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HomeMy WebLinkAboutMiscellaneous - 95 SUMMER STREET 4/30/2018 (2)n� Ci cn cn � c o rn -� m ui ;V1 C) ;u C) 1 o rn o rn c:, -+ iJ TO: NORTH ANDOVER, MASS 0 9`f BOARD OF HEALTH FROM: DESIGN ENGINEER Re: Soil Absorption Sewage System Inspection This is to certify that I have inspected the construction of the said disposal system at 1–� l Su ltit /y1 e R S 7`— North Andover, Mass. SITE LOCATION i The grades and construction are as specified in my plans and specifications dated �' �6 19-� 9 0 i , s ILA � � � � F r,,.;�.��--. ``' ._ .� _,�,.:�-'"''-"•—"�. may- � j� y % �M1 O , t` A. I e r� 5T c O - Y w •p (+t � � (� S? O � O O LIN (A �t10 7rn D 00°• ' to 1 if 4 •A lb 0 0°° ohmg� ft) otn l tb�►n�. O tsrn Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. K ielrm Commonwealth of Massachusetts City/Town of NORTH ANDOVER, MASSACHUSETTS System Pumping Record Form 4 DEP has provided this form for use by local Boards of Health. The System Pumping Record must be submitted to the local Board of Health or other approving authority. A. Facility Information RECEIVE System Location: Q's Som Address t �Y)�o�/' City/Townwnn—}`n _ 2. System Owner: lqmq���. Name Address (if d City/Town State MAY 17 2006 EALTH DEPARTMENT I I -- Z.) ( 6 q"S --)(6q"S Zip Code State 1 Zip Code C�V- - G/ phone e N umber B. Pumping Record 1. Date of Pumping Date 11206 2. Quantity Pumped: 16� Gallons 3. Type of system: ❑ Cesspool(s) OD,S ptic Tank ❑ Tight Tank ❑ Other (describe): 4. Effluent Tee Filter present? ❑ Yes ❑ No If yes, was it cleaned? '❑ Yes ❑ No 5. Condition of System: _ con,rtg� S � 6. System Pumped By: Name Vehicle License Number W if)- ---- Company 7. Location where contents were disposed: Signature of 1116or http://www.mass.gov/dep/water approvals/t5forms.htm#inspect �(- Date t5form4.doc• 06/03 System Pumping Record • Page 1 of 1 Commonwealth of Massachusetss : Massachusetts System Pumping Record Owner Location A,, d uLf C" vz- Type: Emergency Routine Cesspool: w Yes Date of Pumping: a/ /Cf TO/ System Pumped By: Contents transferred to: Contents Disposed at: Date: Wind River Environmental, LLC of System/Other Comments (��, 1,S Pumper Signature: Dep Approved From - 12/07/95 Form 4 -- System Pumping Record Septic tank: No =Yes Ef Quantity Pumped: Q 45—C)o Gallons Permit #: System Owner Jamos Demotuen 95 Summer Street North Andover, MA 01845 (978) 681-5681 Type: Emergency Cesspool: No Date of Pumping: 0 �2 Form 4 -- System Pumping Record Commonwealth of Massachusetss : Massachusetts System Pumping Record tem Location Jamea 95 Summer Street North Ardover< MA 01145 (978) 681-5681 Routine Yes System Pumped By: Wind River Environmental, LLC Contents transferred to: Contents Disposed at: Date: of System/Other Comments Pumper Signature: Dep Approved from - 12/07/95 Septic tank: No Yes �— Quantity Pumped: Gal ns Permit #: CO�1NtON�4'EALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE WINTER STREET, BOSTON, MA 02108 (617) 292-5500 y JrC secretary 0 :)._ UT sovernoc SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Lnun:ssicner PART A CERTIFICATION Property Address: J� �rirn�re:St. N. gAA�m,F Mame of Owner Address of Owner: s!i irnt .Date of Inspection: 9/4S'/7y Name of Inspector; (Please Print) Charles Roux I am a DEP approved system inspector pursuant to Section 15:340 of Title 5 (310 CMR 15.000) Company Name: Tewksbury Sewer Service Mailing Address: 213 Patten Rd., Tewksbury, MA 01876 Telephone Number: (978) 640-9984 CERTIFICATION STATEMENT certify that I have personally inspected the sewage disposal system at this address and that the information reported beiow is :rue. accurate end complete as of the time of inspection. The inspection was performed based on my training and experience in the orooer function and maintenance of on-site sewage disposal systems. The system: _ Passes' Conditionally Passes Needs Further Evaluation By the Local Approving Authority Fails Inspector's Sig arhme: Date: �✓ / The System Inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or OEP)within thirty .'30) 'Jays Of completing this inspection. !f the system is a shared system or has a design flow of 10,000 gpd or greater. *,he inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent -.o 'he system owner and copies sent to the buyer, if applicable, and the approving authority. VOTES AND COMMENTS PLEASE NOTE: The Title 5 Inspection is NOT a Guarantee/Warranty of the future functionality of the Septic System. TC3 . 