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Home My WebLink AboutBuilding Permit #Exception - 177 CARLTON LANE 10/2/2013 't OE 0ORTIf BUILDING PERMIT TOWN OF NORTH ANDOVER ° APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received Too Date Issued: '� l s�cHus t� IMPORTANT:Applicant must complete all items on this page LOCATION X77 C�A�� a,v 1,A) ennt PROPERTY OWNER d/i ,,4,W q�-,— A,tJA4e- �j Print MAP NO: v PARCEL:J ZONING DISTRICT: Historic District yes no Machine Shop Village yes o TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑One family ❑Addition ❑ Two or more family ❑ Industrial ❑Meration No. of units: ❑ Commercial Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑ Well ❑ Floodplain ❑Wetlands ❑ Watershed District ❑Water/Sewer a 77 0/) All Identification Please Type or Print Clearly) OWNER: Name: W,14"Ilyl a z w Phone: Z?Y 4ho-1-7- Address: CONTRACTOR Name: j 04AdcV 7.4 1 Phone: — Address: Supervisor's Construction License: Exp. Date: Home improvement License: Exp. Date: /.5 17 /a ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT.•$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $_ FEE: $ Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Ager Signature of contractor r 'Plans Submitted❑ PlansWaived-❑ Certified Plot Plan ❑ Stamped Plans ❑ .TYPE,OFSEWERAGEDISPOSAL Public Sewer ❑ Tanning/MassageBodyArt ❑.. . ..Swimming Pools ❑ Well ❑ . Tobacco.Sales -❑ Food Packaging/Sales ❑ Private(septic tank, etc.. ❑_. Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED: DATE APPROVED PLANNING & DEVELOPMENT' ❑ ❑ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on /3 Si nature COMMENTS__ !�r_�J� ,3- fo fa�K ( lam?.�T�i ys�✓� �G �S— ( r� � l� � G�3�-e-"�'r'�vrS w 2-d i' G r--U'0 r` 1 Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes - Planning Board Decision: Comments Conservation Decision: Comments Water& Sewer Connection/ Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DtPARTiVIEW =-Temp Dempster on site yes no Located at 124 Mair.Street -Fire Department signatu"re/date`�: i _ r COMMENTS �'" . w i FLOORPLAN Borrower William&Joanne Lauzon File No.: 03070082 Property Address: 177 Carlton Lane Case No,: City: North Andover State; MA Zip:01845 Lender:Chase Manhatten Mortgage Living Area - First Floor 16.0' 14.0'11 Wood Deck �14.0' �t 66.0' Dining Kitchen Dining Room Family 24.0' Room Living Room 26.0 z m DenlOffice Foyer 26.0' 4.0 40.0' Sketch by Apex IV WindowsT"' AREA CALCULAMONS SUMMARY LIVING AREA �� Code Description Size Totals Breakdown Subtotals GLA1 First Floor 1744.00 1744.00 First Floor FSB Wood Deck 224.00 229.00 28.0 x 40.0 1120.00 GI.A2 second Floor 1160.00 1160.00 24.0 x 26.0 624.00 second Floor 29.0 x 40.0 1160.00 Page 10 of 11 w r, r' OFFICIAL INSPECTION FORM NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) a Property Address:_177 Carlton Lame_ _North Andover_ Owner: Volp Date of Inspection:_11/14/2001_ .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. �2 `F `Lv Pit#1 House Driveway Tank Water Meter B D-Boz Pit#3 Pit#2 A to Tank=2018" A to D-Boz=50'5" B to Tank=22' B to D-Boz=43' ,Page 10 of 11 ,r rf ,f OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 177 Carlton Lame_ _North Andover— Owner: Volp Date of Inspection:_11/14/2001_ 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. Pit#1 House Driveway Tank Water Meter B D-Boz Pit#3 Pit#2 A to Tank=2018" A to D-Boz=50'5" B to Tank=22' B to D-Boz=43' Boari of ealth NortY. .,ndover,MaBs . SUBSURFACE DISPOSAL DE,%GN CHECK LIST LOT # 37 CAtfol / APPROTED DATE -fes / DISAPPROVED DATE Provided: Reasons: X� 9" k �+Y Title V FAIL 09 Reg 2.5 The submitted plan must show as a adnimum: a) the lot to be served-area,dimensions lot ##abutters blocation and log deep observation hoes4 -distance to ties c location and results percolation tests-distance to ties d design calculations & calculations shoving required leaching area (e) location and dimensions of system-including reserve area `�•�� (f) existing and proposed contours g) location any wet areas Athin 1.00' of sewage disposal system or disclaimer-check wetlands mapping (h) surface and subsurface drains within 100' of sewage disposal system or disclaimer (i) location any drainage easements within 100' of sewage disposal system or disclaimer-Planning Board files (3) known sources of water supply within 2001 of sewage disposal e system or disclaimer 1(k) location of any proposed well to serve lot-1001 from leaching'.facility (1) location of water lines on property-10I from leaching facility (m) location of benchmark (n) drivewys (o) 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 Other elevations (r) maximum ground pater elevation in area sewage disposal system (s) plan must be prepared by a Professional Engineer or other professional autho�ri.zed by lax to prepare such plans Reg 6 Septic Tanks (a) capacities-15u of flow, water table, tees, depth of tees, access, punping 1(b) cleanout (c) lot from cellar