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HomeMy WebLinkAboutMiscellaneous - 4 Wildwood Circle � ��( (/U l �11���D G�� U / �� i i i TOWN OF SYSTEM PUMPING RECORD _ DATE: o � r-- 16 SYSTEM OWNER & ADDRESS SYSTEM LOCATION (( (example: left front of house) lJ Wim(? C-y c �- - --�� a DATE OF PUMPING: QUANT.PUMPED : ` GALLONS CESSPOOL: NO --�YES SEPTIC TANK: NO YES �w NATURE OF SERVICE: ROUTINE �� EMERGENCY OBSERVATIONS: GOOD CONDITION FULL TO COVER HEAVY GREASE BAFFLES IN PLACE ROOTS LEACIHULD RUNBACK EXCESSIVE SOLIDS FLOODED SOLIDS CARRYOVER OTHER(EXPLAIN) SYSTEM PUMPED BY: Bateson Enterprises, Inc. COMMENTS: CONTENTS TRANSFERRED TO: G.L.S.D Lowell Waste COMMONWEALTH OF ASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF NVIRONMENTAL PROTECTION A f �r O, V! TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address:_40 Wildwood Circle_ _North Andover_ Owner's Name:_John Touchette_ Owner's Address:_40 Wildwood Circle_ RECEIVED North Andover,MA 01845_ Date of Inspection 5/9/2005_ MAY 2 5 2005 Name of Inspector: Neil J Bateson_ TOWN OF NUR i H PINDOVER Company Name: Bateson Enterprises Inc._ HEALTH DEPARTMENT Mailing Address:_111 Argilla Road_ _Andover,Ma.01810 Telephone Number:_(978)475-4786_ 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 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: X Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority F ' Inspector's Signature: ate: _5/9/2005_ The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 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 DEP.The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. Notes and Comments. ****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. Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address:_40 Wildwood Circle_ _North Andover— Owner:_Touchette_ Date of Inspection:_5/9/2005 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: X I 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: 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. Answer yes,no or not determined(Y,N,ND)in the 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. ND explain: 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 ND explain: 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 obstruction is removed ND explain: Page 3 of 11 OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 40 Wildwood Circle_ _North Andover— Owner:_Touchette_ Date of Inspection:_5/9/2005 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 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 coliform bacteria 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,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: Page 4 of 11 • OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 40 Wildwood Circle_ _North Andover— Owner:_Touchette_ Date of Inspection:_5/9/2005_ D. System Failure Criteria applicable to all systems: You must indicate"yes"or`no"to each of the following for all inspections: No Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool No Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool No Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool No Liquid depth in cesspool is less than 6"below invert or available volume is''/z day flow. _No_ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped _No_ Any portion of the SAS,cesspool or privy is below high ground water elevation. _No_ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. No Any portion of a cesspool or privy is within a Zone 1 of a public well. _No Any portion of a cesspool or privy is within 50 feet of a private water supply well. _No 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 coliform bacteria 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,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form.] No (Yes/No)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- 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) 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. Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 40 Wildwood Circle_ _North Andover— Owner:_Touchette_ Date of Inspection:_5/9/2005_ Check if the following have been done.You must indicate"yes"or"no"as to each of the following: Yes No Yes_ — Pumping information was provided by the owner,occupant,or Board of Health No Were any of the system components pumped out in the previous two weeks? Yes _ Has the system received normal flows in the previous two week period? No Have large volumes of water been introduced to the system recently or as part of this inspection? _Yes _ Were as built plans of the system obtained and examined? Yes — Was the facility or dwelling inspected for signs of sewage back up? Yes _ Was the site inspected for signs of break out? Yes _ Were all system components,excluding the SAS,located on site? _Yes_ _ 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? _Yes_ _ 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: Yes no _Yes_ _ Existing information. _YesDetermined in the field(if any of the failure criteria related to Part C is at issue approximation of distan_ _ce is unacceptable) [3 10 CMR 15.302(3)(b)] Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address:_40 Wildwood Circle_ _North Andover— Owner:_Touchette_ Date of Inspection:_5/9/2005_ FLOW CONDITIONS RESIDENTIAL 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):_600_ Number of current residents:_5 Does residence have a garbage grinder(yes or no):_No Is laundry on a separate sewage system(yes or no):_No Laundry system inspected(yes or no): _ Seasonal use:(yes or no): No_ Water meter reading:_On well water_ Sump pump(yes or no):_No_ Last date of occupancy:— Current-COMMERCIAL/INDUSTRIAL Type of establishment:__ Design flow(based on 310 CMR 15.203):_gpd Basis of design flow(seats/persons/sqft,etc.): Grease trap present(yes or no):_ Industrial waste holding tank present(yes or no): Non-sanitary waste discharged to the Title 5 system(yes or no):_ Water meter readings,if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: Pumped last year,owner Was system pumped as part of the inspection(yes or no): Yes_ If yes,volume pumped:_1500_gallons--How was quantity pumped determined?_Measured tank Reason for pumping: _Inspect tank&tees_ TYPE OF SYSTEM X 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) _Tight tank _Attach a copy of the DEP approval Other(describe):__ Approximate age of all components,date installed(if known)and source of information: 22 Years old,11/23/1983, As built plan_ Were sewage odors detected when arriving at the site(yes or no):_No Page 7 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 40 Wildwood Circle_ _North Andover_ Owner:_Touchette_ Date of Inspection:_5/9/2005_ BUILDING SEWER_X_ (locate on site plan) Depth below grade:_24"_ Materials of construction: —X— X_cast iron _40 PVC_other Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.) 4"Cast iron thra wall, 3"PVC in house_ SEPTIC TANKS: X Depth below grade:_12"_ Material of construction: X concrete_metal_fiberglass_polyethylene _other explain) If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of certificate) Dimensions:_10'x 5'x 4' Sludge depth:_4"_ Distance from top of sludge to bottom of outlet tee or baffle: 21"_ Scum thickness:_4"_ Distance from top of scum to top of outlet tee or baffle:_8"_ Distance from bottom of scum to bottom of outlet tee or baffle: 13"_ How were dimensions determined:_Tape measure_ Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.)_Pumped septic tank.Inlet tee ok.Outlet tee ok.Depth of liquid at outlet invert._ GREASE TRAP: (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(on pumping recommendations,inlet and outlet tee or bale condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): Page 8 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 40 Wildwood Circle- - North Andover Owner:_Touchette_ Date of Inspection:_5/9/2005_ 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/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: X Depth of liquid level above outlet invert: _0"_ 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&distribution