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HomeMy WebLinkAboutMiscellaneous - 145 OLD CART WAY 4/30/2018 145 OLD CART WAY 210/107.6-0103-0000.0 WAY II APPLICANT: GAUTHIER P o� f MAP # ��7"! C3 LOT #_._.................................. ................._. PARCEL #�� 2� ---- ----- STREET.- OL-0 .._C/ fL%. ....WP• °, , CO,N.STRUCT.I_QN_.-_ARPRO.VA.L HAS PLAN REVIEW FEE BEEN PAID? YES NO PLAN APPROVAL: DATE__o-h-4MVAPP. DESIGNER: � �(� ,__-- PLAN DA1�E_._.....__/__./...L._`f..l...`'I2i CONDITIONS D _ gyp cn�s;�c.Zer, ,J ---- __----._.._..__ ----=---------- - - _ .................................-.......__..................-......_._....._........__....._................ WATER SUPPLY: TOW WELL WELL PF_RMIT, -- -----.._.. DRILLER_...._..........._._............._........... . WELL TESTS: CHEMICAL - DATE APPROVED FERIA I DATE 611'hRUVLI) BAC RIA II DAZE AF'PFdUVEU COMMENTS: FORM U APPROVAL: APPROVAL TO ISSUE YES NO DATE ISSUED__/ J _ 5-- _..__BY____.___._ ...... ... ............... / ...__..........- _ CONDITIONS: FINAL APPROVAL: ALL PERMITS PAID WELL CONSTRUCTION APPROVAL -Es, NO SEPTIC SYSTEM CONSTRUCTION APPROVAL YLQ==: > NO OTHER YES NO ANY VARIANCE NEEDED YES NO FINAL BOARD OF HEALTH APPROVAL: DATE:(o/" BY: /`��` SEPTICSYS_ __IN5JE LA_1_IU.N IS THE INSTALLER LICENSED? _ NO -!r TYPE OF CONSTRUCTION: NI W F2EPA 111 �,•, NEW CONSTRUCTION: CERTIFIED PLOT PLAN REVIEW _ 4 NO ?' CONDITIONS OF APPROVAL � YES NO (FROM FORM U) ISSUANCE OF DWC PERMIT �- t NU DWC PERMIT N0. I q INSTALLER: _ BEGIN INSPECTION YES 0: EXCAVATION . INSPECTION: NEEDED: �TZF �4i41y•I't' .i�'� 7 19:4 PASSED BY- �. . , 11'Ir CONSTRUCTION INSPECTIONS NEED �• ;, AS BUILT PLAN SATISFACTORY: APPROVAL TO BACKFILL: DATE: ` _,_HY____.•--__ `�:..: � ._____.__-._ FINAL GRADING APPROVAL: DATE _. DY_ r; FINAL CONSTRUCTION APPROVAL: DATE: %' BY F - LOT y o T �-✓�I Y 1Z tia►�TN �lti DOVER M,4, _ —� lag /z7 w6R Sc)PPL7 wnl D WELL- ,dP�oyCD 1YJTC 5EPT"i c SY STS PEsI c,Aj �bPPi{ovt-D DArt' 7 (-� /PR�OVP06 /urljoi�iry PG/JnJ IK _ NAS 7 ! - �D1�PPROVEp •. � �D< <0 .5 " R�SONS " cX4U4T(aN 1tiSPj�-G1-10N ���C Q PfJSs �] F41t— IvSPEcTJon) PIPE Ff24jA-\ H0056 Tv TJ 0 K L1 Pry S5 1--7 F4- )L. ,bPP(�dVEJ� G/STC_ �1�DIT�p�AL. 1�15r�z.j(onjS (gyp a ► NS%�(,(.G(�i ___ _. jy) DtS�QP�'�Zdv�D D,arC Rv4L APPNQVAL iNo1;i -/ U I L til $U t-► oG VES LM COOW, A B G p u Ee-TAA K fjol5' E kN1 D P to k v'sr. BOX ql.v WD 7.9 0 1 ('ell 1,91, ? ,71 os qteHn-rel ,l5I w611 '311 � p 100 a a � � N C98,3lo0�F� M i 1 Ef Ktf. F vTO IN N I:L,-11647 1 L—_A-- — —r. --) lobo 46,L. P.Poe ICM4 ,rA41f. o , ---- 171 ZZ' •. ��• . Sa.�p,' - DL.O GAWAY AS BUILT PLAN OF SUBSURFACE DISPOSAL SYSTEMLOCATEDIN AS PREPARED FOR DATE: I,joYEHr3Ee Zq I'lel V2 SCALE: I F MERRIMACK ENGINEERING SERVICES, INC. PROFESSIONAL ENGINEERS • LAND SURVEYORS • PLANNERS 66 PARK STREET • ANDOVER. MASSACHUSETTS OIR10 TEL )617) 475-35,53, 373-3721 � � [jz, II- I WI )a-d' i Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 145 Old Cart Way Property Address Michael McFadden Owner Owner's Name information is required for North Andover MA 01845 5/13/2016 every page. Citylrown State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important: A. General Information RECZAV When filling out ED ^ forms on the V f"JI computer,use 1. Inspector: MAI 'z,�t LU16 only the tab key to move your Neil J. Bateson T NORTH ANDOVER cursor-do not Name of Inspector use the return HEALTH DEPA T key. Bateson Enterprises Inc. Company Name ffi 111 Argilla Road Company Address Andover MA 01810 til Citylrown State Zip Code 978-475-4786 S115 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: ® Passes ❑ Conditionally Passes ❑ Fails ❑ N eds Further Evaluation by the Local Approving Authority iljA" I 5/13/2016 Inspectors ignatuV 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. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 a' Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 145 Old Cart Way Property Address Michael McFadden Owner Owner's Name information is required for North Andover MA 01845 5/13/2016 every page. Cityrrown 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: ® 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: i I 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. Check the box for"yes", "no"or"not determined" (Y, N, ND)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. j ❑ Y ❑ N ❑ ND(Explain below): I I t5ins-3113 Title 6 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts Tithe 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 145 Old Cart Way Property Address Michael McFadden Owner Owner's Name information is required for North Andover MA 01845 5/13/2016 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes(cont.): ❑ 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 ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ 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 ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): 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. I. 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 t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 145 Old Cart Way Property Address Michael McFadden Owner Owner's Name information is required for North Andover MA 01845 5/13/2016 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) 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 . P asses system if the well water analysis, performed at a DEP certified laboratory, for fecal Y P Y 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 Y 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 ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/2 day flow t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments r� 145 Old Cart Way Property Address Michael McFadden Owner Owner's Name information is required for North Andover MA 01845 5/13/2016 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® 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. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal 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 and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® 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. 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 ❑ ❑ 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. t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 145 Old Cart Way Property Address Michael McFadden Owner Owner's Name information is required for North Andover MA 01845 5/13/2016 every page. CityrFown 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 ❑ ® Were any of the system components pumped out in the previous two weeks? S ❑ Has the system received normal flows in the previous two week period? El ® Have large volumes of water been introduced to the system recently or as part of this inspection? Were as built plans of the system obtained and examined? (If they were not ® ❑ available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ 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. ® ❑ 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)] D. System Information Residential Flow Conditions: 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): 660 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 145 Old Cart Way Property Address Michael McFadden Owner Owners Name information is required for North Andover MA 01845 5/13/2016 every page. Cityrrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: 2 Does residence have a garbage grinder? ® Yes ❑ No Is laundry on a separate sewage system? (Include laundry system