Pumping Records:
Source of information:
Ma 01845
State Zip Code
General Information
Andover
Date
4/24/13
Date of Inspection
Was system pumped as part of the inspection? ® Yes ❑ No
If yes, volume pumped: 1500gallons
How was quantity pumped determined? site guage on truck
Reason for pumping: inspect tank
Type of System:
® Septic tank, distribution box, soil absorption system
❑ Single cesspool
❑ Overflow cesspool
❑ Privy
❑ Shared system (yes or no) (if yes, attach previous inspection records, if any)
❑ Innovative/Alternative technology. Attach a copy of the current operation and
maintenance contract (to be obtained from system owner) and a copy of latest
inspection of the I/A system by system operator under contract
❑ Tight tank. Attach a copy of the DEP approval.
❑ Other (describe):
t5ins • 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 8 of 17
Commonwealth of Massachusetts
F W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
91 Vest Way
Property Address
Joseph & Jean Deluca
Owner Owner's Name
information is
required for every North Anover Ma 01845 4/24/13
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:
30 vears
Were sewage odors detected when arriving at the site?
Building Sewer (locate on site plan):
Depth below grade: 5.5feet
Material of construction:
® cast iron ❑ 40 PVC ❑ other (explain):
Distance from private water supply well or suction line: feet
Comments (on condition of joints, venting, evidence of leakage, etc.):
Septic Tank (locate on site plan):
Depth below grade:
Material of construction:
® concrete ❑ metal
4.5' B.T.G.
feet
❑ fiberglass ❑ polyethylene ❑ other (explain)
If tank is metal, list age: years
Is age confirmed by a Certificate of Compliance? (attach a copy of certificate)
Dimensions:
Sludge depth:
❑ Yes ❑ No
t5ins • 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 9 of 17
Commonwealth of Massachusetts
u Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
°M 91 Vest Way
Property Address
Joseph & Jean Deluca
Owner Owner's Name
information is
required for every North Anover Ma 01845 4/24/13
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
Distance from top of scum to top of outlet tee or baffle
Distance from bottom of scum to bottom of outlet tee or baffle
27
1"
6"
15"
How were dimensions determined? tape measure, sluge 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.):
Both baffles in place, structuly sound, no leakage.
Grease Trap (locate on site plan):
Depth below grade:
Material of construction.-
F-1
onstruction:❑ concrete ❑ metal ❑ fiberglass
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:
t5ins • 3/13
a
feet
❑ polyethylene ❑ other (explain):
Date
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
91 Vest Way
Property Address
Joseph & Jean Deluca
Owner Owner's Name
information is
required for every North Anover
page. City/Town
Ma 01845
State Zip Code
4/24/13
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
Date of last pumping: Date
Comments (condition of alarm and float switches, etc.):
❑ Yes ❑ No
"Attach copy of current pumping contract (required). Is copy attached? ❑ Yes ❑ No
t5ins • 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 11 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
91 Vest Way
Property Address
Joseph & Jean Deluca
Owner Owner's Name
information is
required for every North Anover Ma 01845 4/24/13
page. Cityfrown 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
L
Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any
evidence of leakage into or out of box, etc.):
D -box level good, no leakage, no solids carry over.
Pump Chamber (locate on site plan):
Pumps in working order: ❑ Yes ❑ No*
Alarms in working order: ❑ Yes ❑ No*
Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.):
* If pumps or alarms are not in working order, system is a conditional pass.
Soil Absorption System (SAS) (locate on site plan, excavation not required):
If SAS not located, explain why:
t5ins • 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 12 of 17
Commonwealth of Massachusetts
w W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
91 Vest Way
Property Address
Joseph & Jean Deluca
Owner Owner's Name
information is
required for every North Anover
page. CitylTown
State
01845
Zip Code
4/24/13
Date of Inspection
D. System Information (cont.)
Type:
❑
leaching pits
number:
❑
leaching chambers
number:
❑
leaching galleries
number:
®
leaching trenches
4@54'
number, length:
❑
leaching fields
number, dimensions:
❑
overflow cesspool
number:
❑
innovative/alternative system
Type/name of technology:
Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of
vegetation, etc.):
No Hydraulic failure, no ponding, no damp soils.