equal.No evidence of leakage.Evidence of carryover,pumped d-bog to clean_ PUMP CHAMBER:_(locate on site plan) Pump in working order(yes or no):— Alarm in working order(yes or no): Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): _ Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:_40 Wildwood Circle_ _North Andover_ Owner:_Touchette_ Date of Inspection:_5/9/2005_ SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,excavation not required) If SAS not located explain why: Type _ leaching pits,number:_ — leaching chambers,number:_ leaching galleries,number: _X leaching trenches,number,length:_3 trenches 30'long_ _leaching fields,number,dimensions: overflow cesspool,number: innovative/alternative system Typetname of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation, etc.):_Soil oL Vegetation oL No sign of ponding to surface_ 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 sludge layer:_ Depth of scum layer:_ Dimensions of cesspool: Materials of construction: . Indication of groundwater inflow(yes or no): 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.): Page 10 of 11 UBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:_40 Wildwood Circle _North Andover — Owner:_Touchette_ Date of Inspection:_5/9/2005_ SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks.Locate all wells within 100 feet.Locate where public water supply enters the building. O Driveway To Well A B Septic Tank 2 1 D- Boz A to 1=30'9" A to 2=24' A to D-Boz=28'8" Bto1=20' Bto2=25' B to D-Boz=43'3" • Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 40 Wildwood Circle_ _North Andover– Owner:_Touchette_ Date of Inspection:_5/9/2005_ SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to groundwater _4'_ Please indicate(check)all methods used to determine the high ground water elevation: X Obtained from system design plans on record-If checked,date of design plan reviewed:_6/8/1982_ Observed site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health-explain:_ Checked with local excavators,installers-(attach documentation) — Accessed USGS database-explain: _ You must describe how you established the high ground water elevation: As per design plan_ Tel: (978) 475-4786 Fax: (978) 475-5451 BATESON ENTERPRISES, INC. Excavating-Water.& Sewer Lines-Septic Systems&Pumping Service 111 Argilla Road Andover, Mass. 01810 Title 5 Inspection Report Property Address: 40 Wildwood Circle, North Andover Owner: Touchette Date of Inspection: 5/9/2005 My report contained herein does not constitute a guarantee of future usage and the functionality of the existing septic system. Such report issued herewith is merely based upon my observations, and I hereby disclaim any further operation of your current septic system. Neil J. Bateson Bateson Enterprises, Inc. Commonwealth of Massachusetts City/Town of 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 Important: When filling out 1• System Location: forms on the computer,use ` �T.. {QVt b 6k� only the tab key Address JJ to move your -t �.()i c� V C1 ( I V cursor-do not ( ' j � use the return Cityrrown State Zip Code key. 2. System Owner. I a� Name Address(i(different from location) Cityfrown State Zip Code' �Iq0 Telephone Number B. PuM' ki.g Record I. Date.of Pum in I P g Pate +3 D 2. Quantity�Pumped: C Gallons 3. Type of system: ❑ Cesspool(s) L'1 Septic Tank- ❑ Tight:Tank ❑ Other,(describe).- 4: Effluent Tee Filter present? ❑ Yes II No If yes, was it cleaned? ❑ Yes ❑ No 5. Condition of System:. 6. System Pu , ped By 1 _ Name Vehicle License Number L44wi i Company 7. Location where contents were disposed:: L Signature of l4au er Date http://wwW.mass.gov/dep/­waterlapprovaf8/t5forrns.htm#inspect t5form4.doc-06103 System-Pumping Record•Page 1 of 1 L Commonwealth of Massachusetts City/Town of 1 System Pumping Record MAY 2 2 2006 Form 4 TOWN OF NORTH ANDOVER HEALTH LIE ARTP�,EN r 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 Important: When filling out 1. System Location: forms on he computer•use the tab key Address to to-move your cursor-do not _ J use the return Cityrrown State Zip Code .key. 2. System Owner:�� Name Address(i(different from location) City/Town State /t � J (� `ZippCCode Telephone Number B. Pumping Record . 