inspection information in this report.) El Yes ® No Laundry system inspected? ❑ Yes ❑ No Seasonal use. 0 Yes JZ No Water meter readings, if available(last 2 years usage (gpd)): Yes Detail: Sump pump? ❑ Yes ® No Last date of occupancy: Current Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins-3113 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 145 Old Cart Way Property Address Michael McFadden Owner Owner's Name information is required for North Andover MA 01845 5/13/2016 every page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Pumped 2011, owner Was system pumped as part of the inspection? ® Yes ❑ No If yes, volume pumped: 1500 gallons How was quantity pumped determined? Measured tank. Reason for pumping: Inspect tank&tees. Type of System: ® 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) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins•3113 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System-Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 145 Old Cart Way Property Address i Michael McFadden Owner Owner's Name information is required for North Andover MA 01845 5/13/2016 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: 21 years old, 11/29/1995, as built plan Were sewage odors detected when arriving at the site? ❑ Yes ® No i Building Sewer(locate on site plan): Depth below grade: 4 feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments(on condition of joints, venting, evidence of leakage, etc.): 4" PVC through wall, 3" PVC in house, no leaks visible. Septic Tank(locate on site plan): Depth below grade: 3feet i Material of construction: Z 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: 10'x 5'x 4' Sludge depth: 8.1 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 145 Old Cart Way Property Address Michael McFadden Owner Owner's Name information is required for North Andover MA 01845 5/13/2016 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 26" 6" Scum thickness 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 Tape Measure How were dimensions determined? 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. Center cover has riser 6"deep. Pumped septic tank. Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene El 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 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 145 Old Cart Way Property Address Michael McFadden Owner Owner's Name information is required for North Andover MA 01845 5/13/2016 every page. Cityfrown State Zip Code 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.): 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 per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•3/13 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments r` 145 Old Cart Way Property Address Michael McFadden Owner Owner's Name information is North Andover MA 01845 5/13/2016 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(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-box cover broken, replaced it. D-box level&distribution equal. No evidence of leakage. Evidence of carryover, pumped d-box to clean. D-box 5'deep. I i Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No' Alarms in working order: ❑ Yes ❑ No* Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments "( 145 Old Cart Way Property Address Michael McFadden Owner Owner's Name information is required for North Andover MA 01845 5/13/2016 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ® leaching trenches number, length: 2 trenches 38' Ion Elleaching fields number, dimensions: El i 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.): Soil ok. Vegetation ok. No sign 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 solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 145 Old Cart Way Property Address Michael McFadden Owner Owner's Name information is required North Andover MA 01845 5/13/2016 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): i Privy(locate on site plan): i Materials of construction: i Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 145 Old Cart Way Property Address Michael McFadden Owner Owner's Name information is North Andover MA 01845 5/13/2016 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view 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. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately .74 so e ell. t 0 i i O.-oor t5ins•3f13 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments "< 145 Old Cart Way Property Address Michael McFadden Owner Owner's Name information is required for North Andover MA 01845 5/13/2016 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water Check cellar ® Shallow wells Estimated depth to high ground water: '4 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: Date 987 ate ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health -explain: Design plan i ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: As per test pit data on design plan, no water 4' below trenches Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3/13 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 145 Old Cart Way Property Address Michael McFadden Owner Owner's Name information is required for North Andover MA 01845 5/13/2016 every page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed Z System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 : Commonwealth of Massachusetts City/Town of . Sy tem 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 Locatio • Ig ront of House Left/Right rear of house, Left/right side of house, Left/ Right side of bui inft/Right front of building, Left/Right rear of building, Under deck Addressr— / 1Y� � C� VJ Cityrrown state Zip Code 2. System Owner. Name' Address(if different from location) Cityrrown ' Stater Zip Code Teleph ne Number ' r J • .B. Pumping Record 1. Date of Pumping Date 2. Quanti Pumped: Gallons • fi 3. Type-of system: ❑ Cesspool(s) eptic Tank ❑Tight Tank ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yeas [�'No — If yes, was it cleaned? ❑ Yes ❑ Na 5. Condition of System: 6. System Pumped By: Neil.Batesbn - F5821 Name Vehicle Ucense Number Bateson Enterprises Inc Company 7. Lo here contentwwere disposed: Lowell Waste Water SignAtufe 9t Hhulery Date t5form4.doc�06103 System Pumping Record.Page 1 of 1 Summary Record Card generated on 5/4/2016 2:41:28 PM by Karen Hanlon Page 1 Town of North Andover Tax Map # 210-1073-0103-0000.0 Parcel Id 18216 145 OLD CART WAY MICHAEL & KATHLEEN MCFADDEN 145 OLD CART WAY NORTH ANDOVER, MA 01845 Class 101 Single Family Property Type 1 Residential Zoning2 1 Residential Zoning3 1 Residential Size Total 2.26 Acres FY 2016 UB Mailing Index Name/Address Type Loan Number Active/Inact. From Until MICHAEL&KATHLEEN MCFADDEN Owner 145 OLD CART WAY NORTH ANDOVER,MA 01845 OBRIEN,THOMAS Previous Customer Inactive 2/16/2006 145 OLD CART WAY NORTH ANDOVER,MA 01845 UB Account Maint. Account No Cycle Occupant Name Active/Inactive Bldg Id. 13747.0-145 OLD CART WAY Last Billing Date 2/8/2016 1090425 01 Cycle 01 Active UB Services Maint. Account No. 1090425 Service Code Rate Charge Multiplier/Users MISCFEE ADMIN FEE 0.635/8 7.82 1/ WTR WATER 01 ALL METER SIZE 34.20 /1 UB Meter Maintenance Account No. 1090425 Serial No Status Location Brand Type Size YTD Cons 32945436 a Active 00 b Badger w Water 0.63 0.63 1412 Date Reading Code Consumption Posted Date Variance 4/22/2016 1839 a Actual 8 -10% 1/22/2016 1831 aActual 9 2/19/2016 -89% 10/22/2015 1822 aActual 80 11/20/2015 40% 7/24/2015 1742 a Actual 56 8/14/2015 592% 4/27/2015 