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HomeMy WebLinkAboutBuilding Permit #624 - 48 HAWKINS LANE 4/24/2008Permit NO: 6 ��4 — BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION�F►►�O8QP A�JEXAMINATION AUt�u1 Date Issued: �r IMPORTANTl: icant must I MAP. NO.' ` . PARCEL: ZONING Date Received UJA &rtn' ,omplete all items on this page �'. FRICT: t=listonc District yeso llachirae .S'hop Vl)age. yes "no 'bjryO\ .14 a,.� TYPE OF IMPROVEMENT PROPOSED USE Resid aL Non- Residential New BuildingOne family Addition Two or more family Industrial Alteration No. of units: Commercial Repair, replacement Assessory Bldg Others: Demolition Other Sep#ic Weil F)oodplarra = .. 'Wetlands1/atershed District, ,Mater/Sewer DtNl OWNER: Name: OF WORK TO 1JE,PREFOKNF=D: ti icon Please Type or Print Clearly) ��� ���� L v\. Phone: ARCHITECT/ENGINEER Vt 0UEi L06 6 Phone: 11�- m ' 430� Address: I LI DLSOk) Reg. No. (�3 6t) 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: Pe ons contracting w,#h unregi#-fired contactors do not have access t fund Plans Submitted Plans Waived Certified Plot Plan Stamped Plans TYPE OF SEWERAGE DISPOSAL Public Sewer Tanning/MassageBody Art 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 PLANNING & DEVELOPMENT COMMENTS CONSERVATION DATE APPROVED COMMENTS Viic 'Lsl� G�� u -AA& t 00 � DATE REJECTED DATE APPROVED HEALTH �� o COMMENTS I Zoning Board of Appeals: Variance, Petition No: Zoning'Decision/receipt submitted yes Planning Board Decision: Conservation Decision: Comments Comments Water & Sewer Connection/Signature & Date Driveway Permit Located at 384 Osgood Street FIRE DEPARTMENT --"Temp .D i pstec.on site; -yes : no Located'at 124,91ain.Street : fire .Departtne�nts'ynatnreldate, 'COMMENTS Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector . Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA — (For department use ijt'X—' GI ❑ Notified for pickup - Date Doc.Building Permit Revised 2007 Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits ❑ Building Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract ❑ Floor Plan Or Proposed Interior Work ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks ❑ Building Permit Application ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract ❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) ❑ Building Permit Application ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products VOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit qn all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals iat the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording ,ist be submitted with the building application Doc: INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 evised 2.2007 4 Location No. Date 0/' TOTAL Check # -1/0 2: . 05 Building Inspector TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL Check # -1/0 2: . 05 Building Inspector O �¢ x u °o w v cn 0 w P O or. p w o rx U a x EOEE W O a o rx q w CL O a w- ° w ci q w' O U o. cx a Pi w w w c w cn -` ° cn N O z 3 C 'r' O : m C O ` y-+ O ca V 4 �d= = CL. t. m = m rA a ;moo C. EGO z :gym p O O V r.+ cm :t� �,o RE y.v E 41 O �3 UJ CA Cos Co y W O Em W 4D o y m ' L = O Of ca dm C m C83 y ' = � O O • Z �CA=o ao c my m C �C = m O_-. C N ~ r0+ N m r0+ ~ m y=.. W = O+t+�t F.. .y AR n=... m Z W .E C2c V m GO m � � s = A D H O r- z CL *-cc 43� z O U C/) CO2 O CO2 O O Z 0 ca ccCL CO2 O. ca CO2 C O cc C cc a CO2 O ts co CL GO c CD CM c 0.— D � CD m 0 CD O � CD 0 Q O Cld cma c ..1 O CD G3 C. COD C Y♦ U) W W W U) S 5°15'47" W 223.00' GRID SCALE F oN -� O�d 0 tzi p GRID SCALE F ' Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 48 Hawkins Lane Y%�, Property Address Fred Halohm Owner Owner's Name information is required for No. Andover MA 01845 4/1/08 every page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Important: A. General Information When filling out forms on the computer, use 1. Inspector: only the tab key to move your Benjamin C. Osgood, Jr. cursor - do not Name of Inspector use the return key. New England Engineering Services, Inc. Company Name G 1600 Osgood Street Suite 2-64 Company Address No. Andover _ MA 01845 City/Town State Zip Code 978-686-1768 Telephone Number License Number B. Certification 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: asses ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 9--, - q- /- C6 Inspecto .l;4 Signature Date 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. ****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. TITLE 5 FORM 2007.DOC • 08/06 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 1 of 15 ' &N Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 48 Hawkins Lane Property Address Fred Halohm Owner information is required for