HomeMy WebLinkAboutMiscellaneous - 175 Foster StreetIs
•
Eh
6
C
8
i
c
�o
C
Q
\
>v
Ey
I
i
O
O
�
m
N
s
E
Q
L
c
c
L
� �
R
lU
O E C
s
4l 3 O
�+U
D D Q
2
O
Ed
O
m
41
I
�
%.+
.~
a
O
Q
4-
0
44
_0
O
m
O
U
O
O
C
f r10RT#j
O �
9
It _-
,"SAC .USES
Applicant
N
Town of North Andover, Massachusetts
BOARD OF HEALTH
DISPOSAL WORKS CONSTRUCTION PERMIT
142
19
TELEPH_..�
Site Location__
Permission is hereby granted to Construct ( ) or Repair ( n Individual Soil Absorption
Sewage Disposal System as shown on the Design Approval S.S. No.
Fee 71—
CHAIRMAN, BOARD OF HEALTH
D.W.C. No. %4/J—
NEW ENGLAND ENGINEERING SERVICES
INC
February 15, 1999
North Andover Board of Health
Town Hall Annex
27 Charles Street
North Andover, MA 01845
RE: TITLE V REPORT 175 Foster St.
Enclosed is a copy of the revised Title V report for the above referenced location. The system
passes our i.aspection.
If there are any questions please call me at my office, 686-1768.
Yours truly,
B J in �Osg r., E.I.T.
President
33 WALKER ROAD - SUITE 23 - NORTH ANDOVER, MA 01845 - (978) 686-1768 - (888) 359-7645 - FAX (978) 685-1099
ARGEO PAUL CELLUCCI
Governor
COMMONWEALTH OF MASSACHUSETTS
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
DEPARTMENT OF ENviRoNN ENTAL PROTECTION
ONE WINTER STREET, BOSTON MA 0108 (617) 292-5500
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A j
CERTIFICATION
7el
rMUDY COXE
Secretary
DAVID B. STRUHS
Commissioner
Property Address: / 75 /6 51 cit Sl �' L Name of Owner I- co, r ) lir ^ 5
j Address of Owner: 17S- SGS et ST /V • fi: �t;� J 22
Date of Inspection: / 2/ qe /� _
Name of Inspector: (Please Print) 0-1,; 4 yn'n �� ���Z>Z k J 2
1 am a DEP approved system inspector pursuarrt ttfSection 15.340 of Title 5 (310 CMR 15.000)
Company Name: jZCal LrEAM9-1 4.1,E 0 L-5 i iL�G
Mang Address: 3-3 IAJ f}1.-11kE__ JZ i2D. AZ- fA/406 id7 2
Telephone Number: q7 2 -- 6 E2 7 � t�
CERTIFICATION STATEMENT
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 inspection. The inspection was performed based on my training and experience in the proper function and
maintenance of on-site sewage disposal systems. The system:
asses
Conditionally Passes
_ Needs Further Evaluation By the Local Approving Authority
_ Fails
Inspector's Signature: Date: /;�?3�
The System Inspector shall submit a copy of thi inspection report to the Approving Authority (Board of Health or DEP)within thirty (30) days of
completing 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 Department otrEnvironmetrtat'Protection. The original should be sent to-Vw
system owner and copies sent to the buyer, if applicable, and the approving authority.
NOTES AND COMMENTS
6c e- eil �;`
revised 9/2/98
Page 1 of 11
A
`S Printed on Recycled Paper
SUBSURFACE SEWAGE DISP04AL SYSTEM INSPECTION FIRM
PART A
CERTIFICATION (continued)
Property Address: 1 -7 s t: `, TsT.ill - A n.' k90}
Owner:
Date of Inspection:
12-,
INSPECTION SUMMARY: Check A, B, C, or D:
A. SYSTEM PASSES:
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 Blow.
COMMENTS: () >� O �ti c`J� ��� -kA �� �� �1 ✓� 714C
c 1— I/.1 i k 'ELL
wOT- 2 .0141,
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.
Indicate yes, no, or not determined (Y, N, or NO). Describe basis of determination in all instances. If "not determined", explain why not.
_ The septic tank is metal, unless the owner or operator has provided the system inspector with a copy of a Certificate of
--.- -..---...._ ....
