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HomeMy WebLinkAboutMiscellaneous - 915 JOHNSON STREET 4/30/2018tri H K Lot & Street 9is `J�' '`�' SG��"`- Map/Parcel CONSTRUCTION APPROVAL Has plan review fee been paid: (ES:) NO Permit# 11-2 Plan Approval: Date: �� Approved by: lzj7� Designer: 5lGf- _b_4,4C,ee 5�)f Plan Date: 4-1,17199 Conditions: - Water Supply- . L-To�wn Well_ Well Permit: Driller: Well Tests: Chemical Date Approved Bacteria I- Date Approved Bacteria. ]I-- Date Approve Plumbing. Sign -Off: Wiring Sign -Off: Comments: Form "U" Approval: Date Issued Conditions: Approval to Issue: YES By: Final Approval: All Permits Paid? Well Construction Approval? Septic System Construction Approval? Certification? Other Any Variance Needed? FINAL BOARD OF HEALTH APPROVAL: DATE: APPROVED BY: YES YES YES YES YES YES NO NO NO NO NO WE SEPTIC SYSTEM INSTALLATION Is the installer licensed?YES NO Type of Construction: W PAIR New Construction: Certified Plot Plan Review YES 0 Floor Plan Review YES NO Conditions of Approval from Form U S NO Issuance of DWC permit: NO DWC Permit Paid? Y--- 4&,� O DWC Permit#� Installer: IV Begin. Inspection-- _ YES NO �ivnwe+inn Tnornr*inn- Passed: Construction Inspection: Needed: As Built Plan Satisfactory: YES: 1 Approval of Backfill: Date: ABy: Final Grading Approval: Date: By: Final Construction Approval: Date:By: Certificate of Compliance: Approval: Date: �� LT C` -Z -7 orE; FL,.o # Is ,gar A Tf Of 1'4E 45,j6Su9AAe-9 9Te,!p►L. Oeiret1. t7 Is A QEGpp,a VP Tr49 Lcr-r,,j 4 ND E fit: vwlod of s4 i e�►�'1t I rJ� tiYS�f�rr 40Hr0W& 4 rti, PtSGP.E G �?G► E �7 ►J e''rE.� ' 'WLca.e4 rt EI,p Prue 6-,&v 15, 6.0 1 Lr.*.p4 rip w2 Exlsnt.A 15dK55 150, o' i� Jouho.� AS BUILT PLAN OF 20 F'l t. C Eo rl B rlW.A�� P ED HL PP L"f EAC I `ri l o.! OeO of �S cri-ic- O Lje12, 'fd 55. w ra L d%i EI. -D NT 15; rr2 8z 5 SUB'%0-JURFACE DISPOSAL SYSTEM LOCATED IN AS PREPARED FOR _ F20f> GI.A'� DATE: -J L.J I,`? -7, - I `� `� fir► I o 7A SCALE: I ` :- -,� MERRIMACK ENGINEERING SERVICES, INC. PROFESSIONAL ENGINEERS • LAND SURVEYORS 0 PLANNERS 66 PARK STREET 0 ANDOVER, MASSACHUSETTS 01810 or TEL (617) 475-3553,373-5721 Town of North Andover OFFICE OF COMMUNITY DEVELOPMENT AND SERVICES WILLIAM J. SCOTT Director May 7, 1998 William Dufresne 66 Park Street Andover, MA 01810 Re: 915 Johnson Street Dear Mr. Dufresne: 30 School Street North Andover, Massachusetts 01845 This is to confirm that at meeting held on 4/30/98, the North Andover Board of Health granted waivers to allow 15 feet to foundation and a polybarrier for the repair of the septic system at 915 Johnson Street. With these variances, the plans have been approved. If you have any questions regarding this letter, please call the office. Sincerely, Sandra Starr, R.S. Health Administrator cc: Robert Clay Wm. Scott, Dir. PCD File BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 Town of North Andover OFFICE OF COMMUNITY DEVELOPMENT AND SERVICES WILLIAM J. SCOTT Director Merrimack Engineering 66 Park Street Andover, MA 01801 RE: 915 Johnson Street Dear Mr. Dufresne: 30 School Street North Andover, Massachusetts 01845 April 21, 1998 This is to inform you that the proposed plans for the site referenced above have been disapproved for the reasons below. 1. Wetlands disclaimer missing. (N.A. 8.02s) 2. Profile not to scale. (N.A. 8.02c) 3. Elevation of perc test missing. (N.A. 8.02n) 4. Leach field less than 900 square feet minimum. (N.A. 9.01) 5. Abutters' names missing. (N.A. 8.02j) 6. SAS less than 20 feet to foundation. (Variance requested.) Please be aware that all revision submittals must be accompanied with a $25.00 fee. 