30IS99 I =ev:se8 Pa¢elotll A `l Pnnted on Rec tied Paoer SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIRCATION (conitirwed) Fgoperty Address: q (` Owner: / J v✓n iyu2s Date of Inspection: INSPECTION SUMMARY: Check A, 8, C, of D: A. SYSTEM PASSES: I have not found any information which indicates that any of the failure conditions described in 310 CMR 15.303 exist. any failure criteria not evaluated are indicated below. / /+ COMMENTS: /GlC�4rYI/h rvci �7L�i�i �Ci,arD4Ws Lrr�K[ [ii�Ph viX6 1,"—e,- 8. SYSTEM CONDITIONALLY PASSES: One or more system componerus 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 indicate yes, no, or not determined (Y, N, or ND). Describe basis of determination in it instances. J "not determined explain ,vnv not. The septic tank is metal, unless the owner or operator has pr ded the system inspector with a copy of a ;artificate of Compliance (attached) indicating that the tank was installe within twenty (20) years prior to the date of the inspection; or the septic tank, whether or not metal, is cracked, strut rally unsound, shows substantial infiltration or exfiltration, or tank failure is imminent. The system will pass inspectio ' the existing septic tank is replaced with a complying septic tank as approved by the Board of Health. W Sewage backup or breakout or high s tic water level observed in the distribution box is due to broken or cbstructed pipes) or due to a broken, settled or unev distribution box. The system will pass inspection if (with approval cr the Board of Health). broken pip s) are replaced obstruc ' n is removed distri tion box is levelled or replaced _ The system require umping more than four times a year due to broken or obstructed pipets). The system vid pass inspection if (wit approval of the Board of Health): broken pipe(s) are replaced obstruction is removed rev.sed 9/22/'98 Page 2of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM iNSPECTIGN FORM PART A CERTIFICATION (continued) Property Address: (^ Owner: �J ✓✓Yt/I� 2-(/ Date of Inspection: C. FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: Conditions exist which require further evaluation by the B and of Health in order to determine if the system is failing to protect the public health, safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEA DETERMINES IN ACCORDANCE WITH 310 CHAR 15.303 (1)(b) THAT THE SYSTEM iS NOT FUNCTIONING IN A MANNER WHIC WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THEENVIRONMENT: — Cesspool or privy is within,,K feet of surface water Cesspool or privy is wit o0 feet of a bordering vegetated wettand or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, T ANY) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A+MANNER TZ OTECTS THE PUBLIC H TH AND SAFETY AND THE ENVIRONMENT: The system has a septand soil absorpti system ISAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface upply. _ The system has a septand soil a orption system and the SAS is within a Zone I of a public water supply well. _ The system has a septand so absorption system and the SAS is within 50 feet of a private water supply well. _ The system has a septand oil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply we a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollutthat facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less 5 ppm. :Method determine distance ;approximation not valid). 3) OTHER revised 9/2/98 PaQe3of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (eorttimied) Property Address: G Owner: / �(�✓�-i in C!/ Date of Inspection: D. SYSTEM FAILS: You must indicate either "Yes" or "No" to each of the following: I have determined that one or more of the following failure conditions exist as described in 310 CMR 1 5.303. 