every page. Owner's Name No. Andover MA 01845 4/1/08 City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E / always complete all of Section D A) System Passes: NKI 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 TITLE 5 FORM 2007.DOC • 08/06 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 2 of 15 Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 48 Hawkins Lane Property Address Fred Halohm Owner's Name No. Andover MA 01845 City/Town State Zip Code B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ distribution box is leveled or replaced ND Explain: 4/1/08 Date of Inspection ❑ 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: 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. TITLE 5 FORM 2007.DOC • 08106 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 3 of 15 Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ° 48 Hawkins Lane M Property Address Fred Halohm Owner information is required for every page. Owner's Name No. Andover MA 01845 4/1/08 City/Town State Zip Code Date of Inspection B. Certification (cont.) C) Further Evaluation is Required by the Board of Health (cont.): ❑ 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 indicates absent 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: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or "No" to each of the following for all inspections: Yes No ❑ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ Ea,- 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 ❑ Eg"- Liquid depth in cesspool is less than 6" below invert or available volume is less than 'Y2 day flow ❑ Ea-- 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 SAS, cesspool or privy is below high ground water elevation. ❑ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. TITLE 5 FORM 2007.DOC • 08/06 Title 5 Oficial Inspection Form: Subsurface Sewage Disposal System • Page 4 of 15 Commonwealth of Massachusetts EUMEME)W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 48 Hawkins Lane Property Address Fred Halohm Owner Owner's Name tiis reequirequired for No. Andover MA 01845 4/1/08 o every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) D) System Failure Criteria Applicable to All Systems (cont.): Yes No ❑ lid' Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ED/ Any portion of a cesspool or privy is within 50 feet of a private water suppl ❑ ED -1 Any portion of a cesspool or privy is less than 100 feet but greater than 50 from a private water supply well with no acceptable water quality analysis system passes if the well water analysis, performed at a DEP certifie laboratory, for fecal coliform bacteria indicates absent and the prese of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 p provided that no other failure criteria are triggered. A copy of the an And chain of custody must be attached to this form.] ElThe system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. E] Ej,,, The system fails. I have determined that one or more of the above failur criteria exist as described in 310 CMR 15.303, therefore the system fails. system owner should contact the Board of Health to determine what will b 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. i y well. feet [This d nce pm, a lysis e For large systems, you must indicate either "yes" or "no" to each of the following, in addition to the questions in Section D. Yes No ❑ ©K the system is within 400 feet of a surface drinking water supply ❑ [a/ the system is within 200 feet of a tributary to a surface drinking water supply ❑ [2 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. TITLE 5 FORM 2007.DOC • 08/06 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 5 of 15 The e For large systems, you must indicate either "yes" or "no" to each of the following, in addition to the questions in Section D. Yes No ❑ ©K the system is within 400 feet of a surface drinking water supply ❑ [a/ the system is within 200 feet of a tributary to a surface drinking water supply ❑ [2 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. TITLE 5 FORM 2007.DOC • 08/06 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 5 of 15 Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 48 Hawkins Lane M Property Address Fred Halohm Owner Owner's Name tiis reequirequired for No. Andover MA 01845 4/1/08 o every page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate "yes" or "no" as to each of the following: Yes No [,' ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ LR Were any of the system components pumped out in the previous two weeks? ❑ Has the system received normal flows in the previous two week period? ❑ �/ Have large volumes of water been introduced to the system recently or as part of this inspection? 