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 cc: Wm. Scott, Dir. CD&S Robert Clay File BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 DATE . Am BOARD OF HEALTH TOWN OF NORTH ANDOVER SUBSURFACE DISPOSAL DESIGN REVIEW Sheet of FEE PERMIT # /o/,� DATE RECEIVED 4-11or- g APPLICANT ASSESSOR'S MAP I PARCEL # / 71t ADDRESS �p/u� JO�.USO� LOT # STREET # /�' Jp�,t,USp,V <5,7 ENGINEER (� • � U`iC�ES�E�%1'iE.��/1'�/f�GE' ADDRESS 4D �/�.e.� S�- 442 e ac/ Q/VI(n PLAN DATE CONDITIONS OF APPROVAL: APPROVED REVISION DATE DISAPPROVED__ " - (/-� g g, 0 g cj TAT �%�dUTIE•e5' /j/J�/YIES m155/NG , C�• H . �.�a�� Z _ 5.19.5, Z -r -5s 7'�V14A.J D To jovNp�ria� =(f l J 10,Q J P NG E -ECQ U6- 6 TG 6) PLAN REVIEW CHECKLIST ADDRESS 915 �l�(LU� A-6 ENGINEER GENERAL 3 COPIES STAMP L--' LOCUS NORTH ARROW (/ SCALE CONTOURS-"' PROFILE(Sc) SECTIONc/ BENCHMARK -----SOIL & PERCS ✓ ELEVATIONSY WETS. DISCLAIMER WELLS & WETS WATERSHED?_4 DRIVEWAY. WATER LINE FDN DRAIN M&Py SCH40 `-� TESTS CURRENT? SOIL EVAL '__3 • DuF2C5AVe SEPTIC TANK / MIN 1500G '� .17 INVERT DROPA"GARB. GRINDER (2 comps +200) 10' TO FDN ✓ MANHOLEZ-""' ELEV GW ## COMPS. / GB `____ D -BOX v� SIZE ## LINES J FIRST 2' LEVEL STATEMENT �f INLET OUTLET f&10 _ �T ( 2" OR .17 FT) TEE REQ' D? LEACHING MIN 440 GPD? RESERVE AREA 4' FROM PRIMARY? 20 SLOPE" 100' TO WETLANDS X100' TO WELLS'f 4' TO S.H.GW c' (5'>2M/IN) 20' TO FND & INTRCPTR DRAINS 400' TO SURFACE H2O SUPP 4' PERM. SOIL BELOW FACILITY MIN 12" COVERI--� FILL?— (15') BREAKOUT MET? TRENCHES MIN 440 gpd SLOPE (min .005 or 6"/100') SIDEWALL DIST. 3X EFF. W OR D (MIN 6') RESERVE BETWEEN TRENCHES? IN FILL? MUST BE 10' MIN. 4" PEA STONE? VENT? (>3' COVER; LINES >50') BOT + SIDE - X LDNG = TOT ( L x W x #) ( DxLx2x## ) ( G/ f t2') 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 OR D 12"-48" 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 - VENT MANHOLES 12"-48" STONE SPLASH PADS SLOPE .005 BED/TRENCH (Bed max. 60' X 60') MIN 13' X 16' PIT BOT + SIDE X LOAD = TOTAL (L x W x #) (2 x (L+W)xD x #) (G/ft2) FIELDS / MIN 440 GPD -' 900 ft2 BED2 GW MIN 4' BELOW BOTTOM OF FIELD PIPE ENDS JOINED? G-' 4" PEA STONE? f DIST LINE SLOPE .005? Ll- >31COVER-VENT —" SCH 40 `- MIN 12" COVER Z--- RATE m / ( 45- X lS ) X 16,o/ = TOTAL - ?-Md L W Ol LDG - 1 (J Q U /? DOSING TAN KS_AND PUMPS DIMENSIONS X X = PUMP CAPACITY qpm L W D Vol. DISCHARGE SIZE DISCHARGE RATE DISCHARGE TIME gpm MANHOLES TO GRADE ALARM SEP. CIRC. inlet) HWL LWL CHECK VALVE OP. SWITCH ENUF STORAGE? Copyright 0 1996 by S.L. Starr GW (Min. 1' below BLEEDER HOLE MANUAL SEPTIC PLAN SUBMITTALS �^ LOCATION: JS ' 6 NEW PLANS: $60.00/Plan REVISED PLANS: YES . $25.00/Plan DATE: DESIGN ENGINEER.- When NGINEER: When the submission is all in place, route to the Health Secretary � ,10RTH o a q ;,asACHUSE�� Town of North Andover, Massachusetts BOARD OF HEALTH .01/"-19� Form No. 2 DESIGN APPROVAL FOR SOIL ABSORPTION SEWAGE DISPOSAL SYSTEM Applicant aalj- trzL C/a. cJ Test No. OVA Site Location ` !S 7.0— 4-'..5 Reference Plans and Specs. i3 "'/ / ENGINEER DESIGN DATE Permission is granted for an individual soil absorption sewage disposal system to be installed in accordance with regulations of Board of Health. Fee CHAIRMAN, BOARD OF HEALTH Site System Permit No. /©I 0 Date: July 20, 1998 Town of North Andover, Massachusetts BOARD OF HEALTH CERTIFICATE OF COMPLIANCE This is to