1. Date of Pumping Date 2. Quantity Pumped: Gallons 3. Type of system: ❑ Cesspool(s) ptic Tank- ❑ Tight Tank ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes If yes, was it cleaned? ❑ Yes ❑ No 5. Condition of System- .6. yste� in:� 6. Systgrn Pumped By. Name Vehicle License Number Company -- .7. Locatio where contents w e disposed: -Si nit of au r Date http://www.mass.gov/dep/­water/approvalt,/t5forms.htm#inspect t5form4.doc•06103 System Pumping Record•Page 1 of 1 Board of Health SUBSURFACE DISPOSAL DESIGN CHECK LIST ..LOTS} I,•��t,D•Jndy PPRCNID DATE DISAPPROVED DATE Reasons: `rovided: ,�. � 1 ar✓ 72� /--z;, 'itle V FAIL CK . ;eg 2.5 The submitted plan must show as a min�mnm: a) the lot to be served-area,dimensions lot #,abatters jb' location and log deep observation holes-distance to ties alllocation 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 vet areas thin 100' of sewage disposal system or disclaimer-check wetlands napping (h) surface and subsurface drains within 1001 of sewage disposal system or disclaimer (i) location any drainage easements -within 11J0' of serge disposal system or disclaimer-Planning Board files �(3) known sources of pater simply within 2001 of sage disposal a system or disclainer location of any proposed well to serve lot-1001 from leaching facilit; 41) location of water lines on property-101 from leaching facility M) location of benchmark n) driveways (o) garbage disposals (p) no PVC to be used in construction (q) sement profile of system-elevations of ba , plumb, pipe, septic tank, distribution box Mets and outlets, distribution field piping and 0tter elevations maxclmam ground water elevation in area se-.age disposal system (s) plan mast be prepared by a Professional Eagineer or other professional authorized by lax to prepare such plans Reg 6 Sept ic Tanks (a) capacit es- 50% of flog, water table, tees, depth of tees, access, punping (b) cleanout pool (c) 10' from cellar -all or inground s-.zl- g p (d) 25' from subsurface drains Reg 10.2 Distribution Boxes slope greater than 0.08 Reg 10.4 b} mop p:!nj= Check Litt Page 2 FAIL OB Leaching-Pits. Leaching pits are preferred ere the installation is possible leg 11.2 a) calculations of leac area-n nimm 500 sq ft ll.4 b) spacing 11.10 c surfacerain 2% 11.11 d� cover maters e) k'x2 x11" ,,,,.Lash pad f) tee at box g) no bends in pipe from d-box to pipe Leaching Fields leg 15.1 a) no greater 20 minutes/inch ) area-mini== 900 sq ft i5.4 c) construction of field 15.8 ) surface drainage 2 % 3.7 e) 201 from cellar wall or inground Swimadng pool Leaching Tnmche R 111.1 a) c ons leaching area-min 500 sq ft 14.3 1 b) spacing-4 f min 6 ft with reserve between 14.4 c) dir sio 1-3.6 1d) cons tion 14.7 e) ston 1h.10 f} ace drainage 2% 4 Dounhill SI e asope yx = o be shown) COPTvv� ) y/x Z 150 - (to be shown) nr6 (4" Purms Reg 9.1 a) approval 9.6 b) stand-by power - WV, eoa �'r 42, -�^�-mss A6�ecvS SOIL PROFILE & PERCOLATION TEST DATA �/o/cg/�Z North Andover, Mass. Street No Z�- //���[) Lot No L6e/Subdiv. / Pland Owner Investigato / /G Observer SOIL PROFILE DATES l.tl.ev 2.Elev� 3.Elev 4.Elev 0 ` 0 0 0 V\114k (D� Ties P�s est 2 2 2 2 3 3 3 3 4 4 4 4 5 5 \ 5 5 6 0 6 6 6 7 7 7 7 8 8 8 8 9 9 9 9 10 /10 10 10 Benehmar cr- 7,5 n U W Ing c),' Location Elevation Datum PERCO;,ATION TESTS DATES Pit Number 1 2 3 4 Start Saturation Soak-Minutes Start e Drop of 3"-Time Drop of 6"-Time Mmms-lst 3" drop Mins.2nd " Drop Percolation SOIL PROFILE & PERCOLATION TEST DATA North Andover, Mass. Street No l.✓bl Wed �� ✓ J-� Lot No L Loc/Subdiv, Pland Owner N-�✓ ►^ Investigator P Observer ✓`C.� Z5 SOIL PROFILE DATES 1_'Elev 2.Elev 3.Elev 4.Elev 0 0 0 0 Ties � Test Pits 2 2 2 2 nr5�t � 3 3 3 3 4 4 4 4 5 5 5 5 6 6 6 6 7 7 7 7 8 8 8 8 9 9 9 9 10• 10 10 10 Benchmark Location Elevation Datum aPERCO TION TESTS �'— DATES L- Pit Number 1 2 3 4 Start Saturation Soak-Minutes Start e 1W,40 4O Drop of 3"-Time .