2 ❑ Were as built plans of the system obtained and examined? (If they were not i note as N/A) /available ❑ Was the facility or dwelling inspected for signs of sewage back up? L� " E2"" ❑ Was the site inspected for signs of break out? L�' ❑ Were all system components, excluding the SAS, located on site? Yes No [,' ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ LR Were any of the system components pumped out in the previous two weeks? ❑ Has the system received normal flows in the previous two week period? ❑ �/ Have large volumes of water been introduced to the system recently or as part of this inspection? 2 ❑ Were as built plans of the system obtained and examined? (If they were not note as N/A) /available ❑ Was the facility or dwelling inspected for signs of sewage back up? L� " E2"" ❑ Was the site inspected for signs of break out? L�' ❑ Were all system components, excluding the SAS, located on site? ❑ 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? ©/ ❑ 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: Existing information. For example, a plan at the Board of Health. ❑ g" Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] TITLE 5 FORM 2007.DOC • 08/06 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 6 of 15 Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 48 Hawkins Lane Property Address Fred Halohm Owner information is required for every page. Owner's Name No. Andover MA 01845 City/Town State Zip Code D. System Information Residential Flow Conditions: 4/11/08 Date of Inspection Number of bedrooms (design): If Number of bedrooms (actual): DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x # of bedrooms): Number of current residents: Does residence have a garbage grinder? Is laundry on a separate sewage system? [if yes separate inspection required] Laundry system inspected? Seasonal use? Water meter readings, if available (last 2 years usage (gpd)): Sump pump? Last date of occupancy: Commercial/Industrial Flow Conditions: Type of Establishment: Design flow (based on 310 CMR 15.203): Basis of design flow (seats/persons/sq.ft., etc.): Grease trap present? Industrial waste holding tank present? Non -sanitary waste discharged to the Title 5 system? Water meter readings, if available: Last date of occupancy/use: Other (describe): G G G P� ["Yes ❑ No ❑ Yes [r No ❑ Yes L�' No ❑ Yes EvYNo ❑ Yes [gNo G.� roc .. Date Gallons per day (gpd) ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No Date TITLE 5 FORM 2007.DOC • 08/06 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 7 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 48 Hawkins Lane Owner information is required for every page. Property Address Fred Halohm Owner's Name No. Andover City/Town D. System Information (cont.) General Information Pumping Records: Source of information: Was system pumped as part of the inspection? If yes, volume pumped: How was quantity pumped determined? Reason for pumping: 4/1/08 Date of Inspection `iJrnO�cY ZooD �C/Z $c� I-'( gallons Type of System: EEK Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Yes UL No ❑ 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: 9,—� 4 i`tSct Pv0- o--, -i E2 Were sewage odors detected when arriving at the site? ❑ Yes No TITLE 5 FORM 2007.DOC - 08/06 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 8 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 48 Hawkins Lane Property Address Fred Halohm Owner Owner's Name information is required for No. Andover MA 01845 4/1/08 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Building Sewer (locate on site plan): Depth below grade: 'S feet Material of construction: ❑ cast iron LK 00 PVC ❑ other (explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Septic Tank (locate on site plan): Depth below grade: feet Material of construction: 19/concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other (explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No -------------------------------------------------------------------------------------------------------------------------- Dimensions: Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle 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 How were dimensions determined? 15-o ° �p L A ze C. 2 AA -e*s v r-- s-11 C, R - TITLE 5 FORM 2007.DOC • 08106 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 9 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °wM 48 Hawkins Lane Property Address Fred Halohm Owner information is required for every page. Owner's Name No. Andover City/Town 4/1/08 Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): -'-A/%-/ 14 !ti/ Craoy to�D��J�. Can<!