certify that the Individual Soil Absorption Sewage Disposal System constructed ( ) or repaired ( x ) by -John Soucy, Installer, at 915 Johnson Street, North Andover, MA 01845 has been installed in accordance with Board of Health Regulations as described in the Design Approval Site System Permit # 1010 dated June 5, 1998. The issuance of this certificate shall not be construed as a guarantee that the system will function satisfactory. SS/cjp Revised: 7/20/98 I r toard of Health TOWN OF NORTH ANDOVER SEWAGE DISPOSAL SYSTEM INSTALLATION CERTIFICATION The undersigned hereby certify that the Sewage Disposal System ( ) constructed; () repaired; by 12OU & I ':�P Ewl f t e gr.04ir / JOaO �ZO- U C' ? located was installed in eonformauce with the Andover Board of Health approved plan, System Design Permit # ~moo ' dated , ,with an.approvad design flow of 44+1D ,gallons per day. Ue materials used ere in conformance with those specified on the approved plan; the system was.installed in accordance with the provisions of 310 CMR 15.000, Title S and lova! regulad S, the final grading agrees substantially with the approved plan. All work is -accurately repr d on th7A'It which has bets submitted to the Board of Health. Installer. Lia #: Date: Design EnDate: gin '% 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 17Ae-i�) �ZC� I�E� P H 0 N E LOCATION: Assessor's Map Number 107-A /K PARCEL SUBDIVISION % LOT (S) YSTREET CAAA"".�'A% 5rKSLv� ST. NUMBER�5 Y *********** "***********OFFICIAL USE ONLY*********************************** ,ewolo u -C- 1 Yts f /C X /6 , ��` or.�c- RECOMMENDATIONS OF TOWN AGENTS: Ae���ruva l Fo/1 S CONSERVATION ADMINISTRATOR DATE APPROVED I DATE REJECTED X COMMENTS TOWN PLANNER COMMENTS FOOD INSPECTOR -HEALTH SEPTIC INSPECTOR -HEALTH COMMENTS DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED PUBLIC WORKS - SEWERIWATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR Revised 9\97 jm DATE Town of North Andover, Massachusetts Form No. 3 NORTH BOARD OF HEALTH F � �'°•,�.o��"� DISPOSAL WORKS CONSTRUCTION PERMIT ,SgACHUSEt Applicant � NAME _ ADDRESS TELEPHONE Site Location Permission is hereby granted to Construct ( ) or Repair () an Individual Soil Absorption Sewage Disposal System as shown on the Design Approval S.S. No. /D/ 2 Fee TUC - CHAIRMAN, BOARD OF HEALTH D.W.C. No. 161'/0 TOWN OF NORTH ANDOVER SEWAGE DISPOSAL SYSTEM INSTALLATION CERTIFICATION The undersigned hereby c.-rdfy that the Sewage Disposal System ( ) constructed; �_/) repaired; by f Uh ►�y Ulf l / - - located at 6?/5S OMh /-) --s Z')r) cJ %. — was installed in conformance with the. North Andover Board of Health approved plan, System Design. Permit/Z , dated jd- G/� with an approved design flow of gallons per day. The material's used were in conformance with those specified on the approved plan; the system was installed irraccordance with the provisions of 310 CNIR 15.000, Title 5 and local regulations, and the final gradifig-agrees substantially with the approved plan. All work is accurately represented on the As -built which has been submitted to the Board of Health. Installer: Lic. 'r: Date: Design Engineer: Date: APPLICATION FOR DISPOSAL WORKS CONSTRUCTION PERMIT DATE: CURRENT INSTALLER'S LICENSE# LOCATION: LICENSED INSTALL -, o SIGNATURE: CHECK ONE: REPAIR: 1 C V NE# C �'3, 579t NEW CONSTRUCTION: IF NEW CONSTUCTION, PLEASE ATTACH FOUNDATION AS -BUILT. Administrative Use Only $75.00 Fee Attached? Yes ✓ No Foundation As -Built? Yes No Floor Plans? Yes No Approval Date: )AY -- 5 Applican Site Location Engineer Town of North Andover, Massachusetts Form No. 1 BOARD OF HEALTH A&I c 19 APPLICATION FOR SITE TESTING/INSPECTION SMEADDRI 9/C� '/O/56U.J� Jam; E IVAIVIC AUUKtbb I tLLYHONE Test/Inspection Date and Time AL/%R 7�- CHAIRMAN, BOARD OF HEALTH Fee Test N o. �?3 S.S. Permit No. lb/o?