Cesspools (cesspool must be pumped as part of inspection) (locate on site plan):
Number and configuration
Depth — top of liquid to inlet invert
Depth of solids layer
Depth of scum layer
Dimensions of cesspool
Materials of construction
Indication of groundwater inflow ❑ Yes ❑ No
t5ins • 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 13 of 17
Owner
information is
required for every
page.
t5ins • 3/13
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
91 Vest Way
Property Address
Joseph & Jean Deluca
Owner's Name
North Anover
City/Town
D. System Information (cont.)
Ma
State
niRa.r;
Z -1p %,VUV
4/24/13
Date of Inspection
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.):
Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 14 of 17
Commonwealth of Massachusetts
- Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
91 Vest Way
M
Property Address
Joseph & Jean Deluca
Owner Owner's Name
information is
required for every North Anover
page. Cityrrown
D. System Information (cont.)
Site Exam:
®
Check Slope
❑
Surface water
®
Check cellar
❑
Shallow wells
State
01845
Zip Code
4/24/13
Date of Inspection
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
M.
III
E
If checked, date of design plan reviewed: 3/4/83
Date
Observed site (abutting property/observation hole within 150 feet of SAS)
Checked with local Board of Health - explain:
pulled file
Checked with local excavators, installers - (attach documentation)
Accessed USGS database - explain:
You must describe how you established the high ground water elevation:
plans drawn by flvnn assoiastes water Ca. Elvation 142 bottom of trench elevation 146.
Before filing this Inspection Report, please see Report Completeness Checklist on next page.
t5ins • 3113 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 16 of 17
N Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
"M 91 Vest Way
Property Address
Joseph & Jean Deluca
Owner Owner's Name
information is
required for every North Anover Ma 01845 4/24/13
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
t5ins - 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 17 of 17
RECZ 16�
Commonwealth of Massachusetts
City/Town of Uj 1 0 20iz
System Pumping Record ;� :rte #I. r,,R
Form 4
DEP has provided this form'for use by local Boards of Health. Other forms may be used, -but the
information must be substantially the same as that provided here. Before using this form, check with your
local Board of Health to determine the form they use. The System Pumping Record must be submitted to
the local Board of Health or other approving authority.
A. Facility Information
1. System Locatio Rig ron o house eft / Right rear of house, Left / right side of house, Left /
Right side of bus , Left / Right fron of building, Left / Right rear of building, Under deck
Address
Citylrown (� v State Zip Code
2. System Owner.
Name
Address (if different from location)
City/rown
B. Pumping Record
I. Date of Pumping
3. Type of system: ❑
State � � � _ �,,Zip Cod
Telephone Number 6J
Date 2. Quantity Pumped:
Cesspool(s) Septic Tank
❑ Other (describe):
4. Effluent Tee Filter present? ❑ Yes No
Gallons
❑ Tight Tank
If yes, was it cleaned? ❑ Yes ❑ No
5. Condition o)f. My 'O J � ✓�" +Cx-�
6. System Pumped By:
Neil Bateson
Name
Bateson Enterprises Inc
Company
7. Locatle contents were disposed:
Waste Water
t5form4.doc• 06/03
F5821
Vehicle License Number
- �r t l C) -
.5a Date
System Pumping Recons • Page 1 of 1
Commonwealth of Massachusetts
City/Town of
System Pumping Record
Form 4
DEP has provided this form for use by local Boards of He;
information must be, substantially the same as that provide
local Board of Health tQ, determine the form they use. The
the local Board of Health or -other approving authority.
AaRsHVW9§WfJ's d, but the
, check with your
mping Record must be submitted to
A. Facility Information
1. System Location: Left side of house, Right side of house LWigreiar�o�f
use Right front of house,
Left rear of house, Right rear of house. Left rear of buildingbuilding.