1686 a Actual 8 5/19/2015 -40% 1/30/2015 1678 aActual 15 2/20/2015 -72% 10/24/2014 1663 aActual 50 11/14/2014 -33% 7/25/2014 1613 a Actual 76 8/13/2014 299% 4/24!2014 1537 a Actual 18 5/15/2014 -5% 1/27/2014 1519 aActual 21 2/14/2014 -79% 10/23/2013 1498 aActual 97 11/18/2013 86% 7/23/2013 1401 a Actual 51 8/15/2013 260% 4/24/2013 1350 a Actual 14 5/20/2013 23% 1/25/2013 1336 a Actual 12 2/13/2013 -83% 10/23/2012 1324 aActual 68 11/9/2012 -33% 7/23/2012 1256 a Actual 101 8/14/2012 405% 4/23/2012 1155 a Actual 20 5/9/2012 -5% 1/23/2012 1135 aActual 21 2/13/2012 -63% 10/24/2011 1114 aActual 58 11/14/2011 2% 7/22/2011 1056 a Actual 55 8/15/2011 163% 4/22/2011 1001 a Actual 20 5/16/2011 -12% 1/25/2011 981 aActual 25 2/11/2011 -75% 10/21/2010 956 aActual 93 11/12/2010 0% 7/22/2010 863 a Actual 93 8/16/2010 304% 4/22/2010 770 a Actual 23 5/12/2010 56/0 1/21/2010 747 aActual 22 2/12/2010 -64% COMMONWEALTH OF MASSACHUSETTS fD EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS a DEPARTMENT OF ENVIRONMENTAL PROTECTION d F Vr III SV TITLE 5 OFFICIAL INSP ION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUB URFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address:_145 Old Cart Way_ — —�c--- _North Andover_ r. Owner's Name:_Thomas O'Brien_ [I Owner's Address:_145 Old Cart Way_ F _North Andover,MA 01845_ �, ,JAN 12 2005 Date of Inspection:— nspection:_12/11/2004_ i Name of Inspector: Neil J.Bateson 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: X Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Is Inspector's Signature: Date: _12/11/2004_ 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:_145 Old Cart Way_ _North Andover_ Owner:_O'Brien_ Date of Inspection:_12/11/2004 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:_145 Old Cart Way_ _North Andover— Owner:—O'Brien— Date 'BrienDate of Inspection:_12111/2004_ 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 T 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: 145 Old Cart Way_ r North Andover— Owner:_O'Brien_ Date of Inspection:_12111/2004_ 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 orSlogged 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 fit 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 1?pd. 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 T _ 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 fair.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 l l OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address:_145 Old Cart Way_ _North Andover— Owner:_O'Brien Date of Inspection _12/11/2004_ 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. _Yes_ _ 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:Add145 Old Cart Way_ – _North Andover– Owner:_O'Brien_ Date of Inspection:_12/11/2004_ 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):_660_ Number of current residents:_1 Does residence have a garbage grinder(yes or no): Yes_ 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 readings: Yes_ 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/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 three years ago,owner Was system pumped as part of the inspection(yes or no): Yes_ If yes,volumepumped:_1500 lions--How was quantity pumped determined?–Measured tank Reason for pumping: _Inspect tank 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:_9 years old,11/29/1995, 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:_145 Old Cart Way_ _North Andover— Owner:_O'Brien_ Date of Inspection:_12/11/2004_ BUILDING SEWER_X_ (locate on site plan) Depth below grade:_36"_ Materials of construction: —cast iron —X-40 PVC,other Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): _4"PVC thru wall to tank. 3"PVC in house,no leaks visible._ SEPTIC TANKS: X_ Depth below grade: 24" 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 5'149 Sludge depth —2"_ Distance from top of sludge to bottom of outlet tee or baffle: 28"_ Scum thickness:_6"_ 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:_16"_ 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.