�� - ! n OIC Grease Trap (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass feet ❑ 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: Date Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 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): TITLE 5 FORM 2007.DOC • 08/06 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 10 of 15 Ni Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 48 Hawkins Lane Property Address Fred Halohm Owner's Name No. Andover City/Town D. System Information (cont.) Tight or Holding Tank (cont.) Dimensions: Capacity: Design Flow: Alarm present: Alarm level: Date of last um in ' MA 01845 4/1/08 State Zip Code Date of Inspection gallons gallons per day ❑ Yes ❑ No Alarm in working order: ❑ Yes ❑ No p p gDate Comments (condition of alarm and float switches, etc.): * Attach copy of current pumping contract (required). Is copy attached? ❑ Yes ❑ No Distribution Box (if present must be opened) (locate on site plan): it Depth Depth of liquid level above outlet invert 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.): 92* 1^ �� �o.,�• ' ', an - e,; e� /T /_5_ _ z -4j j"As % GLGGi2• 7`14/S /n�S�• la/le'S ►1Gs� NT7 `c/c"✓L MC4 rsol Da �C7�'fi rJ �4- i ri J,,,,T1bl 9oxl Pump Chamber (locate on site plan): Pumps in working order: Alarms in wD* o der: ❑ Yes ❑ No ❑ Yes ❑ No `-� %� ii1/�`7 hCG✓L bcGn dLC�►M ti3 <� w n p TITLE 5 FORM 2007.DOC • 08/06 C. 1 t1,�, cell) ��n /� G /) Title 5 Official Inspection Form: Subsurface Sewage Disposal System Page 11 of 15 �1sT2f�►/71C3n 070X. .+Y Commonwealth of Massachusetts W Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 48 Hawkins Lane Property Address Fred Halohm Owner Owner's Name information is required for No. Andover MA 01845 4/1/08 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: []� leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): .41-Cia o F D 1 TS 4 -Dv K !!!; hDA-e" fRL TITLE 5 FORM 2007.DOC - 08/06 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 12 of 15 • Commonwealth of Massachusetts x 1;W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 48 Hawkins Lane Property Address Fred Halohm Owner Owner's Name information is required for No. Andover MA 01845 4/1/08 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 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 solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ 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.): TITLE 5 FORM 2007.DOC • 08/06 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 13 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 48 Hawkins Lane D. System Information (cont.) 4/1/08 Date of Inspection 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. S ec, fe'fTAG4z�v TITLE 5 FORM 2007.DOC • 08/06 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 14 of 15 Property Address Fred Halohm Owner Owner's Name information is required for No. Andover MA 01845 every page. City/Town State Zip Code D. System Information (cont.) 4/1/08 Date of Inspection 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. S ec, fe'fTAG4z�v TITLE 5 FORM 2007.DOC • 08/06 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 14 of 15 Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 48 Hawkins Lane Property Address Fred Halohm Owner's Name No. Andover City/Town D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells KAA 01845 Zip Code 4/1/08 Date of Inspection Estimated depth to ground water: feet Please indicate all methods used to determine the high ground water elevation: Obtained from system design plans on record If checked, date of design plan reviewed: 98�{ Date ® 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: �L 7"C �%L 5 1 � rf d JJ � • �J ✓L q heSu w CY l.✓' (g Q I. T5 17 R�j Du 21 j0. w 'r7"[: -S 4 ,d TITLE 5 FORM 2007.DOC • 08/06 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 15 of 15 Ab j fr v J P -I-- 51- 'N 4- P 6 2, 131,64 114.57 7 a 1-1 JThe Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers'. Compensation Insurance Affidavit: Builders/Contractors/Electricans/Plumbers Applicant Information Name (Business/or PIease Print Tie 'bI ganization/Individnal): Address: City/Slate/Zip: /1/4/ Phone.#: %�� o� L .— a � j Are.y6u an employer? Check the appropriate box: 1. [� IF am a employer with 4. Q I am a general7have Fh f (required).` Employees (hili and/or patt_time)•* have hired theconstruction 2.0 I am a'soie proprietor or part ter_ listed on the aodeling . ship and have no employees These sub-con working forme in any capacity. employees and have workers' olition [No workers' co co mp. insurance comp- insurance.# ing. addition required.] 