- D.W.C. No. C.C. Date Plbg. Permit No. W, BOARD OF HEALTH 30 SCHOOL STREET TEL. 688-9540 NORTH ANDOVER, MASS. 01845 APPLICATION FOR SOIL TESTS DATE: `I- Z - LOCATION OF SOIL TESTS: %/'� d/ -//US o Assessor's map & parcel number: 101A. Z 1 -1q - OW NER-. -1q-OWNER: )200-Cr4- GZ A Y TEL. NO.: 6 0 ADDRESS- 115 , 1Uf����crJnJ ENGINEER: �i�s f f� �rd�r �. NO..- CERTIFIED O.:CERTIFIED SOIL EVALUATOR: �• %/v%5�� Intended use of land: residential subdivision, single family home, commercial THE FOLLOWING MUST E INCLUDED WITH THIS FORM: 1. Proof of land ownership (Tax bill, deed, or letter from owner permitting tests) 2. Plot plan 3. Fee of $175.00 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 soil evaluation forms shall be submitted. DATE: `% —I _"� — F 9 LOCATION ENGINEER: .I BOH WITNESS: IR VAS PERCOLATION TEST # - . BOTTOM DEPTH OF PERC TEST: .� TIME OF SOAK:�1 1 � � � � 3 (At least 15 minutes long) TIME AT 12"e TIME AT 9" TIME AT 6" i OVERNIGHT SOAK TIME STARTED NEXT DAY SOAK. (At least 15 minutes) TIME AT 12" 1 I TIME AT 9" TIME AT 6" FORM 11 - SOIL EVALUATOR FORM Page 1 Date....lr..l�?.. Commonwealth of Massachusetts Massachusetts New Construction ❑ Repair [� v Office Review Survey Available: No ❑ Yes Published Soil Sur y . � Cbl Year Published Publication Scale... ��Vv Soil Map Unit ...... Drainage Class ....... Soil Limitations........................................................... Surficial Geologic Report Available: No Yes ❑ Year Published Publication Scale GeologicMaterial (Map Unit)........................................................................................................................................................... Landform.............................................................................................................................................................................................................. Flood Insurance Rate Map: Above 500 year flood boundary No ElYes r [� ❑ Within 500 year flood boundary No Yes Within 100 year flood boundary No 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 ❑ Below Normal ❑ other References Reviewed: IoRhs i I - SOIL EVALUATOR FORM Page 2 Deep Hole Number AfQ !.../.... Date:... Time:.- Weather.....St :;y. Location(identi�o site pian)........."a+�.....�.�.`C`.'`......................................................................................................................................... Land Use ........................................................ Slope l%) .�. �3..� Surface Stones . f ............................................................ Vegetation.........R-!........................................................................................................................................................................................................ Landform o..�0 i1�r�rc�cJ�................................................................................................................................................... .............