vall or ingroun.d swi.mndng pool (d) 251 from subsurface drains eg 10.2 Distribution Boxes (a) s ope greater than 0.08 s 10.4 (b) std Board of Health SEPTIC SZiT MVUH-! North Andover�Haaa. INSTAMATICK CHITE LIST LOT OVID DATE DISAPPRNED AVAITIC�J Og SIL ea ins t K av CEI 1V f30f OK 1. Distance Tot a. Wetlands b. Drains Well 2. Water Line Location 3• No PPC Pipe 4. Septic Tank a. ..Tees -_Length & To Clean Out Covers b. Cement Pipe to Tank, - On Both Sides of Tank 5. Distribution Box a. Covers-& Box - No Cracks b. All Lines Flowing Equal Amounts c. No Back Flow 6. Leach Field or. Trench a. Dimensions b. Stone Depth c. Capped ids 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. -FSna7 Grading Inspection 10. Barricading Covered System ---- �( 11. As Built Snbmitted a. Lot Location b. Dimensions of System c. Location with Regard-to Pere Test d. Elevations -.---- ----._-- e.' Water Table Address . l"27 CX. 4- to 4l Title of Fide Page of Date File Open: Date File closed: Doc Document/Action Title Date of Refer to other Purpose of Document Acti -- action Document/ docurnent/ / on and notes Num. Action Department Board of Appends — Board of Health —'Plan nin.gBoard ; Conseruatiion Comm' — tssian Building Departrmen;t TOWN OF NORTH ANDOVER SYSTEM PUMPING RECORD DATE: SYSTEM OWNER &ADDRESS SYSTEM LOCATION (example: left front of house) 4 DATE OF PUMPING: ('� QUANTITY PUMPED Ls-?-e-/ GALLONS CESSPOOL: NO - S SEPTIC TANK: NO YES 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: \ COMMENTS: CONTENTS TRANSFERRED TO: CEJ �--. S '✓, COMMONWEALTH OF MASSACHUSETTS Z � EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS ti d DEPARTMENT OF ENVIRONMENTAL PROTECTION A V a a ' gV TITLE 5 OFFICIAL INSPECTION FORM NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 177 Carlton Lane_ _North Andover_ Owner's Name: Jeff Volp_ Owner's Address: 177 Carlton Lane North Andover_ Date of Inspection: 11/14/2001_ NOV 3 0 Name of Inspector: Neil J.Bateson_ 2001 Company Name: Bateson Enterprises Inc._ — -- –. 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: Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature: Date: _11/14/2001_ 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:_177 Carlton Lane_ _North Andover— Owner: Volp Date of Inspection:_11/14/2001^ 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: 177 Carlton Lane_ _North Andover — Owner: Volp Date of Inspection:_11/14/2001_ 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: T 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 wanner 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: 177 Carlton Lane_ —_North Andover— Owner: Volp Date of Inspection: 11/14/2001_ D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes No 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 less than''/a 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`oyes"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 11 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:_177 Carlton Lane_ _North Andover_ Owner: Volp Date of Inspection: 11/14/2001_ 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?(If they were not available note as N/A) 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.For example,a plan at the Board of Health. No Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance_ 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:_177 Carlton Lane_ _North Andover– Owner: Volp Date of Inspection:_11/14/2001 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: Does residence have a garbage grinder(yes or no): No_ Is laundry on a separate sewage system(yes or no): No_ [if yes separate inspection required] Laundry system inspected(yes or no): Seasonal use:(yes or no):–No_ Water meter readings: N/A_ Sump pump(yes or no).--Yes_ Last date of occupancy:— Current-COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seaWpersons/sgft,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 two months ago,owner Was system pumped as part of the inspection(yes or no): No If yes,volume pumped:______gallons--How was quantity pumped determined? Reason for pumping: 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:_16 years old,1/30/1985, 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:_177 Carlton Lane_ _North Andover_ Owner: Volp Date of Inspection:_11/14/2001 BUILDING SEWER(locate on site plan)X Depth below grade: 28" Materials of construction:—X—cast iron —X-40 PVC_other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.):_4"Cast iron thru wall,3"PVC in house. No leaks._ SEPTIC TANK: X locate on site plan) Depth below grade:_16" Material of construction:_X concrete—metal ___polyethylene metal_fiberglass _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: 1" Distance from top of sludge to bottom of outlet tee or baffle:—26" Scum thickness: 1" 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:_19" How were dimensions determined: Subtract scum&sludge depth to tee