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:_145 Old Cart Way- —North Andover— Owner:_O'Brien Date of Inspection:_12/11!1004_ 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.Light carryover, pumped d-box 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:_145 Old Cart Way_ _North Andover_ Owner:_O'Brien_ Date of Inspection:_12/11/2004 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: 2 trenches 38'long_ 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.):_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 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address:_145 Old Cart Way_ _North Andover Owner: O'Brien Date of Inspection _12/11/2004 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. A to Tank=50'6" A to D-bog=5916" B to Tank=44'6" B to D-bog=50' Garage House B Driveway A Water Meter !il Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:_145 Old Cart Way_ _North Andover Owner:_O'Brien_ Date of Inspection:_12/11/2004 SrM EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water 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:_4/27/1987_ 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, no water 4' below trenches_ Summary Record Card generated on 1/3/2005 2:08:18 PM by Lisa Warren Page 1 Town of North Andover Tax Map # 210-1073-0 145 OLD CART WAY OBRIEN, THOMAS 145 OLD CART WAY NORTH ANDOVER, MA 01845 Class 101 Single Family Property Type 1 Residential Size Total 2.26 Acres FY 2005 UB Mailing Index Name/Address Type Loan Number Active/Inact. From Until OBRIEN, THOMAS Payor 145 OLD CART WAY NORTH ANDOVER, MA 01845 I UB Account Maint. Account No Cycle Occupant Name Active/Inactive Bldg Id. 7384.0- 145 OLD CART WA Last Billing Date 11/1/2004 1090425 01 Cycle 01 Active UB Services Maint. Service Code Rate Charge Multiplier/Users MISCFEE ADMIN FEE 0.63 5/8 7.82 1/ WTR WATER 01 ALL METER SIZE 22.40 /1 UB Meter Maintenance Serial No Status Location Brand Type Size YTD Cons 41304765 a Active Y ENC F.L. ? w Water 0.63 0.63 0 Date Reading Code Consumption Posted Date Variance 10/27/2004 1502 a Actual 8 11/15/2004 60% 8/3/2004 1494 a Actual 5 8/25/2004 182% 5/10/2004 1489 a Actual 2 6/8/2004 -61% 2/4/2004 1487 a Actual 5 2/24/2004 0% I I q t t �: to F II V mm6i N Ln v."L1:N td/'as Ln.--1 Ln Cl- DD 4 I C�mmmm991 1�Lr1M O000C 9c G0 *. Ca m MMA^?�rimN co 0,m L'V f A. � E� -r, `V'N�-•i r"!r{si � Imo. 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Excavating-Water.&Sewer Lines-Septic Systems&Pumping Service 111 Argilla Road Andover, Mass. 01810 Title 5 Inspection Report Property Address: 145 Old Cart Way, North Andover Owner: O'Brien Date of Inspection: 12/11/2004 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. Vl eJ. ateson Bateson Enterprises, Inc. 4e, N'V Ts P POT" f N Exisf. pOfjl. 5,3 S' ��� 171.n� f - •� 53-76'! j!� 'r srER�r CeA72-)- To -n4 O T 3 U t D N rFl DEPT T.yiQT TiVE r D'ft.:, /3 LGY.4TE0 a v T/�E LaT AS slwllv"v Ai✓O T/GIT?OAFS GGLI/FGtPA1 �N lY/T/f T.'/E-m.j�1' Of tJv.A r4DOyif L.ZGLV/NG CE6!/G4T•t2(�S , RF oeo/NG SE,-,X4C.rS FZoM s FU,�7.S�C.0 GF•!T/FY Tif�ilT TN/1 F D'}"I.1, - /S�t/OT Lnc47,W hl/ T.yE FEGE.P.4G F�aoo ffgZ.4.e•O .e pE.4. O.PAff�i(/ fO.P Syawn!OPV FE,..q'L'GMNuv/Ty P.tvGL 'R 250098 ai15C -DATED .1ut4 Z, 1993 P>a�r2Err 13�.i�pi; �5 N� 9OFMANN HEu(LtirG�- >;�`la I�JE.21 Ufa �jEQV IGc'q l I, . X36381 �+ ss►o °s® LSUR" ,4 a �vovt�2, Maw. 0� 810 over Town . of _ No. 504 - - - -- ``='"_ -.Norti dover, Mass., 19 9S BOARD OF HEALTH Food/Kitchen PERMIT TO Septic System 4o/ /17-/4 BUILDING INSPECTOR ��- THISCERTIFIES THAT...n r......'