Compliance _(attached).indicating that_the.tank__was. nstall.ed within twenty (20) years_prior to the .date _of the inspection;_ or -
the septic tank, whether or not metal, is cracked, structurally unsound, shows substantial infiltration or exfiltration, or tank
failure is imminent. The system will pass inspection if the existing septic tank is replaced with a complying septic tank as
approved by the Board of Health.
Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipes) ,
or due to a broken, settled or uneven distribution box. The system will pass inspection if (with approval of the Board of
Health).
broken pipe(s) are replaced
obstruction is removed
distribution box is levelled or replaced
_ The system required pumping -more than—four—times a yeardue to broken or obst. cted pipe(s). The system wilF�fess'�
inspection if (with approval of the Board of Health): '
broken pipe(s) are replaced
obstruction is removed
revised 9/2/98 Page 2orii
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address:
Owner:
Date of Inspection: 1-( c= lam)
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 the
public health, safety and the environment.
1I SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERk6NES W ACCORDANCE WITH 310 CMR 15.303 (1)(b) THAT THE SYS"
IS NOT FUNCTIONING IN A MANNER WHICH-WILLPROTECTTHE PUBLIC HEALTH.AND SAFETY. AND THE ENVIRONMENT --
Cesspool or privy is within 50 feet of surface water
Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh.
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 AND SAFETY AND THE 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 soil absorption system and the SAS is within a Zone I of a public water supply well.
_ The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well.
The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a
private water supply well, unless a well water analysis for coliform be and volatile organic compounds indicates that the
well is free from pollution from that facility and the presence of -ammonia nitrogen and nitrate nitrogen is equal to or less
than 5 ppm. Method used to determine distance (approximation not valid).
3) OTHER
� nn
revised 9/2/98 Page 3orii
SUBSUME SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: I j %v --e
Owner:
Darte 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 15.303. The basis for this
determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure.
Yes No
Backup of sewage into 4ecility or-aTstem component•duetto an overloaded or cogged SASor1ce53p00l. =�
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 112 day flow.
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 Soil Absorption System, cesspool or privy is below the high groundwater elevation.
Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply.
Any portion of a cesspool or privy is -within a Zone I of a public well.
Any portion of a cesspool or privy is within 50 feet of a private water supply well.
Any portion of a cesspool or privy is less -than 100 feet but greater than 50 feet from a private water supply well with no
acceptable water quality analysis. If the well has been analyzed to be acceptable, attach copy of well water analysis for
—coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. -
E. LARGE SYSTEM FAILS:
--------You-must indicate either- "Yes"-or."No" to each of the following:..... .
The following criteria apply to large systems in addition to the criteria above:
The system serves a facility with a design flow of 10,000 gpd or greater (Large System) and the system is a significant threat to public
health and safety and the environment because one or more of the following conditions exist:
Yes No
the system is within 400 feet of a surface drinking water supply
the system-is-witWn 200 feat of-a-04KAary-teaeurfaoo
the system is located in a nitrogen sensitive area (interim Wellhead Protection Area = IWPA) or a mapped Zone 11 of a public
water supply well)
The owner or operator of any such system shall upgrade the system in accordance with 310 CMR 15.304(2). Please consult the local regional
office of the Department for further inforgiation.
revised 9/2/98 Page 4of11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: 1 75- Fo
Owner:
Date of Inspection:
Check if the following have been done: You must indicate either "Yes" or "No" as to each of the following:
Ye/ No j
✓ Pumping information was provided by the owner, occupant, or Board of Health.
_ - None of the system sompoaants.h"w- l)—^n pupvlmdufosatleast two %v aa." snd•the-system hasi►ssaascsiaingrnasal 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. Note if they are not available with N/A.
i/ 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 tank 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 orrthe site has been determined based on:
Existing information. For example, Plan 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)
115.302131(b)1
The facility owner Iand.occupa❑ts.if different tha pnpar .. Ai tan&Q ..f
SubSurface Disposal Systems.
revised 9/2/98 Page 5or11
Property Address: -�
Owner: L -e o,x
:. Date of kupection:
SUBSURFACE SEWAGE DIS�AL SYSTEM INSPECTION FORM --�
PART C
SYSTEM INFORMATION
f:b <<-N - , A), �.�� >JC
FLOW CONDITIONS
RESIDENTIAL:
Design flow: g.p.d./bedroom.