Address R C t ! Q�
Cityrrown
2. System Owner:
Name
Address (if different from location)
City/Town
B. Pumping Record
1. Date of Pumping
3. Type of system: ❑
❑ Other (describe):
P6kAA-\- k
State
Zip Code
St Zip Code
Telephone Number
—3v -co
Date 2. Quantity Pumped
Cesspool(s) eptic Tank
Gallons
❑ Tight Tank
4. Effluent Tee Filter present? ❑ Yes [3'Iq-o-— If yes, was it cleaned? ❑ Yes ❑ No
5. Condit• ion ofcte�"�
6. System Pumped By:
Neil Bateson
7
F5821
Name Vehicle License Number
Bateson Enterprises Inc
Company
t5form4.doc• 06/03 System Pumping Record . Page 1 of 1
Commonwealth of Massachusetts
City/Town of ;e.cord
System Pumping Record
Form 4SEP DEP has provided this form for use by local Boards of Healt . Other formbut the
information must be. substantially the same as that provided L Befog@ check with your
local Board of Health tQ determine the form they use. The S It be submitted to
the local Board of Health or otter approving authority.
A. Facility Information
1. System Location: Left side of house, Right side of hous �rear
ight front of house,
Left rear of house, Right rear of house. Left rear of building.ng.
Address
Cityrrown State Zip Code
2. System Owner:
Name
Address (if different from location)
City/Town
B. Pumping Record
1. Date of Pumping
3. Type of system: ❑
Stat Zip C e
g cf
Telephone Number
Date Quantity Pumped: Gallons
Cesspool(s)eptic Tank ❑ Tight Tank
❑ Other (describe):
4. Effluent Tee Filter present? ❑ Yes O_No
If yes, was it cleaned? ❑ Yes ❑ No
5. Condition of System:
r-\ D�- t�6LA 1� V\_ +:�541�
6. System Pumped By:
Neil Bateson F5821
Name Vehicle License Number
Bateson Enterprises Inc
Company
7. Location where contents were disposed:
,,P"L.S.D Lowell Waste Water
Signature of Hauler Date
t5form4.doce 06/03 System Pumping Record • Page 1 of 1
Important:
When filling out
forms on the
computer, use
only the tab key
to move your
cursor - do not
use the return
key
_ I
Commonwealth of Massachusetts -'
City/Town of
System Pumping Record OCT - 2008
Form 4
DEP has provided this form for use by local Boards of Health. Other forms may be used, -but the
information must be substantially the same as that provided here. Before using this form, check with your
local Board of Health to determine the form they use. The System Pumping Record must be submitted to
the local Board of Health or other approving authority.
A. Facility Information
1. System Locat' n:
Gam_ v
Address 91 �f (� -C
Wrown State
2. System Owner. UO-�
Name
Address (if different from location)
City/Town
Zip Code
State ^ � ^ � �p Code
Telephone gumber
B. Pumping Record q_-- RHDF-s
1. Date of Pumping 2. QuantityPumped: p g Date p Gallons
3. Type of system: ❑ Cesspool(s) 9—Septic Tank ❑ Tight Tank
❑ Other (describe):
4. Effluent Tee Filter present? ❑ Yes 9-40If yes, was it cleaned? ❑ Yes ❑ No
5. Condition of Syst I,/\ o I '�Aa "a k
6. Systerp P mpod By:
Name
ej
Company
�' R�1s 1h
Vehicle License Number
l
t5form4.doc• 06/03 System Pumping Record • Page 1 of 1
Important:
When filling out
forms on the
computer, use
only the tab key
to move your
cursor - do not
use the return
key.
VQ
a 10
Tenn
Commonwealth of Massachusetts
City/Town of
System Pumping Record
Form 4
;-� ;-.ems►'„ i ti
SEP 14 2007
TOV`iti Ci NOr" -1 A^ tKAIER
HEALT�-' DEPA,2; A,,r'NT
DEP has provided this form for use by local Boards of Health. Other forms may be -used, but the
information must be substantially the same as that provided here. Before using this form, check with your
local Board of Health to determine the form they use. The System Pumping Record must be submitted to
the local Board of Health or other approving authority.