-Drop of 6"-Time Mmms.lst 3" drop Mins.2nd " Drop Percolation 00C � /r� r�t "^JF Board of Health • , SEPTIC STSTEM North An ver Ma.aa. � jG(/GU� IN SPALLATICK CHBCB LISP LOT U�TFsD D s SAPPRO ED AVA L �J to FAIL OK - — CK ea�ansi �' 1. Distance Tot Wetlands b. Drains00 - c. Well 10 0,(-F0000 leo o(V 2. Water Line Location 3. No PVC Pipe }s. Septic Tank - ry b6 a. _Tess -_Length & To Clean Out Covers b. Cement Pipe to Tank On Both Sides T 5. Distribution Box � a. Covers & Box - No Cracks b. All Lines Flowing Equal Amounts �tGi c. No Back Flow 6. Leach Field or Trench a. Dimensions b. Stone Depth c. Capped Inds d. Clean Double Washed Stone 7. Leii ts a. si s b. epth c. h Pads d.e. t Pipe to Pit - Both Sides. £. Clean Double Washed Stone 8. No Garbage Disposal 9. Anal. Grading Inspection 10. Barricading Covered System 11: As Built Submitted a. Lot Location b. Dimensions of System c. Location Stith Regard-to Perc Test d. Elevations e: Water Table 'WELL DAT.A3ASE W'�i i. LOC a. ;ON.: OF _] T�OF DRIL= � b DUG C_ U-N�aIvNN 1tr11�iGrrLNE_ Y Cry aoy Y N y -GH OF �v T'yrL.L.DRL.I.�t �T�LL P=V-7 LiC.CAT N- : � LL PES DAT_• DFPTI:OF rrY'c'1� G T YPE OF L: z. DRI'i..L�D b. DuG' c. L%f`a�i07r/�' L rL OF WATiR3EA G ROCK: WATER A NA.LysIS DATE: ETE N AINGA ESE: y `+ �?0'r_a0N: y N OT--,----,-R CONy N Commonwealth of Massachusetts V- "U-J,(Massachusetts System Pumping Record System Owner System Location �-- �v � Date of Pumping: �j ��( �� Quantity Pumped: /,574�gallons Cesspool: No [a� Yes [I Septic Tank: No [] Yes H- System Pumped by: S'arw" License# Contents transferred to: Greater Lawrence Sanitary District Date: Inspector: TOWN OF SYSTEM PUMPING RECORD DATE j,;Ay - 2 20U3 SYSTEM OWNER& ADDRESS SYSTEM LOCATION (� (example:left front of house) a� LIC) Wt<JOOJ CC � DATE OF PUMPING: ` 02 D ! QUANTITY PUMPED : 60b GALLONS CESSPOOL: NO YES *PTIC TANK: NO YES 7 NATURE OF SERVICE: ROUTINE EMERGENCY OBSERVATIONS: GOOD CONDITION FULL TO COVER HEAVY GREASE BAFFLES IN PLACE ROOTS LEACHFIELD RUNBACK EXCESSIVE SOLIDS FLOODED SOLIDS CARRYOVER OTHER(EXPLAIN) SYSTEM PUMPED BY: Bateson Enterprises, Inc. COMMENTS: CONTENTS TRANSFERRED TO: 1 �1 i TOWN OF NORTH ANDOVER SYSTEM PUMPING RECORD DATE: SYSTEM OWNER &ADDRESS SYSTEM LOCATION (example: left front of house) -�40v� ey� kax��!, DATE OF PUMPING: QUANTITY PUMPED [ 5d� GALLONS CESSPOOL: NO V YES SEPTIC TANK: NO YES NATURE OF SERVICE: ROUTINE YEMERGENCY OBSERVATIONS: GOOD CONDITION FULL TO COVER HEAVY GREASE BAFFLES IN PLACE ROOTS LEACHFIELD RUNBACK EXCESSIVE SOLIDS FLOODED SOLIDS CARRYOVER OTHER (EXPLAIN) SYSTEM PUMPED BY: Lr- < � COMMENTS: CONTENTS TRANSFERRED TO: L Commonwealth of Massachusetts 111 lr3 lye,< , Massachusetts System puinping Recoud Syale�u Utvsier System Location Date of Ilumpilig: QuaWity Pumped: C 5© Q gallons Cesspool: NoP�- Yes Septic Tank: No Yeg- Syslent I'ui)iped by: Vat'eaors gift` 4W License # __-_-- Conlenls transferrred to : Gloater LAWre"ro Aonifwry District Date: _ Inspector: ti Commonwealth of Massachusetts . , Massachusetts System Pumping Record System Owner System Location Date of Pumping: . - l �� �� Quantity Pumped: - 4---gallons Cesspool: No Yes ❑ Septic Tank: No ❑ Yes a System Pumped by: Fit&d" 454&0 ida License# Contents transferrred to : Greater Lawrence Sanitary District Date: Inspector: � S 'Y � k I k , � f i � 3 w st 1 tt!V i m 5,'TAkIK 1141.61 � �.' f f�.l•Y �psi �,r«t?y4 l y�-� h!Ycc � ttit�l!clf��ye�f��itiC�� r1-fJ.�t k Y 0- _LOT LI tS f f LOT �-A 1 •L. KEREBY .0 1 1F' .(' / .ii\ ♦T , i C.C-. ! c T , AYE _ _ S Q GATE WfL ` C� i `. 9 CiRCL F- { �'3 � ► AQ o'ul Ll PLANq o F OF � iSUBSURMCEDISPOSAL LOCATED IN E i NORTH ANDOVER , MASS, AS PREPARED FOR F CONE CONSTRUCTION QATE : f4OVEMBE€ f983 SCALE: 1'"t 40' � z f 49 + 1 ' MERRIMACK ENGINEERING SERVICES- INC. 6e PARS STRf ET ANDC1VM M�ASWK TT$ 01810 • XEL. 017)475-WA. 373-3n) r .r � a 1� ��- � � �l I i i � s �� < � �N�" 1 i I 1 --- r