.�).5�..�,�.(��....... .A.��.,�,,.��r��.................................................................................... t;Foundatto� ll`��cit �, �. has permission to erect..WPO4....F�. ...MF_buildings on ..�. ..... �z)....;' .:��.... �........ . "..".. ti? to be occupied as.. I, + clE,.: !Y�1. , .`.l liJ�.. ..�t ... .5a�fr.A .�.............................I provided that the person accepting this permit shall in every re ect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of , Buildings in the Town of North Andover. PERMIT FOR FOUNDATION ONLY PLUMBING INSPECTOR REGULATED BY PARA. 114.8-S. B.C. VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough , fin)D;DATEFEE PAID = .. = PE '.N%III �;-�1'I��� I �._ ) �'� - _ a r..<'.: - ELECTRI AL IN PECTO lo PERMIT FOR FRAME/BUILDING ....... ...... 'L ..................`........... ...:... '.k� ` U ervra l� BUILDING INSPECTOR DATE: FEE PAID-- GAS INSPE O pL11-1C:y� -C'llllot ��t C-li�C�'t.-� itJ Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and- Approved by the Building Inspector. Burner FINAL CONSERVATION FINAL Street No. PLANNING Smoke Det. SEWER/WATER FINAL DRIVEWAY ENTRY PERMIT t HORTM 1 O 0 Z. BOARD OF HEALTH + M x 120 MAIN STREET TEL. 682-6483 9SSACHusEt NORTH ANDOVER, MASS. 01845 Ext23 December 5, 1994 Scott Construction Co. , Inc. 395 Main Street Salem, New Hampshire, 03079 Dear Mr. Betty: This letter is to confirm that onecember 1, 1994 the North Andover Board of Health voted to d the approval of the septic system designs for Lots 1, 2 4 , 5, 6, 7 , 8, 9, 10, 11, 12 , 14 , 16, 20 and 21 for one year to cember 1, 1995. If you have any questions, please call the office at the above number. Sincerely, Sandra Starr, R.S. Health Administrator i cc: File Town of North Andover, Massachusetts Form No.3 NoRTIl, BOARD OF HEALTH ,.� ti A 19 _ .7 ��•'s� DISPOSAL WORKS CONSTRUCTION PERMIT SACHUSE • � 1 Applicant NAME ADDRESS TELEPHONE Site Location # � Permission is hereby granted to Construct ( Repair ( ) an Individual Soil Absorption Sewage Disposal System as shown on the Design Approval S.S. No. O �FE L O 6 G Fee D.W.C. No. 7 I �('omm nwe Ith of Massachusetts Massachusetts System Pumping Record System Owner System Location � C% s�o l� W Date of Pumping: 3— U Quantity Pumped: /1/�gallollg Cesspool: No f Yes U Septic Tank: No Yes System Pumped by: Fctt`edda Sil&+'toned License# Contents transferrred to : Greater Lawrence Sanitary District Date: _ _ Inspector- �R TOWN OF NORTH 'AN'DOVE^R : -- - SYSTEM PUMPING RECORD,�6 APR - 72003 r • �1 STEM OWNER & ADDRESS � SYSTEM LOCATION_ _ � (example; left front of hou,e)� C OF PUMPING; &1311Z93 QUANTITY P U M P C D 0ALLc» � ;. i;SSP00L: NO YES SEPTIC TANK: NO YES ' a ATURE OF SERVICE; ROUTINE � EMERCENCY I FRVAT10NS, GOOD CONDITION. FULL TO COVER HEAVY CREASE BAFFLES IN PLACE'. ROOTS LEACHFIELD RUNBACK.. CXCESSIVE SOLIDS FLOODED SOLID'S CARRYOVER . �HFR (EXPLA.IN) >1 >'I'l:M PUMPCD 0Y: U 11 'vl rNTS: ON,I'I..'NTS tiZANSFCIZRED 'T'0: AP G\ � $t � • ...: ' . . - �'. '� � - �.+ •'�":.2 �f • -w�y`� ..r• � .. •.j^:tee... it'!.. Ft1 '.�N apt,.- - . : • '4. • � ��-t.h.�* �.�z:-1 t�� L: A T ..� r. At410 © r u n P� 9 > .v S ..1: t rl, .x 3 :.Y i 2 - t r y o' r 1�, _r. J !J. .t. •t •r } cF t� .r - a •t 2 e� r ,l yY s t. -�' f .•Y'K'. i h M v .'Y -F• L - •r _ /9- h :g �Z wo 'r r /01 44. N •a �f • r v P ,ice y A n h. K. `n• yIZ' 6 j 7• r J t +x•- r2 �. AA 10 . . M ., V 01-0 rl 7i • ... � - - , •! •� \ .. .r �r AT\ > S - .