A. Facility Information
1. System Location: 'D4-- DU
Address A),
Cityrrown Stike
2. System Owner:
Name
Address (if different from location)
Cityrrown
Zip Code
Stat!2 Zip Cgsie
Telephone Number
B. Pumping Record 9-0-cJ7
1. Date of Pumping Date 2. Quantity Pumped:
3. Type of system: ❑
❑ Other (describe):
Gallons
Cesspool(s) [-Sep is Tank ❑ Tight Tank
4. Effluent Tee Filter present? ❑ Yes 0-110---"
5. Condition of System:
6. Systqln Ptfmped By:
If yes, was it cleaned? ❑ Yes ❑ No
Name
Company
7. Locatire contents were di ed:
on
Vehicle License Number
Date
t5fonn4.doc• 06103 System Pumping Record • Page 1 of 1
Commonwealth of Massachusetts
City/Town of RECEIVdaz
System Pumping Record
Form 4 SEP 2 5 2006
4,y
TOWN OF NORTH Ar ^O� �R
DEP has provided this form for use by local Boards of Health. The SystemTPumptng;Re�cordi must
be submitted to the local Board of Health or other approving authority. .
A. Facility Information
.Important:
When filling out 1
forms on the
computer, use
only the tab key
to move your
cursor - do not
Systein Locati
Address ► 1
use the:retum Cityfrown
key.
2. System Owner:
Name
Address (if different from location)
c
Zip Code
Cityfrown Stat
Zip Chdw
Telephone Number
B. Pumping Record
1. Date. of Pumping Date 2. Quantity Pumped:
Gallons
3. Type of system: ❑ Cesspool(s) ❑ epr8" tie Tank- ❑ Tight Tank
❑ Other (describe):
4. Effluent Tee Filter present? ❑ Yes 19'No If yes, was it cleaned?
❑ Yes ❑ No
5. Condition of Systern:� �I
6. System um a y'
Name �� Vehicle License Number
Company
7. Locati w ere ontent dif�ed:
Sign ure auler Date
http://www.mass.gov/dep/w to approvals/t5forms.htm#inspect
t5form4.doc• 06103 System Pumping Record • Page 1 of 1
SOIL PROFILE & PERCOLATION TEST DATA
North Andover, Mass. Street No V C li;;r Lot No 2-'2- (o
Loc/Subdiv. o (.SG- S Pland Owner
Investigator 'SI -4A -F-5 ego Observer
SOIL PROFILE DATES
1.Elev 2.Elev 3.Elev 4.Elev
0
l
c
2
3
I4
15
6
Benchmark
Elevation
0
1
2
3
1
0
1
2
3
3
' 6
0
_ 6
Start Saturation
5
1
5
3
' 6
0
_ 6
Start Saturation
7
7
Soak -Minutes
ar e
— 9
9
10 .
10
DATES
I
0
1
2
3
4
5
6
7
8
9
10
Tiles to Test
Pits
Location
Datum
PERCO;,ATION TESTS
i
Pit Number
1
2
3
4
Start Saturation
Soak -Minutes
ar e
Drop of 3" -Time
-Drop of 6" -Time
M622 - lst 3" drop
Mins.2nd " Drop_
Percolation
U, -)-r 3 c0
1
7-12:2;, (S-31
F1 I PN-
JulL r1MVf.1LA , a rr ttWuillvar 1rw71 �uaie�
North Andover, Mass. Street No � T Wa\-(• Lot No 3(D
Loc/Subdiv. Pland OwnerGO
Investigator Observer
SOIL PROFILE DATES
1Alev 2.Elev 3.Elev 4.Elev
Benchmark
Elevation
0
1
2
3
4
5
6
7
8
9
10
DATES
0
1
2
3
4
5
6
7
8
9
10
I
Location
Datum
PERCO�TION TESTS
r,l B V
0
1
2
3
4
5
6
7
8
9
10
Tres Pto Test
1
Pit Number
1
2
3
4
Start Saturation
0419
Soak -Minutes
;
ar e
Drop of 3" -Time
;
Drop of 6'1 -Time
11• Z
M6ns.Ist 3" drop
Z(i
-
Mins.2nd " Drop35'
Percolation
Z.
Ilk- AL T',j C, U bT
LUI J(
A
I DI S A.-� I i'(j v a F ass_/ -
AP PF CN ED DATE
Reasons:
Frovide,d*.
FAIL
LA 114 — — - I I
CK
Title V
Reg 2.5 Afbe r -to a minimum.