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. Yes No 3ackup of sewage into facility or system component due to an o oaded or clogged SAS or cess000l. Discharge or ponding of effluent to the surface of the gr d or surface waters due to an overloaded or ciogded SAS or cesspool. Static liquid level in ate distribution box abov utlet invert due to an overloaded or clogged SAS or cesspooi. Liquid depth in cesspool is less than 6" elow invert or available volume is less than 1/2 day flow. Required pumping more than 4 t es in the last year NOT due to clogged or obstructed pipets). Number of times pumped Any portion of the Soil sorption System, cesspool or privy is below the high groundwater elevation. Any portiorrof a c spool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion a cesspool or privy is within a Zone I of a public well. Any po on of a cesspool or privy is within 50 feet of a private water supply well. A 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 Nater analysis for coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. E. LARGE SYSTEM FAILS: You must indicate either 'Yes" or 'No" to each of the following: The following criteria apply to iarge systems in addition to the criteria above: The system serves a facility with a design flow of 10,000 gp r greater (Large System) and the system is a significant -hreat to public health and safety and the environment because one or m of the following conditions exist: Yes No the system is within 400 feet of urface drinking water supply the system is within 200 fea 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 .I Of a DUCHC water supply well) The owner or operator of any such system shall upgrade the system in accordance with 310 CMR 15.304(2). ?lease consult the local regionai office of the Department for further information. revised 9/2/98 P2ge4ofII SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECXUST Property Address: C Owner: Date of Inspection: Check if the following have been done: You must indicate either "Yes" or 'No" as to each of the following: Yes No _ Pumping information was provided by the owner, occupant, or Board of Health. None of the system components have been pumped for at least two weeks and -the system has been•receiving,rrnmal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. _ As built plans have been obtained and examined. Vote if they are not available with N/A. The facility or dwelling was inspected for signs of sewage back-up. The system does not receive non -sanitary or industrial waste flow. The site was inspected for signs of breakout. All system components, excluding the Soil Absorption System, have been located on the site. _ The septic lank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum. The size and location of the Soil Absorption System on the site has been oetermined based on: Sxisting information. For example, ?Ian at B.O.H. Determined in the field (if any of the failure criteria related to Part C is at issue, approximation of distance is unacceptable) !15.302(3)(b)] _ The facility owner ,and occupants, if differem from owner) were provided with information on the proper :-naintenance�f SubSurface Disposal Systems. rev—sed 9/2/98 Page 5of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C. SYSTEM INFORMATION Property Address: Owner. �f .S Sv✓y� �« Date of Inspection: FLOW CONDITIONS RESIDENTIAL. Design flow: 1/ O 3.p.d.rbedroom. Number of bedrooms (design):_ Number of bedrooms (actual): Total DESIGN flow --gip 6 b Number of current residents: ( ' Garbage grinder (yes or no): � S,y.Sizi,. IvOi- treccv14'."k,f JQU uV- (y Laundry ;separate system) es or.1nol: A/ ' If yes, separate inspection required Laundry system inspected ±yes or no) N!