5. We are a corporation and its \ 3. ❑ I am a homeowner doing all work rical repairs or additionsofficers have exercised (heirmysolf. [No workers' comp, rightof exemption per MGL.ing repairs or additions insurance required..] t c. 152, § 1(4), and we have no 12.0 Roof repairs employees. [No workers' 13.0 Other �mP insurance required:] *Any applicant that checks box #1 must also fill out the section below showing their workers, compe�ati� policy information. t Homeov.aems who submit this davit indicating the), are doing all work and then hire outside contm-t= must submit a new +Contractors that check this box must attached an additional sheet showing the name affidavit indicating such,of the sub -contractors and state wimetim-m or not those entities have employees. If the sub eonimactors.have employees, tk ey must provide their war k=T' comp: policy number, I am. an employer that is providing workers' c pensation information. insurance form emp yees. Below is the policy .and job site ,�� Insurance Company Name: .Nt Policy # or Self -ins. Lic. #i V (� r/ Expiration Date' Job Site Address: City/State/Zip: 00 (i pie h,— Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties -of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil of up to $250.00 a day against the violator.. Be advised that a co penalties m the form of a STOP WOR{ ORDER and a fine Investieations of the DIA r insurance cov a e verification. PY of this statement maybe forwarded to the Office of Ido hereby certify er the ains•aad realties of perjury that the information provided above true an correct Si ature• —� Date: lj Phone'#: 7�— SC% �� L — Offceial.use only. Do not write in this area, to be completed by city or town official City or Town: Permit/License # Issuing Authority (circle one): '1. Board of Health 2. Building Department 3. City/Town Clerk 4. Elec 6. Other trical Inspector 5. Plumbing Inspector ContactPerson: Phone #: Information an. d Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as "...every p=rson in the service of another under any contract of hire, express or implied, oral or written." r An employer is defined as "an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including t3ae legal representatives of a deceased employer, or the receiver or trustee 'of an individual, partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the.occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on .such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6) also states that "ever ,y state or to cal licensing agency shall withhold the issuance or renewal of a license or permit to,bpera`tem business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of co nnplianee with the insurance coverage required." 1 Additionally, MGL chapter 1,52, §25CO) states 'Neither the commonwealth nor any of its political subdivisions shall enter into any contract for. the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority. Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub-contractor(s) name(s), address(es) and phone number(§) along with their certificate(s) of insm=e. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members or partners, are not required to carry workers' compensation insurance. If.an LLC or LLP does have employees, a policy is required. Be advised that this affidavit maybe submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the perazit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the. law. .or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town.Offidals Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant Please be sureto fill in the permittlicense number which will be used as a reference number. In addition, an applicant that must submit multiple permitllicense applications in any given year, need only submit one affidavit indicating current policy information (if necessary) and under `.`Job Site Address" the applicant should write "all -locations in (city or town)." A copy of the affidavit that has been. officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future peimaits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related -to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.) said person is NOT required to complete this affidavit The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone -and fax number. The Cornrnonwealth of Massachusetts. Department. of Industrial Accidents Office of Inveest of ons 600 Washington Street. Boston, MA 02111 Tel. # 617-727-4300 exfi.4W or 1-877-MASSAFE ` Fax # 617-727-7749 Revised 11-X22-06 VWv.massgovldia �/ce �o�emran.,ueald �,/uaoAaclruaei�4 BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number: CS 089793 f Birthdate: 05/13/1959 j Expires: 05/13/2008 Tr. no: 89793 1 - Restricted: 00 GEORGE H PIPERIDIS " 79 MICHIGAN AVE ► LYNN, MA 01902 C/9141i/ Commissioner. ,per 711ae �anvinoveivea�ii a�✓�iaaoar/u�aetl �\ Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registration:, 148811 Expiration. 