Amitted plan must show as &
the lot to be served-are-ajdimen's-Ionn lot #,abuttcrs
location and log deep observation boles-distrnee to ties
location and results percolation tests -distance totieschin are,&
design calculations & calculations shouring requilg
location and dimensions of system -including reserve area
L/ I existing and proposed contours
locat, n any vt areas vithin 1001 Of sewage disposal systun or
di scle-mer- check wetlands napping loot of s"-Rge disposal
subsurface drains i4thin
sr face and
-jyst.cm or ei-sclainer
X(i location vz�y -Ilts -t�t.Mn 1001 of Bei-ge
di �osPl
Ysystem or cItsc1airsr-P3_vuib3g DD<trd files
) "Durcus of -.7-A :r sig -ply vriti-In 2001 of rv,,-e dispor-al
systcm or edsclainer
location of any proposed imll. to serve lot -1001 from leaching facilit�
location of later lines on property -101 from leaching facility
�n) location of benchmark
drive vmys
garbage dispo sals ion
no PVC to be used in construct
(onI rb tn_�
(q) pi of _-y,_�temelezations of basereent., Plu '9 Pipe., Septic
elstribution box inlets and outletsj, distribution field piping and
U1j-.ar elevations
tion in area sewage disposal system
L-,-tyji�:am groi,nd iter Pleva
s) plan viust be prepart:d by a jr0fcs,_jo, al Mginocr or other
Drofessicra tathorlized by law to prepare such plans
Sgtic Tanks
Reg 6 t/ — , itjes-150% of flow., voter table., tees., depth of tens,capac purging
K) cleanout
�C) lot from cellar wall, or inground sut=ing pool
r
F_ (d) 251 from subsurface drains
Rcg 10.2 Distribution Boxes
)
aslope grf-4ter than 0.08
_A].
Fcg 10.4 _,�b) vwV
7.
L! I:-, t� I
_4z
Reg 11.2
11.4
11.10
11.11
Reg 15.1
15.4
X5.8
3.7
Reg 14.1
14.3
14.4
14.6
ih-10
Reg 9.1
°.6
FAIL
OX
Ler:cr Pits
LeaJJrg pit9rre prcfarred ,,',ere the installation is possible
a) calculations'of leaching area-minimum 500 eq ft
b) spacing ! /
,c surface drainage 2%
d) cover aaterlal
e) 21ly- " splash pad
f} #tee at elbow
no bends in pipe from d-box to pipe
Leaching Fields
a) no greater 20 minutes/inch
b� area-mii 900 sq ft
c cons on of field
d) our a drainage 2 %
e) 2 from cellar im11 or inground ndnning pool
Leachi.n ► Trcnches -
} calculations of leaching Area-rain 500 8q ft
spacing-4 ft min 6 ft with reserve betyweea
dirmasions
onsta-action
f} zarfa^s J. -�i!%ige 2%
Downhill Slope
ss osppe�y/'x = to be shown
b) y/x X 150 = (to be shoiwra)
I
a) ap p 4a1
b) s d-by poser
N
c -!r. Cnri.es Foster
znsp:�ctor
And_'over, MA3S.
!'nor a•:r. l,oster.
March 29, 1983
Please witt hol.ci Issuance of
foundation permits oi-. 'Lots 36 .r 47 Vc- VH t i, ._�. r uta
L 1, •.? i .
din 4';c^vP .;;n to correct fz ,�."c4d j:ii7�:Z ;Ti IIO int OW1 ?SY
in the revised plarls.
Very truly yours,
lel "Osat,
,005 Sv�v�a 3 a
(Board of Health
North An42yer,IMasa.
BBPTIC STSTEK
INS'TALLATICK CHECK LIST
LOT 3lo VEST'
EXCAVATION OK FAIL
1.
Distance Tot
ja.
Wetlands
b. brains
c. Well
2.
Water Line Location
3•
No PPC Pipe
4.
Septic Tank
a. _Tees-_Letngth & To Clean Oat Covers. .
b. Cement Pipe to Tank -- On Both Sides of Tank
5.
Distribution Box
a. Covers & Box - No Cracks
b. All Lines Flowing Equal Amounts
c. No Back Flow
6.
- Leach Field or Trench
a. Dimensions
b. Stone Depth
c. Capped 'Ends
d. Clean Double Washed Stone
7.