� Seasonal use (yes or no): tV nn Water meter readings, if available (last two year's usage (gpd):_ Sump Pump (yes or no): Last date of occupancy:�m COMMERCIAL/INDUSTRIAL: Type of establishment: Design flow: apd f 3ased on 1 5.203) iasis of design flow Grease trap present: (yes or no)_ Industrial Waste Holding Tank present: (yes or Non -sanitary waste discharged to the Titte s Water meter readings, if available:_ Last date of occupancy: OTHER: (Describe) _ Last date of occupancy: stem: lyes or no)_ GENERAL iNFORMATION PUMPING RECORDS and source of information: kn4s 1z System pumped as part of inspection: ;yes or no)L✓ :f yes, volume pumped:gallons Reason for pumping: TYPE OF SYSTEM ✓ Septic tank/distribution box/soil absorption system Single cesspool Overflow cesspool ?nvy Shared system (yes or no) (if yes, attach previous inspection records, if any) i/A Technology etc. Attach copy of up to date operation and maintenance contract Tight Tank Copy of DEP Approval Other APPROXIMATE AGE of all components, date installed (if known) and source of information: Sewage odors detected when arriving at the site: (yes or no) '_"eV_sed 9/2/918 Page 6of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: Owner: Date of Inspection: BUILDING SEWER: .,Locate on site pian) Depth below grade:-% Material of construction: _ cast iron /'--10 PVC _ other (explain) Distance from private water supply well or suction line jL Diameter /q Comments: icondition of joints, venting, avidence of leakage, etc.) /V L7 teC-,(01-f + Ve-St- SEPTIC TANK:_/ :locate on site pian) v Depth below grader Material of construction: /concrete _metal _Fiberglass _?olyethylene _othertexplain) If tank is metal, list age _ is age confirmed by Certificate of Compliance _ (Yes/No) Dimensions: L -! n X L, -S- X y- q_ 4 (�CJ Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle:_ Scum thickness:_ 0 7 Distance from top of scum to too of outlet tee or baffle:6 . k Distance from bottom of scum to bort9m of outlet to or b�a-/ffle: How dimensions were determined: ✓�O Comments: (recommendation for pumping,nd*t1on of inlet and outlet tees or baf-fles, depth of liquid level in relation to outlet invert, structural integrity evidence of leakage, etc.) - / 0 IQv — "iz.. ,__r >., —t.n—_ _ w, C le.u.0 /ti &d-,.,,. /n.OSlcr_ GREASE TRAP: - ;locate on site plan) Depth below graae: Material of construction: _concrete _metal _Fiberglass _Polyethylene ther(explain) 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 Date of last pumping: Comments !recommendation for pumping, condition of inlet evidence of leakage, etc.) outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, =elT=Sect 9/ 2/98 Page 7of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) property Address: Owner: y Sir k -v] T, -e + Date of Inspection: TIGHT OR HOLDING TANK: (Tank must be pumped prior to, or at time of, inspection) (locate on site plan) Depth below grade:_ Material of construction: _concrete _metal _Fib er s _Polyethylene _other(explain) Dimensions: / Capacity: gallons Design flow: gallons/day Alarm present Alarm level: Mar n working order: Yes _ No_ Date of orevious pumping• Comments: ;condition of inlet to , condition of alarm and float switches, etc.) f DISTRIBUTION BOX:_ !locate on site plan) Depth of liquid level above outlet invert:.L Comments: (note if level and distribution istequal, evidence solids carr over, evidence of leakage into or out of box, etc.) !� '(3UX ( �(j,- Till 6 .4Z 44 1-11 C n h ]' UPC (I; V CAP --�7 PUMP CHAMBER:_ (locate on site plan) Pumps in working order: (Yes or Nol Alarms in working oraer (Yes or Nol Comments: ,note condition of pump chamber, condition of pumps and appurten 7 etc.) �w;SeC ?,! L; Q8 Page�3of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: j Owner: Date of Inspection: SOIL ABSORPTION SYSTEM (SAS):_/ (locate on site plan, f possible; excavation not required, location may be approximated by ncn-intrusive methods) if not located, explain: Type: leaching pits, number:_ leaching chambers, number:_ leaching galleries, number:_ leaching trenches, number, length: l f leaching fields, number, dimensions:C'C -e overflow cesspool, number: T Alternative system: Name of Technology: Comments: (note condition of soil, �ens of hydr�ylic failure, level of ponding, damp soil, condition of vegetation, atc.) s it (� laves 43, I — k f� ww�c� �c,�� C; CESSPOOLS: _ (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: ZZ Materials of construction: indication of groundwater: inflow icesspool must be pumped as part of inspectio Comments: 'note condition of soil, signs of hydraulic failure, I el of ponding, condition of vegetation, atc.; PRIVY: ;locate on site pian) Materials of construction: Dimensions: Depth of solids: Comments: (note condition of soil, signs of hydraulic failure, leve/.fponding, condition of vegetation, atc.) revJseC? :/22/98 Page 9oi11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: Owner: Date of Inspection: SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two oermanent reference landmarks or benchmarks locate all wells within 100' (Locate where public water supply comes into house) rev'sed 9/2/98 Page 10oi11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: �^ Owner: Date of Inspection: MRCS USGS Report name Soil Type_ Typical depth to groundwater Date website visited Observation Wells checke Groundwater depth:allow SITE EXAM Moderate Deep ,.,Grface water Check Cellar Shallow wells , 4, stimared Depth to Groundwater f') Feet ?lease indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record Observed Site („butting property, observation hole, basement sump etc.) i Determined from local cdffiditions Checked with local Board of health Checked FEMA Maps Checked oumping records Checked local excavators, installers Used USGS Data Describe how �/ou established the High Groundwater Elevation. ;Must be comDietedl 41 (0 1c ='eV_Sed 9/2/98 Page 11 of 11 J1 J, 10/UY) ,ALU LI:AA 1.iA o bob 8;i/3 ..Uniii .i\UU+t.< L;1- ;�.j:;�I m Ln Imp V> •• •• u t l a- r r rr ••v,N i I �•�• a� yrs I I O tD C6 O d W .... Q, ® ow I W po�ppe P -4®M r" i of id O+ CT CT Ch CP -Cr � I O C>r Ct• a a v Cr L CU T- CMF" ma 1 -Fil•• r�-1O0aNLOnC¢iCdV ® p LAN •• I r•Ir=t AtNV3hO O C9 a S L I •rd r r, � N S9 d a I d R e N � i r M• .. c ..CS z • • •N N QSe th 6?` Ri la: •`a +• 4a r-9 •r4 Piss Co) -m .J •O •O WN U1 Ln Ln 4. W (,L. fm d N ® C'7 M u Q% CT O• C!• Ch C7` V �rr04•r0%�Ck••n V-4CL is O oo A i +`g\ ` N p`, �"p� C~3 ice - �O Z vel AJ r•I �d�P1�QtbMO Q{1� p-ZEL =J C 1 A: .. .. c--wsi—os.- -a0L�n a�e Q do L. a u O iJ O"I•rNNr•+9�o Zd g C16 Z r4M r r �X O V d O CD '9 tyu i Zw Ze ® ur r i P" CD ® u O O CI9 n Cil M Lf1 i I� ~ �Q �y ly�� Ill �• O •• I Crrrrrr- CC \ •r4 LI ad CJ S. I 0 •�► ! 1 rs L cm -m4 In •• w I N a S 2 N O O N I 01 !A » C9 w F CS I cmIM CN c SCO r CQ .. Cq T co i 1 • • 11%® 0 •• 6,1 �+J N 1 LA I Ctw�d I LCTa Ci docow u C.) w • • I •r1 CY• C51• Cp• C�• C7• C:. -1 ,•, 14 �. a ca • • I. LL C►• Cay a o• a CT L Z id d Ctd. •• L!°' I.i I Prrrrr CC C3 4-1 C C3• X i•/ *% ` � C O X 1 I "1. %%. %% W u.4! �A 0JR. =u—V I I v Nq490 m I ap ...2t4K /Vk 0 C4 —J2 -_7L /Soo Gaz, SJ 7/31/99 ACTION KING ENTERPRISES, INC. SERVICE DA rE'S DISPOSAL REPORT - NORTH ANDOVER 7.1/99 7)/31/99 DATE CUSTOMER DESTINATION EST GALLONS 7/6/99 THE LOFT RESTAURANT FITCHBURG 3500 1140 OSGOOD ROAD 7/8/99 BAY STATE CHOWDA CORENCO 1500 109 -MAIN -STREET x/20/99 MARYLYN MOORE LOW.ELL 1500 95 SUMMER STREET_ 7/29/99 JOE F1SH SAEFOOD REST. CORENCO 3000 1120 OSGOOD STTREET 6 A`ryv This is PROPRIETARY and CONFIDENTIAL information which may be used only by the Board of Health for reguiatonj ,,�.arposes,. 57- r1l 4r?,p Xa4l I� h C 194 t I� t W N N I 01 O • w�;co �R b (9 W G CD � n w I f e4F-5 tAI,4,e p oe A-, -'3 C! W& R f-4. v 17 -7 49 C?.2sL- /-v -11*57 A3 ON , 0 3 7- t0 /C- IRA" -3 Ao 0 Hd3SOr Jo /Soo clilk 5 Form 4 -- System Pumping Record Commonwealth of Massachuse RECEIVED Massachusetts i System Pumoin a Record JUL - 9 2004 TOHEA�LTH DEPARTMENNORTH TER System owner system Location �i,'�,1'h Shw+r.1"� .Pi, i'_d•.. s � +_i"`.I"t 1'ai`]•..• _�.ir '{,ir'i' 'oii. i• 47:,, 1 t . . Type: Emergency Routine Cesspool: No Yes septic tank: No Yes Date of pumping: �j ��. �( Quantity Pumped: �5GiGGallons System Pumped By: Wind River Enai»nnrental, LLC permit #: Contents transferred to: Contents Disposed at: Date: Condition of System/Other Comments Dep Approved Form - 12/07/95 ° T� t �j I rt i 2 ' ICE k §L.Al f Ln lk 11 e V '^.• 1r t Ile i �nJ 'C). � / ..0 � .