length._ Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.):_Inlet tee ok.Outlet tee ok.Depth of liquid at outlet invert. No evidence of leakage._ 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 baffle 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:_177 Carlton Lane_ North Andover- Owner: Volp Date of Inspection:_11/14/2001 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 (if present must be opened)(locate on site plan) 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-Boz level&distribution equal.Evidence of carryover,pumped d-box to clean.No evidence of leakage.D-box cover broken,replaced same._ PUMP CHAMBER: (locate on site plan) 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.): Page 9 of 11 OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:_177 Carlton Lane_ _North Andover— Owner: Volp Date of Inspection:_11/14/2001_ SOIL ABSORPTION SYSTEM(SAS):_X (locate on site plan,excavation not required) If SAS not located explain why: Type X leaching pits,number:_3 T leaching chambers,number: leaching galleries,number: leaching trenches,number,length: leaching fields,number,dimensions: overflow cesspool,number: innovative/altemative system Type/name 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.Camera inside of pits thru outlet pipes in d-box, water in pits 12"from inverts. CESSPOOLS: (cesspool must be pumped as part of inspectionxlocate on site plan) Number and configuration: Depth—top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes 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 OFFICIAL INSPECTION FORM NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 177 Carlton Lane_ _North Andover_ Owner: Volp Date of Inspection:_11/14/2001_ 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. Pit#1 House Driveway Tank Water Meter B D-Boz 14e Pit#2 A to Tank=2018" A to D-Boz=50'5" B to Tank=22' B to D-Boz=43' Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:_177 Carlton Lane_ _North Andover — Owner: Volp Date of Inspection:_11/14/2001_ SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water_4 feet 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:_8/17/1986_ 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: 177 Carlton Lane, North Andover Owner: Volp Date of Inspection: 11/14/2001 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. Neil4Baon Bateson Enterprises, Inc. LOT37 ° zARIL-roli �s G39 �z 24.' RS' Pif ill 13� CARO-ON l..APA5- & -r iELoyA r1c>N -c-, AT FoUN DAT►PW O TAW( wL" 0UTLOFi 158, 70 PST y ls'170 4 PIT / Commonwealth of Massachusetts City/Town of System Pumping Record Form 4 DEP has provided this form for use by local Boards of Health. Other forms may be used, but the information must be substantially the same as that provided here. Before using this form,check with your local Board of Health to determine the form they use. The System Pumping Record must be submitted to the local Board of Health or other approving authority. A. Facility Information Important: When fining out 1. System�Location- forms on the l��°� t;'�J computer, use — only the tab key Address to move your cursor-do not Citylrown State Zip Code use the return key. 2. System Owner: Name Address(if different from location) Cityrrown State�� Zip Code � % 7 Telephone Number B. Pumping Record 1. Date of Pumping Date 2. Quantity Pumped: Gallons 3. Type of system: ❑ Cesspool(s) Septic Tank ❑ Tight Tank ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes No If yes, was it cleaned? ❑ Yes ❑ No 5. Condition of System: 6. System =: ��► -2 r Name Vehicle License Number Company 7. Location cont nts w dis Signatur of ler Date t5form4.doc•06/03 System Pumping Record•Page 1 of 1 Commonwealth of Massachusetts City/Town of NOV 2 0 2012 System Pumping Record Form 4 DEP has provided this form'for use by local Boards of Health. Other forms may be used, but the information must be substantially the same as that provided here. Before using this form, check with your local Board of Health to determine the form they use.The System Pumping Record must be submitted to the local Board of Health or other approving authority. A. Facility Information 1. System Location: Left/Right front of house, Left/Right rear of house, Left c ht side of hous eft/ Right side of building, Left/Right front of building, Left/Right rear of building, Under ec c Address r-7 t J Q( — p l.I \, v0� Cityrrown Z StateZip Code 2. System Owner. Lau Name Address(if different from location) City/Town State � �Zi Code �' Telephone Number B. Pumping Record _ 1. Date of Pumping Date ;,2e-. Qua Pumped: Gallons 3. Type of system: ❑ Cesspool(s) Septic Tank ❑ Tight Tank ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes No If yes,was it cleaned? El Yes No 5. Condition of System: �A)i �k tekmJ v\4�\&kf 6. System Pumped By: Neil Bateson F5821 Name Vehicle License Number Bateson Enterprises Inc Company 7. Locati where contents were disposed: JG-U-0 Lowell Waste Water Date t5form4.doc•06/03 System Pumping Record•Page 1 of 1