L/alh
abh
cs
deeto Pit - Both Sides
f. Clean Double Washed Stone
8.
No Garbage Disposal
9.
Final Grading Inspection
10.
Barricading Covered System
11.
As Built Submitted
a. Lot Location
b. Dimensions of System
c. Location with Regard -to Pere Test
d. Elevations
e: Water Table
ti
^4c~sLas L
SUBSUP_ME DI&POS,AL DEE ICS CEFBOK LIST
APPROM ` DATE
Provided:
/— PcWc. 7Z2
2 r Sy P,4' 7V '3e -a O!c
DISAPPROVED DATE
Reasons:
LOT # 3Co JCST
Title V
FAIL
CK
Reg 2.5
The submitted plan must show as a minimum:
the lot to be served-area,dimensions lot ##abutters
location and log deep observation hoes -distance to ties;
location and results percolation tests -distance to ties
design calculations & calculations showing requid leaching area
relocation and dimensions of system -including reserve area
1di)
) existing and proposed contours
) location any Wet areas vithin 1001 of sewage disposal system or
disclaimer -check wetlands mapping
(h) surface and subsurface drains within 100' of sewage disposal
system or disclaimer
(i) location any drainage easements Within 1001 of sewage disposal
system or disclaimer -Planning Board files
(j) knosn sources of water supply within 2001 of sewage disposal a
system or disclaimer
(k) location of any proposed well to serve lot -1001 from leaching facilit,
(1) location of water lines on property -101 Brom leaching facility
m) location of benchmark
(n) driveways
o) garbage disposals
) no PVC to be used in construction
(q) profile of system -elevations of basement, plumb, pipe, Septic tank,
distribution box inlets and outlets, distribution field piping and
ether elevations
(r) maximum ground water elevation in area se -wage disposal system
s) plan mast be prepared by a Professional Engineer or other
professional authorized by law to prepare such plans
Reg 6
Aa)
Septic Tanks
capacities -15D of flow, mater table, tees, depth of tees,
access, pumping
b) cleanout
(c) 101 from cellar wall or inground swimming pool
(d) 251 from subsurface drains
Reg 10.2
Reg 10.4
Distribution Boxes
a) s pe greater than 0.08
b) soap
�l • 1�emC- -ry JG-2.tr-It
x,
l C/P'bo Q 1 4vuse
._
Z. i �1
Lti is
Li�i P£^s 2
Leashing Pits
Leaching pits are pre d where the installation is possible
Reg 11.2
3-1.4
11.10
11.11
a) calculations o eaching area-ml nimcm 500 eq ft
b) spacing
c) surface drainage 2%
d) cover material
e) k'x2t R splash pad
f) tee t elbow .
g) bends in pipe from d-box to pipe
Reg 15.1
15.4
15.8
3.7
Leaching Fields /
a) no greater than,zo x1nutes/inch
b) area-minimum 900 sq ft
c) construction of field
d} surface,,&ainage 2 %
e} 201 firm cellar va11 or ingronnd mdmadng pool
14.3
14.4
Reg 14.1Tf
Leaching IDcmches
c �,A -ions ofleaching area-min 500 sq ft
spacing-4 ft min 6 ft with reserve between
dimensions
14.6
construction
114.7
1!4.10
stone
surface drainage 2%
Downhill Slope
a) s ope y xto be shown)
b) y/x X 150 - (to be shown)
Reg 9.1
9.6
s
a approval
) stand-by power
1141v,
eD
FaOLA
1 S C, l.j . 40 1?J (, t':,- �'�� c,err�D FJ� 4�ER- 'DP-4 06 S
TOWN OF N • .div e,`
SYSTEM PUMPING RECORD
DATE: �- 0 S
SYSTEM OWNER & ADDRESS
SYSTEM LOCATION
(example: left front of house)
Ie�} -w -6k VLtj"4se
DATE OF PUMPING: S QUANTITY PUMPED: GALLONS
CESSPOOL: NO YES .SEPTIC TANK: NO
YESy
NATURE OF SERVICE: ROUTINE k EMERGENCY
OBSERVATIONS:
GOOD CONDITION
HEAVY GREASE
ROOTS
EXCESSIVE SOLIDS
SOLIDS CARRYOVER
FULL TO COVER
BAFFLES IN PLACE
LEACHFIELD RUNBACK
FLOODED
OTHER (EXPLAIN)
SYSTEM PUMPED BY: Bateson Enterprises, Inc.