� v. � .'tit`.' Y �" ✓ ev- Z�o �- FORM U - IAT RFM ASE FORM INSTRUCTIONS: This fora is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable local or state law, regulations or requirements. ****************Applicant fills outthissection***************** APPLICANT: R �v ��P 5 Phone 4 LOCATION: Assessor' s Map Number /0-7 6 Parcel /off, I cY Subdivision yy �,6 Lot(s) T Street a 1c! eA2t 1�W A- St. Number ************************Official Use Only************************ RECO IONS OF TOWN AGENTS: Date ADnroved 3 Co e ation Administrator Date Rejected I Comments V. `e IQ _ Date Approved Z. Town Planner Date Rejected Comments Date Approved Food Inspector-Health Date Rejected Date Approved 3 `S Septic Inspector-Health Date Rejected i Comments Public Works - sewer/water connections 7-w driveway per-mit- Fire ermitFire Department e eived by Building Insp ctor Date Town of North Andover, Massachusetts Form No.s of MOoTM, BOARD OF HEALTH : •:Mo � w A DESIGN APPROVAL FOR ass"C"USE`S SOIL ABSORPTION SEWAGE DISPOSAL SYSTEM Applicant 3VC.0kO4Y1 r61o� Test No. Site Location_ LOT [,Lnc�v� • Reference Plans and Specs. 4cry1 (un. t �anol nGCXI ENGINEER DESIGN DATE Permission is granted for an individual soil absorption sewage disposal system to be installed in accordance with regulations of Board of Health. CHAIRMAN,BOARD OF HEALTH pd Fee Site System Permit No. y-�L DATE Sheet of BOARD OF HEALTH TOWN OF NORTH ANDOVER ( / SUBSURFACE DISPOSAAL DESIGN REVIEW FEE 710 , PERMIT # �CJ/� . DATE RECEIVED l�/S APPLICANT ASSESSOR'S MAP_ /U'723 ADDRESS PARCEL # 7 LOT # STREET Oz-b CAnr ZZJAY ENGINEER _�OA/1 L1L'Y10 ADDRESS (0100 73yr S AV&6 /J J PLAN DATE 1��9 REVISION DATE 9111A CONDITIONS OF APPROVAL: Ta BE � " U,��Ar� APPROVED DISAPPROVED f am'alialm I 4 11 i I 1 { io—IS�c� S�J�Ec�C4, 11 ; z � f L12 ,�, z rr'• � I a i z74 71 T��1 r ��,,�, •� 1 1H H-D.� .. w I - wC( y 14 l t5 7-4 0 low. Jove '.r -j ,y I, cJCrs j4 TILL 4 S i PLAN REVIEW CHECKLIST ADDRESS �� Ln �/�,pj��y ENGINEER GENERAL 3 COPIES STAMP LOCUS NORTH ARROW SCALEI/ a 4?,CONTOURS j/ PROFILE {% SECTION c/ BENCHMARK j�o 6e-f SOIL & PERC INFO ELEVATIONS WETS. DISCLAIMER WELLS & WETLANDS WATERSHED?_ DRIVEWAY d/ .(Eley) WATER LINE FDN DRAINSCH40 TESTS CURRENT? Q L 1 u GLEE. SEPTIC TANK / �/ MIN 1500G. V . 17 INVERT DROP t/� GARB. GRINDER /(/D (+200% EDF) 25' TO CELLAR MANHOLE TO GRADE ELEV OC GW D-BOX SIZE -D,R-3 # LINES FIRST 2' LEVEL STATEMENT INLET /07 q,7 - OUTLET 7 _ ./ (2" OR . 17 FT) TEE REQ'D? /(/d LEACHING RESERVE AREA L,'-"�4' FROM PRIMARY?_L,/ 100' TO WETLANDS VX 2% SLOPE C/ 100' TO WELLS C/ 35' TO FND & INTRCPTR DRAINS 4' TO S.H.GWC/ 325' TO SURFACE H2O SUPP L/ 4' PERM. SOIL BELOW FACILITY c�-- MIN 12" COVER_LZ FILL?Z (25' )i above natural elev; 101iftbelow) BREAKOUT MET? TRENCHES / MIN 660 gpd V SLOPE (min . 005 or 6"/1001 ) -� >3' COVER? - VENT SIDEWALL DIST. 2X EFF. W OR D (MIN 61 ) IS RESERVE BETWEEN TRENCHES? Vl' IN FILL? L, MUST BE 10' MIN. L--' 4" PEA STONE? BOT X LDNG L Z� + SIDE P-6 X LDNG S7� = TOTljd (L x W x #) (G/ft2) (DxLx2x#) f Q i DATE__C -\1 Sheet Of BOARD OF HEALTH TOWN OF NORTH ANDOVER SUBSURFACE DISPOSAL DESIGN REVIEW F EE , p PERM IT # DATE RECEIVED APPLICANT ASSESSOR'S MAP_ 1016 ADDRESS PARCEL RCEL # 27 l�►J�f7c>G� LOT # ENGINEER STREET ��t?�1..t�e.1 ��jc�r _ ADDRESS _ wID 'PAI&LJ�i� l�(Z., MA PLAN DATE f REVISION DATE CONDITIONS OF APPROVAL: APPROVED DISAPPROVED "A 5 TC> � 15Lja,) TbY s, SO55UlL ovA� cow P1 �l� w �) �(A� � Sall "�fto� cDE� TOWN OF e--� SYSTEM PUMPING RECORD DATE: SYSTEM ER& ADDRESS SYSTEM LOCATION t (example:left front of Louse) DATE OF PUMPING: 1 QUANTITY PUMPED : GALLONS CESSPOOL: NO YES SEPTIC TANK: NO YES �1 NATURE OF SERVICE: ROUTINE EMERGENCY OBSERVATIONS: ISI GOOD CONDITION FULL TO COVER HEAVY GREASE BAFFLES IN PLACE ROOTS LEACHMLD RUNBACK EXCESSIVE SOLIDS FLOODED SOLIDS CARRYOVER OTHER(EXPLAIN) SYSTEM PUMPED BY: Bateson Enterprises, Inc. COMMENTS: i i CONTENTS TRANSFERRED To: G.L.S.D Lowell Waste