10/27/2009 Tr# 262860 ,. 1Typ __ IniidiVidual GEORGE H. PIPEVIDIS . f - GEORGE PIPERIDIS N 79 MICHIGAN AVE LYNN, MA 01902 Administrator ACORD,M CERTIFICATE OF LIABILITY INSURANCE4 DATE(320MM/OD/YYYY08) PRODUCER Phone: 508-651-7700 Fax: 508-653-8089 Eastern Insurance Group LLC -Commercial Lines 233 west Central Street Natick MA 01760 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED 13Y THE POLICIES BELOW. LTR WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE INSURERS AFFORDING COVERAGE NAIC # INSURED George H. Piperidis DBA: Old Towne Construction INSURER A:Nautilus Insurance Company INSURER B: Travelers Indemnit Co 5658 INSURER C: 85 Exchange Street, Suite L1 INSURER D: Lynn MA 01901 INSURER E: 7/13/2007 COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE TYPFOFINSURANCF POUCYNUMBER POLICY EDATE MFFECTIVE POLICYEXPIRATION LIMITS A GENERALLIABILITY NC703215 7/13/2007 7/13/2008 EACHOCCURRENCE $1,000,000 PREMISES Eaoccurenoe $100,000 X COMMERCIAL GENERAL LIABILITY CLAIMS MADE © OCCUR MEDEXP(Anyoneperson) $ 000 PERSONAL &ADV INJURY $1,000,000 GENERALAGGREGATE $2,000,000 AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPRWAGG $1,000,000 hGENt POLICY n PRO LOC AUTOMOBILE LIABILITY ANYAUTO COMBINED SINGLE LIMIT (Eaaocidert) $ BODILY INJURY $ (Perpot—) ALLOWNEDAUTOS SCHEDULEOAUTOS BODILY INJURY (PeraocMri) $ HIREDAUTOS NON40WNEDAUTOS PROPERTYDAMAGE $ (Peraocklerd) GARAGE LIABILITY ALITOONLY -EA ACCIDENT $ OTHERTHAN EAACC $ ANYAUTO AUTOONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACHOCCURRENCE $ AGGREGATE $ OCCUR CLAIMSMADE $ DEDUCTIBLE $ RETENTION $ B WORKERS COMPENSATION AND UB0714L11 7/12/2007 7/12/2008 WORYLIMITS CSTATU- FR EMPLOYERS' LIABILITY EL EACHACCIDENT $ ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. DISEASE - EA EMPLOYEE $ OFRCER/MEMBEREXCLUDED? Ilyyes describeurder SPEG�IAL PROVISIONS below E.L DISEASE - POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONS / LOCATIONS /VEHICLES/ EXCLUSIONS ADDED BY ENDORSEMENT/ SP ECIALPROVISIONS he Workers Compensation certificate will be issued from the carrier, coverage is in effect. he Workers Compensation policy does not provide coverage for George Piperidis. CERTIFICATE HOLDER CANCFI I ATIAN f►wrlu zo tzuu>I /uol 0 ACORD CORPORATION 1988 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED Town Of North Andover BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE 84 Hawkins Lane CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO North Andover MA 01810 SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHOR¢EDREPRESENTATIVE 2 f►wrlu zo tzuu>I /uol 0 ACORD CORPORATION 1988 C., CREScheck Software Version 4.1.3 �J( Compliance Certificate Project Title: New Addition Report Date: 03/27/08 Data filename: C:\Documents and Settings\Phillip Kritikos\My Documents\WORK SPACE\DOCUMENTS\Private\Alholm\Energy Report.rck Energy Code: Location: Construction Type: Glazing Area Percentage: Heating Degree Days: Construction Site: 48 Hawkins Lane North Andover, MA 01845 20001ECC North Reading, Massachusetts Single Family 28% 6268 Owner/Agent: Fred Ahlholm 48 Hawkins Lane North Andover, MA 01845 Compliance: Compliance: 2.3% Better Than Code Maximum UA: 132 Your UA: 129 Designer/Contractor: Phillip Kritikos Kritikos Associates Architects 14 Olsen Road Peabody, MA 01960 978-531-4164 kaarch@yahoo.com Ceiling 2: Flat Ceiling or Scissor Truss 434 30.0 30.0 / Wall 1: Wood Frame, 16" o.c. 750 19.0 19.0 18 Window 1: Wood Frame:Double Pane with Low -E 180 0.470 85 Door 2: Glass 33 0.350 12 Floor 1: All -Wood Joist/Truss:Over Outside Air 434 33.0 33.0 7 Boiler 1: Other (Except Gas -Fired Steam)92 AFUE Compliance Statement. The proposed building design described here is consistent with the building plans, specifications, and other calculations submitted with the permit application. The proposed building has been designed to meet the 2000 IECC requirements in REScheck Version 4.1.3 and to comply with the mandatory requireVature in the REScheck Inspection Checklist. 1 -1 -HU -1p � 17"1 KyS— INS I PU 3 ° g o � Name - Titl SDate Project Notes: Previously saved project information: Kritikos Associates Architects 14 Olsen Road Peabody, MA 01960 Project Title: New Addition Report date: 03/27/08 Data filename: C:\Documents and Settings\Phillip Kritikos\My Documents\WORK SPACE\DOCUMENTS\Private\Alholm\Energy Report.rck Page 1 of 4 REScheck Software Version 4.1.3 Inspection Checklist Date: 03/27/08 Ceilings: ❑ Ceiling 2: Flat Ceiling or Scissor Truss, R-30.0 cavity + R-30.0 continuous insulation Comments: Above -Grade Walls: ❑ Wall 1: Wood Frame, 16" o.c., R-19.0 cavity + R-19.0 continuous insulation Comments: Windows: ❑ Window 1: Wood Frame:Double Pane with Low -E, U -factor: 0.470 For windows without