CONIlVIENTS:
coNTENTs nuNsFEmED To: G.L.S.D V Lowell Waste
TOWN OF - (111
SYSTEM PUMPING RECORD
DATE:Q3
SYSTEM OWNER & ADDRESS
U- CA
X11 U4 Wai,
SYSTEM LOCATION
(example: left front of house)
14 0
�
DATEOFPUMWING:
1,1712—LIQUANTITY PUMPED : 0-0 GALL NS
CESSPOOL: NO YES SEPTIC TANK: NO YES
NATURE OF SERVICE: ROUTINE EMERGENCY
OBSERVATIONS:
GOOD CONDITION
HEAVY GREASE
ROOTS
EXCESSIVE SOLIDS
SOLIDS CARRYOVER
FULL TO COVER
BAFFLES IN PLACE
LEACHFIELD RUNBACK
FLOODED
OTHER (EXPLAIN)
SYSTEM PUMPED BY: Bateson Enterprises, Inc.
COMMENTS:
coNTENTs TRANsFERRm To: G.L.S.D V Lowell Waste
�i
TOWN OFP B0'7-,
SYSTEM PUMPING RECORD
d VO 14 2002
DATE: 11-11-0c),
SYSTEM OWNER & ADDRESS
SYSTEM LOCATION
(example: left front of house)
C� =p � "A 64 --
DATE OF PUMPING: � (1 --0 &-QUANTITY PUMPED: ` GALLONS
CESSPOOL: NO YES SEPTIC TANK: NO YES
NATURE OF SERVICE: ROUTINE EMERGENCY
OBSERVATIONS:
GOOD CONDITION
HEAVY GREASE
ROOTS
EXCESSIVE SOLIDS
SOLIDS CARRYOVER
FULL TO COVER
BAFFLES IN PLACE
LEACHFIELD RUNBACK
FLOODED
OTHER (EXPLAIN)
SYSTEM PUMPED BY: Bateson Enterprises, Inc.
COMMENTS:
CONTENTS TRANSFERRED TO:
Commonwealth of Massachusetts
-A). Amr�ei:L, Massachusetts
System Pumping Record
System Owner
�e �C C�
Date of Pumping: ) 0 5—
C)D
cesspool: No M/ Yes Ll
System Location
Quairiity Pumped: 15-"`" gallons
Septic Tank: No U Yes LI
System Pumped by: SireQort 51f& ,44ma License #
Contents transferrred to : Greater Lawrence Sanitary District
Date:
Inspector:
►i
ELEVATIONS
''`---.. . • TOR f=OU NDAT IQry : i 5
DWELLING OUTLET:4MI2.
''••- 'SEPTIC TAvi� INLET=1
5EPTICTAHKOUTi-ET-14(j.33 ,
4� ' D BOX .FLET: f4Ra4
I D BOX OUTLET: 1402
A E N D OF TRENCHA 1=149.41
2:145
i f 3' 148.50'
< G .
n 4' 147.96
S
' 3►^ ' F �'�. $5:147.06
r
NQjE
� r
!• BOUNDARY- AND DWELLIR G LOCATION }
4O? r r
I
FROM FORt,i A PLAN 'C3Y R.F.M ,`
INSKI ►
AND ASSCC-
CERTIFY TffAT. THE SUM, WAs
INSTALLED AS SHOWN AND WITH
CONSTRUCTION MATERfAO AS
SPZCIFIED IN THE RELATED DESIGN. ?
PLAN of AS -BUILT
CONDITION S
LOT 36 B -VEST ViAY
OWNER. MATLYN RsT. .
DATE_8-11-83 SCALE: I° 40'
"`- PREPARED BY:
FLYNIV A-330cjr(l
PCS. BOX 569
PLAISTOW N.H. 03865
OF
r. 4 1
• ^ i� t
LOT 36. e�•_
694064 lik = ``'•>
t
ILI
i
I