Number of bedrooms (design):_ Number of bedrooms (actual):
Total DESIGN flow —
Number of current residents:
Garbage grinder (yes or no):_j/y%
Laundry (separate system) (yes or no):/1/(C; If yes, separateinspection-required
Laundry system inspected (yes or no)
Seasonal use (yes or no):.>,'C
Water meter readings, if available (last two year's usage (gpd):
Sump Pump (yes or no):_,dLO
Last date of occupancy: &.1
C O M M ER C IA L/IN D U S TR IA L:
Type of establishment:
Design flow: apd ( Based on 15.203)
Basis of design flow
Grease trap present: (yes or no)_
Industrial Waste Holding Tank present: lyes or no)_
Non -sanitary waste discharged to the Title 5 system: (yes or no)_
Water meter readings, if available:
Last date of occupancy:
OTHER: (Describe)
Last date of occupancy:
GENERAL INFORMATION
PUMPING RECORDS and source of information
System pumped as part of inspection: yes or no)A
If yes, volume pumped: / V c' ✓ gallons
Reason for pumping: -r -c, a pe—, r^ J -c
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)
I/A Technology etc. Attach copy of up to date operation and maintenance contract
Tight Tank Copy of DEP Approval
Other
0 ,� ✓� e!'
APPROXIMATE AGE of all components, date instalied#f known) -end source of4nforrnation: -• e
Sewage odors detected when arriving at the site: (yes or no)
revised 9/2/98 1`2ge6of11
SUBSURFACE SEWAG— DtiSPOSAL SYSTEM INSPECTION FORM –�
PART C
SYSTEM INFORMATION (continued)
Property Address: 1-7 S sT s ^% • �} ✓�� w ��
OOwwnofj t�:•� lam%, ��(, . a
Date Inspection:
BUILDING SEWER:
(Locate on site plan)
Depth below grade:
Material of construction: cast iron 40 PVC _ other (explain)
Distance from private water supply well or suction line 0'
Diameter „
Comments: (condition of joints, venting, evidence of feakage,-etc.) -
-!� < l 11T ,Fac ._ .A w,e,:i - -
SEPTIC TANK:_ 1
(locate on site plan) �)
Depth below grader C"–
Material
" Material of construction: �ncrete _metal _Fiberglass _Polyethylene _other(explain)
If tank Is _(petal, list age _ Js.age.confwmed by Certificate of Compliance _ (Yes/No)
Dimensions: ti G,- lb (�u�
Sludge depth: /&,*
Distance from top of sludge to bottom of outlet tee or baffle:Zcr'
Scum thickness: /
Distance from top of scum to top of outlet tee or baffle:_ ro-V 0pe- e,_ t -o
Distance from bottom of scum to bottom of outlet tee or baffle:
How dimensions were determined: Y g e- C� s 1 C K.
Comments:
(recommendation for pumping, condition of inlet and outlet tees or -baffles, depth of liquid level in relation to o tlet. invert structureF•integrity,
evidence of leakage, etc.) �� y Ic « �` 4f C �, « . �� !� �% C S
GREASE TRAP:_LV4
(locate on site plan)
Depth below grade:_
Material of construction: _concrete _metal _Fiberglass _Polyethylene _other(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 baffle:
Date of last pumping:
Comments:
(recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid.level in relation to outlet invert, structural integrity,
evidence of leakage, etc.)
revised 9/2/98 Page 7of11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address:
Owner: 1
Date of Inspection: ,g
TIGHT OR HOLDING TANK: A (Tank must be pumped prior to, or 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/day
Alarm present
Alarm level: Alarm in working order: Yes _ No_
Date of previous pumping:
Comments:
(condition of inlet tee, condition of alarm and float switches, etc.)
DISTRIBUTION BOX:—
(locate on site plan)
Depth of liquid level above outlet invert:
Comments:
(note if /le�vel and distribution is equal, evidJe1noe of solids
PUMP CHAMBER:"
(locate on site plan)
avid ce of leakage int oI or out box, etc.) —
IC -.N 7 /GC,' c CDS
Pumps in working order: (Yes or No)
Alarms in working order (Yes or No)
Comments:
(note condition of pump chamber, condition of pumps and appurtenances, etc.)
revised 9/2/98 Page 8of11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM —
PART C
SYSTEM INFORMATION (continued)
Property Address: J-1,5- 1=-p n? S I S-1 /t_),
Owner:
Date of Inspection: y y. U✓v t,�% S - j
S6IL ABSORPTION SYSTEM (SAS)
(locate on site plan, if possible; excavation not required, location may be approximated by non -intrusive methods)
If :not located, explain:
Type: I
leaching pits, number:_
leaching chambers, number:_,
leaching galleries, number:_
leaching trenches, number, length:
leaching fields, number, dimensions: i C" X C' s
overflow cesspool, number:_
Alternative system:
Name of Technology:
Comments:
(note condition of soil, signs of hydraulic failure, level of ponding, damp s il, condition of vegetation, etc.)