�'?.l:.k......................................................... Positionon landscape (sketch on the back)......................................................................................................................................................... Distances from: , Open Water Body `. feet Drainage way.... feet Possible Wet Area *>19P'.. feet Property Line .... .J :t feet Drinking Water Well'21W... feet Other ......................................... DEEP OBSERVATION HOLE G Depth from Surface Soil Horizon Soil Texture Soil Color Soil Mottling Other (Inches) (USDA) (Munsell) (Structure, Stones, Boulders, Consistency, % Graven 19 - y S L /0 yo- -5/3 V'- A/"to 1 `' C �^ �. s. 2�Y shy �•� � -�r�6(o '&., /oYh�/fa � • rJru�+e� Parent Material (geologic)..............L'..................................................................... Depth to Bedrock: ....dY� Death to Groundwater: Standing Water in the Hole: ... PoLe'Weeping from Pit Face:..... 6.0%' Estimated Seasonal Hign Ground Water:..... NORM 11 - SIAL EVALUATOR FORM Page 2 0 Deep Hole Number A/ -Z. Date:�`f.�O Time-/�Weather .........5............ l� u................................................................................................................................ Location (identify on site plan) ............... ���... Lend Use ............... %t.b.44........................... Slope (%) .v'3`i'�. Surface Stones ........ fi.(.r"',................................................. Vegetation........... ,..r,ti,/.................................................................................................................................................................................................... Landform ................... Cla..0ute�............ .. ................................................................. ............................................................................. Positionon landscape (sketch on the back)......................................................................................................................................................... Distances from: Open Water Body .. t .` feet Drainage way,?: a '.. feet Possible Wet Area ..ztr feet Property Line ...1..5`x:. feet Drinking Water Well...>.I,q�'. feet Other ......................................... Parent Material (geologic) ...................... ..I....!.L(.,.................................................................... . Depth to Bedrock: .. . 9 Death to Groundwater: Standing Water in the Hole: now - Weeping from Pit Face:... u ' Estimated Seasonal High Ground Water:.... DEEP OBSERVATION HOLE G Depth from Surface (Inches) Soil Horizon Soil Texture (USDA) Soil Color (Munsell) Soil Mottling Other (StConst Stones 96 GB alders, !vell o V bc. 3/,71 i�Y�L� ��d Ste• Parent Material (geologic) ...................... ..I....!.L(.,.................................................................... . Depth to Bedrock: .. . 9 Death to Groundwater: Standing Water in the Hole: now - Weeping from Pit Face:... u ' Estimated Seasonal High Ground Water:.... FORM 11 - SOEL EVALUATOR FORM Page 3 Method Used: ❑ Depth observed standing in observation hole ................... inches ❑ Depth weeping from side of observation hole ................... inches ❑ Depth to soil mottles ...t ... .... 