labeled U -factors, describe features: #Panes Frame Type Thermal Break? Yes No Comments: Doors: ❑ Door 2: Glass, U -factor: 0.350 Comments: Floors: ❑ Floor 1: All -Wood Joist/Truss:Over Outside Air, R-33.0 cavity + R-33.0 continuous insulation Comments: Heating and Cooling Equipment: ❑ Boiler 1: Other (Except Gas -Fired Steam): 92 AFUE or higher Make and Model Number: Air Leakage: ❑ Joints, penetrations, and all other such openings in the building envelope that are sources of air leakage are sealed. ❑ Recessed lights are 1) Type IC rated, or 2) installed inside an appropriate air -tight assembly with a 0.5" clearance from combustible materials. If non -IC rated, fixtures are installed with a 3" clearance from insulation. Vapor Retarder: ❑ Installed on the warm -in -winter side of all non -vented framed ceilings, walls, and floors. Materials Identification: ❑ Materials and equipment are installed in accordance with the manufacturer's installation instructions. ❑ Materials and equipment are identified so that compliance can be determined. ❑ Manufacturer manuals for all installed heating and cooling equipment and service water heating equipment have been provided. ❑ Insulation R -values, glazing U -factors, and heating equipment efficiency are clearly marked on the building plans or specifications. ❑ Insulation is installed according to manufacturer's instructions, in substantial contact with the surface being insulated, and in a manner that achieves the rated R -value without compressing the insulation. Duct Insulation: ❑ Ducts in unconditioned spaces are insulated to at least R-5. Ducts outside the building are insulated to at least R-6.5. Duct Construction: ❑ All joints, seams, and connections are securely fastened with welds, gaskets, mastics (adhesives), mastic -plus -embedded -fabric, or tapes. Tapes and mastics are rated UL 181A or UL 181B. Exceptions: Project Title: New Addition Report date: 03/27/08 Data filename: C:\Documents and Settings\Phillip Kdtikos\My Documents\WORK SPACE\DOCUMENTS\Private\Alholm\Energy Report.rck Page 2 of 4 Continuously welded and locking -type longitudinal joints and seams on ducts operating at less than 2 in. w.g. (500 Pa). The HVAC system provides a means for balancing air and water systems. Temperature Controls: Thermostats exist for each separate HVAC system. A manual or automatic means to partially restrict or shut off the heating and/or cooling input to each zone or floor is provided. Service Water Heating: Li Water heaters with vertical pipe risers have a heat trap on both the inlet and outlet unless the water heater has an integral heat trap or is part of a circulating system. Ej Circulating hot water pipes are insulated to the levels in Table 1. Circulating Hot Water Systems: LI Circulating hot water pipes are insulated to the levels in Table 1. Swimming Pools: Lj All heated swimming pools have an on/off heater switch and a cover unless over 20% of the heating energy is from non-depletable sources. Pool pumps have a time clock. Heating and Cooling Piping Insulation: E] HVAC piping conveying fluids above 105 degrees F or chilled fluids below 55 degrees F are insulated to the levels in Table 2. Project Title: New Addition Report date: 03/27/08 Data filename: C:\Documents and Settings\Phillip Kritikos\My Documents\WORK SPACE\DOCUMENTS\Private\Alholm\Energy Report.rck Page 3 of 4 'r . , 4 Table 9: Minimum Insulation Thickness for Circulating Hot Water Pipes Table 2: Minimum Insulation Thickness for HVAC Pipes Insulation Thickness in Inches by Pipe Sizes Insulation Thickness in Inches by Pipe Sizes Non -Circulating Runouts Circulating Mains and Runouts Heated Water Up to 1" Up to 1.25" 1.5" to 2.0" Over 2" Temperature ("F) Low Pressureffemperature 201-250 170-180 0.5 1.0 1.5 2.0 140-169 0.5 0.5 1.0 1.5 100-139 0.5 0.5 0.5 1.0 Table 2: Minimum Insulation Thickness for HVAC Pipes NOTES TO FIELD: (Building Department Use Only) Project Title: New Addition Report date: 03/27/08 Data filename: C:\Documents and Settings\Phillip Kdtikos\My Documents\WORK SPACE\DOCUMENTS\Pdvate\Alholm\Energy Report.rck Page 4 of 4 Insulation Thickness in Inches by Pipe Sizes Piping System Types Fluid Temp. Range("F) 2" Runouts 1" and Less 1.25" to 2.0" 2.5" to 4" Heating Systems Low Pressureffemperature 201-250 1.0 1.5 1.5 2.0 Low Temperature 120-200 0.5 1.0 1.0 1.5 Steam Condensate (for feed water) Any 1.0 1.0 1.5 2.0 Cooling Systems Chilled Water, Refrigerant and 40-55 0.5 0.5 0.75 1.0 Brine Below 40 1.0 1.0 1.5 1.5 NOTES TO FIELD: (Building Department Use Only) Project Title: New Addition Report date: 03/27/08 Data filename: C:\Documents and Settings\Phillip Kdtikos\My Documents\WORK SPACE\DOCUMENTS\Pdvate\Alholm\Energy Report.rck Page 4 of 4