CESSPOOLS: /V
(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 (cesspool must be pumped as part of inspection)
0
Comments:
(note condition of soil, signs of hydraulic failure, level of rending, condition of -vegetation, etc.) _
PRIVY: /
(locate on site plan)
Materjals of construction: Dimensions:
Depth of solids:
Comments:
(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation; etc.)
revised 9/2/98 Page 9of11
SUBSURFACE SEWAGE DISPOSAL SYSTEM;INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 17,5 r�P.—
Owner:
Date of kwec&— w -1 i •t ,i
:z
SKETCH OF SEWAGE DISPOSAL SYSTEM:
include ties to at least two permanent reference landmarks or benchmarks
locate all wells within 100' (Locate where public water supply comes into house)
I I
75' f l�G«.In
revised 9/2/98
getoorn
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 11
Owner: ► n. - A. i J o L
Date of Inspection: t,,' G IL, L A-4'
NRCS Report name "�i Es5c-K C/*e'." --
Soil Type_"ct ,✓1
Typical depth to groundwater 7 (U.D"
USGS Date website visited
1 Observation Wells checked
Groundwater depth: Shallow Moderate tK Deep
SITE EXAM Slope
Surface water
Check Cellar
Shallow wells
Estimated Depth to Groundwater 3 Feet
Please.indicate all the methods used to determine High Groundwater Elevation:
Obtained from Design Plans on record
Observed.Site (Abutting property, observation hole, basement sump etc.)
Determined from local conditions
Checked with local Board of health
Checked FEMA Maps
Checked pumping records
Checked local excavators, installers
Used USGS Data
Describe how you established the High. Groundwater Elevation. (Must be completed)
��• V'S- ix,S S < <✓:^✓ej C, c�.,hr�.S �(o. v `
a rFc
revised 9/2/98 page ttortt
1
02/18/1999 09:54 9786920023 THORSTENSEN LAE PAGE E1
66 LITTLETON ROAD. WESTFORD, MA01886
Report Number: W-35874
Client:
Leon Wilkins
175 Forest Street
North Andover, MA 01845
Sample taken by: Client
(978) 692.8395 FAX (978) 692-0023 1 -600.649 -TEST
Report Date: January 12, 1999
Sample taken at:
Same
On: 12/30/98
FPA524.2 MCI. RESULTS PARAMETER
MCL RESULTS
Benzene
5.0
ND
1, 1 -Dichloroethane _-
ND
Carbon Tetrachloride
5.0
ND
1,1,2,2 -Tetrachloroethane --
ND
1, 1-Dichloroethylene
7.0
ND
1,3 -Dichloropropane ._
NTD
1, 2-Dichloroethane
5.0
ND
Chloromethane --
N -D
p -Dichlorobenzene
5.0
ND
Brornornethane __
ND
Trichloroethylene
5.0
ND
1,2,3-Trichloropropane -
ND
1,1,1 -Trichloroethane
200.0
ND
1,2,4-Trimethylbenzene
ND
Vinyl Chloride
2.0
ND
1,1,1,2 -Tetrachloroethane --
ND
Chlorobenzene
100.0
ND
Chloroethane ._
ND
o -Dichlorobenzene
600.0
ND
1,2,3-Trichloropropane
ND
trans-l,2-Diehloroethylene
100.0
ND
2,2-Dichloropropane
ND
cis-1,2-Dichloroethylene
70.0
ND
o-Chlorotoiuene
ND
1,2 -Dichloropropane
5.0
ND
p-Chlorotoluene
ND
Ethylbenzene
700.0
ND
Bromobenzene -
ND
Styrene
100.0
ND
1,3-Dichloropropene -
ND
Tetrachloroethylene
5.0
ND
n-Propylbenzene --
ND
Toluene
1000.0
ND
n-Butylbenzene _
ND
Xylene (total)
10000.0
ND
Naphthalene -
ND
Dichloromethane
5.0
ND
Hexachlorobutadiene
ND
1,2,4-Trichlorobenzene
70.0
ND