% � � � .c"",. cam -•-cin` 1 �) r ♦ rx v o � r r� a X333 L t Z Z b � 011V:iVf3b�8 G Wd3Sl 30 \� � oZ or- 3 a Zy u Sir � -4i a X333 L t Z Z b � 011V:iVf3b�8 G Wd3Sl 30 \� � oZ or- �- u Sir � -4i © o y �� 4 o 't- a ° th b a a X333 L t Z Z b � 011V:iVf3b�8 G Wd3Sl 30 \� � oZ or- �- u , � -4i e o -a Z �� 4 a ° th b a a X333 L t Z Z b � 011V:iVf3b�8 G Wd3Sl 30 \� e° u e o � _ a � a � b 41 of b m 3 h y D I^ fin\ Ob CA ohmg� 1Om Z� r o Z n r m rn • � m 4 y Z SOIL PROFILE & PERCOLATION TEST DATA North Andover, Mass. Street Na Lot No Lac/Subdiv. Pland Owner o KsN Investigator QOH• o Observer SOIL PROFILE DATES l Alev 2. El ev 3. Elev 4. Elev • S'31 � �3 �v� n n �'`WGTL Benchmark Elevation 1 4 5 6 7 8 9 10 1 2 3 .4, 5 6 7 8 9 10 Location Datum PERCOLATION TESTS GE 55 n/-v� Ta /0 Tres Ptq s est 2 3 4 5 6 7 8 9 10 DATES Pit Number °1 Q13 �nJ 2 3 4 Start Saturation ``•ID 1'.13 Soak -Minutes Start e Drop of 3" -Time 3 I0 lD Z' 3 Drop of 6" -Time 6, Mms-lst 3" drop V'v1r Mins.2nd " Drop 'i0 /r(D Percolation 1A (y Board of Hcalth. . North Andover'Mass. 0--� � sEpnc siSTEH INSTAUATICK CHECK UST LAIL Reammst 1. Distance Tot a. Wetlands LOT", AVATION OK FAIL 41 b. Drains c.. Well 2. Watei Line Location 3. No PVC Pipe 4. Septic Tank a. -Tess -Length & To Clean, Out Covers b. Cement Pipe to Tank — On Both Sides of Tank 5. Distribution Box a. Covers & Box - No Cracks b. An 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. Leach Pits a. Dimensions b. Stone Depth c. Splash Pads. d' Tees e.� Cement Pipe to Pit Both Sides f. Clean Double Washed Stone 8. No Garbage Disposal 9. Final Grading Inspection 10. Barricading Covered System 3-1. As Built Submitted a. Lot Location b. Dimensions of System c. Location with Regard -to Pere Test d. Elevations e. Water Table Board of Health Xpeth ;indover,Mass SUBSURFACE DISPOSAL DESIGN CHECK LIST APPROVED DATE%'/jp- DISAPPROVED DATE Provld6d: Reasonss Ate✓ F01 -Z Title V Reg 2.5 Reg 6 Reg 10.2 Reg 10.4 LOT #—/ SUM� 5 J((h) e submitted plan must show as a miniamm: 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 required leaching area location and dimensions of system -including reserve area existing and proposed contours location any eget areas within 1001 of sewage disposal system or disclaimer -check wetlands mapping surface and subsurface drains within 1001 of sewage disposal system or disclaimer location any drainage easements vithin 1001 of sevage disposA system or disclaimer -Planning Board files (3) known sources of water supply within 2001 of sewage disposal g system or disclaimer 71(k) location of amy proposed well to serve lot -100, from leaching facilit; '(1) location of water lines on property -101 from leaching facility m) location of benchmark driveways garbage disposals p) 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 - Otter elevations r) maximum ground water. elevation in area sewage disposal system (s) plan must be prepared by a Professional Bhgineer or other professional authorized by law to prepare such plans Septic Tanks (a) capacit es- 50% -of flog, water table, tees, depth of tees, access, pumping (b) cleanout c) 101 from cellar wall or inground s -W wring pool R(d) 251 from subsurface drains Distribution Boxes ` slope greater ERE 0.08 b) sump /I l bDesign Check List Page 2 IFAIL I Og Reg 15.1 15.4 15.8 3.7 Reg 14.1 14.3 14.4 1.4.6 14.7 14.10 Reg 9.1 9.6 Leaching Pits Leaching pits are preferred where the installation is possible a) calculations of leaching area -minimum 500 sq ft b) spacing c surface drainage 2% dj cover material e) k1R2tx4p splash pad f) tee at elbow g) no bends in pipe from d -box to pipe Leaching Fields a) no greater than 20 minutes/inch 566 FjvG4,qSet tX b� area -rani um 900 sq ft c construction of field 4) surface drainage 2 % e) 201 from cellar wall or inground swimmdng pool Leaching Trenches a) ca cola ons o eacbi.ng area -min 500 eq ft b) spacing -4 ft min 6 ft with reserve between c) dimensions d) construction e) stone f) surface drainage 2% Dounhill Sloe a) se y7x to be shown) b) y/x X 150 = (to be shown) DMS a) anal b) stand -bp power