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 Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? Ilef If not, what is the depth of naturally occurring pervious material? Certification 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 b.l�� Date Y- / S�% FORM 12 - PERCOLATION TEST COMMONWEALTH OF MASSACHUSETTS � , Massachusetts Site Passed 2/ Performed By: Site Failed ❑ Witnessed By: Y, . kul—V U 0 Comments:....... Percolation Test Date: ............9 . Time: ..... Observation Hole # jov Depth of Perc �Q u Start Pre-soak End Pre-soak Time at 12" ` 3.3 Time at 9" Time a� 6" Iz it/ Time (9"-6") Rate Min./Inch Site Passed 2/ Performed By: Site Failed ❑ Witnessed By: Y, . kul—V U 0 Comments:....... MASSACHUSETTS •,.� t • , s Ka )'' "{ � ��,1,,'1.'h�' f ;:1%r�� .�,Yt � •���tit. f:1.'r.:,. •.het. w.� t r 1;>rlirn•;n;wr'.. .1 A; • '�.N�1,{� J y: i..,r�'I' }(%•�j'?!.<•�..)i:1.�: `: i:'.t:''i.:,,�.lil la•,yj:.. DEP..ha: pro duel t I • form for•usa by local Boar be:ubml(:ted to the.local'Board of Health or other ap�p�o j �orsy tem Pumping Record mss A: Facility Inforn%tlon E 0 7 2007 h_ '•r'..��' .• UQ out'. ; i.. $yStem Location''' TOWN OF NORTH ANDOVER .; f017,T1i.On th°: 'r , HEAL T D PARTMENT '� .. CLYTIpUter, uSe � , .. � r---•.•� only the tab key Address �7cSD.L1 ,S , to move your:: �• .ausor.� do dot : �:, :,, - '�•�l, .. : �'uiat th! ro 'i• . !.' • r.,. �... State—�---_.- '•L- tuiii•:,%, • .CItY/TOWn `': ! p Coda .System Owner':' •:rr , Name' ''>:;•'"' +>:i:j. rt:: • ':J',,,•' Ali ). �, .,.'. r /I.11 '.`•J. �' ' 1, �� dim.01' different from location) CttylTOva. ; �;', State' — ZJ „• �"� ;",r;cJ0 p Code Telephone Number — :.P,um.Pf0g'R,0.9ord: : :�t •1 }.''i:,t�r•.,;: 1 �'{f161,,i, 6 040; Of Pumpinga" Date 2. Quantlty Pumped; . ..., ;:, ::;• ; ';,'' ;i. ;,, •: , Gallons pf,system; : ❑ Cesspools) Septic Tank ❑ Tight Tank : jOther (describe); ;4,Y' Effluent Tee Filte(pr�sant? .❑ Yes ❑ No' If es w y as It cleaned? ❑ Yes ❑ N :.R�:6,,'Cortditlon`.ofSysE, )• : e'k b Pumped .. .., '•; ..�:1.x,5', y. �•�' .1:..':: ` [J.. �� '' 'i 1'. �j.1j u', "'„Aq.' .i i;'/•' :me•i\ C}�,'u'i �%•;: �'•'' 1'.•.' :,t �'v ' ...• ' .�i �: ��. fir;'•;' ;i `�yil;!c):1.:i 4..•��}JY . � 1, : Sic: ,: � .•s ; : , •�; � v .. Y' �r,� J�'; ;' '+' �'•p,. 't'�te'•lir::r ,• �,.• :.J,:; ':�•).YJ,r:j;tlNi ,; I�. , , � i 1v,�V�'; l �.d F� `,r,'!�1-!i.;:lill!t. f •i.4r • Y.S ''!L•. i; ..r{.i�1•v. y'rp,�it hti.�}t%+;r, �';1' t��•')�:.VC�r �; LocaflOrly ere oonterts Wer a di;;posed; " - .,�• •:L:r.,1'�',: .. •r :i.,l' •i�l:•;.'. •i�a:+:rf,.`,r,,:.:i�t';r •'�r , •'"i,.a ` ;i..•a.� �yi#v 'ic,'� ��1i.,t' .... �, k"t' 7t r.r•.y.ii' .. ,a:'•�,.:'%:::.•, :.i;;•...;//Jt>H°;`�,'$�llatur of I,, ',,�: '.'::. ,�:�.., ?,-'i'lLj�,J';���(;,• •; •f. ,.1,.e HauWr; j>:�:;u,Jy{.(�. .'�.•: •.t'. ' httpJA ww.mass,gov/dep/waf8r/approvaJs%t5forms,htm#Inspect t5form4.doa!081Q3 •,� ' I , Yehicle Ucenie Number ' Date Sy:tam Pumping Record ' Page a o; i a Ls �� o cab Julius; ; M.D., Chairman Julius V R. George Caron Edward J. Scanlon BOARD OF HEALTH NORTH ANDOVER MASSACHUSETTS 01845 TEL. 682-6400 SOIL PROFILE & PERCOLATION TEST DATA Town/ Ci No.&Street 0'4"P ' Lot No.----/ 02 U ✓o�i�✓oma Loc./Subdiv. Plan Owner Investigator 0 Observer 1' lev. 0 to i,1 7 7 0 1 1 2 2 3 3 4 4 5 5 6 6 7 7 6 8 D_ 9 10 SOIL PROFILES -DATE ?' Elev. 0 1 2 3 4 5 6 7 8 9 10 3. Elev. -_• 0-� 1 2 3 4 5 6 7 9 10 4. -Elev. Benchmark Location Elevation Datum i Percolation Tests -Date G » � Notes & Sketches on Back Frank C. Gelinas &Associates, North And. Pit Number 1 2 3 4 5 Start Saturation Soak -Mins. Start Test -Time :2 3 Drop of 3" -Time Dro of 611 -Time Mins.lst 3"Dro Mins . 2nd 3"Dro �,,:, 1 3L< 7', 9 : 17 4q a '- 40 IM I,C 1� Y1_ 1';x`'1 = fon. - -b AelA,�/z/ // — o, F. S no s-CQ&d- "0 Ileve, OD AL NJ ra v F) 4-r— cl S no s-CQ&d- "0 Ileve, AL NJ ra v F) 4-r— cl /00.00 ktr� -14 4 0* `. F