1,3,5-Trimethylbenzene --
ND
1,1,2 -Trichloroethane
5.0
ND
p-Isopropyltoluene -
ND
Chloroform
--
ND
Isopropylbenzene
ND
Bromodichloromethane
--
ND
tert-Butylbenzene -
ND
Chlorodibromomethane
--
ND
sec-Butylbenzene --
ND
Brornoform
--
ND
Fluorotriehloromethane --
ND
n1 -Dichlorobenzene
--
ND
Dichlorodifluoromethane -
ND
Dibromometh.ane
--
ND
Bromochloromethane --
ND
Methylene Chloride
--
ND
1,2-Dibromo-3-Chloropropane -
ND
1,1-Dichloropropene
--
ND
1,2-Dibromoethane -
ND
Recoveries of Internal Standards%
ND=None Detected
Fluorobenzene
84
MCL=Maximum Contamination Level,
4-Bromofluorobcnzene
80
Results are in ug/L
1,2 -Dichlorobenzene -d4
80
Detection Lirnit=0.5 ug/L
� j���
This sample was analyzed at DEP approved facility MA072
Mic el P. Carlson, for
Thorstensen Laboratory Inc.
- 4
�--O�r4/%P/12.'��/J'!,
66 LITTLETON ROAD, VVES TFORD, MA 01986
At ort Number; V-3604;—
_
Client: -
Leon Wilkins
175 Forest Strect
North Andover, MA ol.gA a!
Szmple, taken by: Client.
..colic9Q of Anal sia
Test Para-ruetcr' EPA Lutist
Total Coliform (P) 0
(N)= Nrirnaq EPA Std.
(978) 692-8395 FAX (978) 692-0023 1-800-849 TEST
Report Date: Jam , -
azj' 14.1.999.....--_�
Sample taken at:
Same
On: 1/13/99
Result Units
0 per1001111
This water sa.tnpic as tested, meets BPA health standards for Coliform Bacteria.
Massachusetts State Certifiers
Mi
Testing Laboratory #MA048 c el P. Carlson, forThorstensen Laboratory Inc.
". 01A7/99 SLiN 11:30 FAX
#`/'�Y r,
66 LITTLETON ROAD, WESTFORD, MA 01886
Report Number: W-35874
Client:
lin Wilkins
175 Forest Street
North Andovcr, MA 01845
arnple taken by: Client
TEST PARAMETER
EPA MAIC
(976) 692-8395 FAX (978) 692-0023 1-800.649•TEST
Report Date: January 12, 1999
Sample take ;
Same<
On:1 12/30/98
RESULTS UNITS
Total Coliform (P) 0 # 15 per 100ml
Ammonia Not Spec. <0.03 mg/L
Nitrates (as NST) (P) 10 <0.01 mg/L
Nitrites (as N)(P) 1 <0.01 mg/L
NT=Not tested, #--Value Exceeds EPA STD, TNTC=Too Numerous To Count
*=Background Bacteria Noted, "=EPA Advisory Limit,' =Exceeds Advisory Limit
(P)=Primary EPA Standard, (S) --Secondary EPA Standard (may affect aesthetics
of Drinking Water, i.e. taste,color,etc.)
This water sample as submitted; does not meet EPA requirements for
Coliform Bacteria and is considered UNSAFE for human consumption -
Massachusetts State Certified
Testing Laboratory #MA048
Michael P. Carlson, for
Thorstensen Laboratory Inc.
TOWN OF NORTH ANDOVER
BOARD OF HEALTH
CERTIFICATE OF COMPLIANCE
DATE OF COMPLIANCE:
12/11/98
This is to certify that
the individual subsurface disposal system
constructed ( ) or repaired ( X )
by Ben Osgood Jr. a North Andover Licensed Installer
at 175 Foster Street, North Andover, MA 01845
has been installed in accordance with the provisions of Title V of the State Sanitary Code
and with the North Andover Board of Health regulations as described in the Design
Approval Site System Permit # N/A dated N/A. Distribution Box Only.
The Issuance of this certificate shall not be construed as a guarantee that the system will
function satisfactorily.
Board of Health Inspector