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Home My WebLink AboutMiscellaneous - 157 OLD CART WAY 4/30/2018 _ r _ 157-OLD CART WAY JI 210/107-B-0104-0000-0 j 4____ . .--vluv C RI' WAY II APPLICANT:. GAUTHEIR j ?'v fti MAP # r. LOT # 1. PARCEL ^# = STREET HAS PLAN REVIEW FEE BEEN PAID? YES _. ' NO PLAN APPROVAL: ' DATE c ARP. BY DESIGNER: PLAN DATE. CONDITIONS WATER SUPPLY: TOWN WELL WELL PERMIT DRILLER--------_----_- WELL TESTS: CHEMICAL DATE APPROVED — ll. _ . BACTERIA I DATE APPROVED,_,_.__...__.__.__.___. BACTERIA II DATE APPROVED,+ _ COMMENTS: FORM U APPROVAL: APPROVAL TO ISSUE `'-- YES NO DATE ISSUED f BY _..i' ..... — CONDITIONS: - FINAL APPROVAL: ALL PERMITS PAID YES NO WELL CONSTRUCTION APPROVAL YES NO SEPTIC SYSTEM CONSTRUCTION APPROVAL YES NO OTHER YES NO ANY VARIANCE NEEDED +AYES NO FINAL BOARD OF HEALTH APPROVAL: DATE: __BY:_ .. rf • .,• � SEPT I_�S1L�ZEM_�N.�S�l.4l,.A�.t�RN. IS THE INSTALLER LICENSED? cES NO v TYPE OF CONSTRUCTION: NEW REPAIR NEW CONSTRUCTION: CERTIFIED PLOT PLAN REVIEW (YF� NO CONDITIONS OF..APPROVAL YES NO (FROM FORM U) ISSUANCE OF DWC PERM TjJ YES ) NO INSTALLER: DWC PERMIT NO;-L& BEGIN INSPECTION YES Np: EXCAVATION . INSRECTION: NEEDED: -PASSED J �� BY CONSTRUCTION INSPECTIONS NEEDED: AS BUILT PLAN SATISFACTORY: - %< /_� f . APPROVAL TO DACKFILL: SATE: ��j , tai BY FINAL . GRAIING APPROVAL: DATE If �-� 9� BY _ FINAL CONSTRUCTION APPROVAL: DATE: -BY .•1,• , ... - . it . AS U 1 JELE VATI D N S A !5 6U I LT Ll ScN. yo P•ve. wv. e- &D4 _. = I8s,9i. ,l�G. Goe. A Lt,v ►u 35, Z' 367, 1 ' " lMv ov7"S.7' ` 185,18 D - go X luv Biu D-Fox = 165,08 )._i z -rpe.. I 42 0 Ikiv ovro-BaX IS..Ll GtiD -re,r 2 X31 56.0 ' FE'rzF: lAjv. Etifl -Mwl PNo�N lob 0 S N 1S00 6AL. SreTfe- 33' TAu►G - ergs Box 60. - _ L 60_21 - AS BUILT ' '" PLAN OF SUBSURFACE DISPOSAL SYSTEM LOCATED IN ND R-1- A NJ DOVE R , MA AS PREPARED FOR LF G T DATE : ocTo ,p- 1 , 1 qq&, SCALE: Lo T -s- D1._D cA2T- MERRIMACK ENGINEERING SERVICES, INC. PROFESSIONAL ENGINEERS • LAND SURVEYORS • PLANNERS. 66 PARK.STREET * , ANDOVER, MASSACHUSETTS 01810 0 TEL (5ae) 473.3555, 373.5721 .. .s-, "v!-^ ,Y-' " '.z'a3hw �R '�%'� '...•, .," - .i. ....r�..,.w..el1Wrr',PSiF�.YfY4!M.K. Form No.4 Town of North Andover, Massachusetts BOARD OF HEALTH CERTIFICATE OF COMPLIANCE tfi• This is to certify that the Individual Soil Absorption Sewage Disposal System constructed (X ) or repaired ( ) by Mi kP Rei 1 1 v INSTALLER ' at 157 nlrl Cart Wav (T�nt_ S1 North Andover MA 1. 'i':•''• 'TRITE LOC"AT OWN has been installed in accordance with Board of Health Regulations as described in the Design Approval Site System Permit No. 483 dated Sept. 6 , 19 91 The issuance of this certificate shall not be construed as a guarantee that the system will function satisfactorily. , BOARD OF HEALTH a . s l t , � NORTI-� Town of ove .I ......... ..... v -_- - o dower, Mass., 'Z 19 COC HICHEWICK \ AORATED P ,�5 BOARD OF HEALTH PERMIT T. D Food/Kitchen Septic System v ii. >/ / BUILDING INSPECTOR THIS CERTIFIES THAT................................ ..I�............GAII. `I�......... i.......................................... Foundation has permission to erect.......... .,p......... buildings on .......... .. .............r3 ......... A. `.....,.?.A Y Rough G g tobe occupied as............................................ /1 C - .............c... .. . ........................................................ Chimney provided that the person accepting this permit shall in every respect 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. PLUMBING INSPEgCTPR VIOLATION of the Zoning or Building Regulations Voids this Permit. t REGULATE FOR FOUNDATI PERMIT EXPIRES IN 6 MONTHS D By pAl? ON ONL UNLESS CONSTRUCTION STA.I�.�� % 1 X14.8 S QC. ELECTRICAL INS UNLESS R FEE P/' U � S ............................. ................... . .. .........................................1�...... Service LDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove Rough Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke 4D ,,e Form No.3 Town of North Andover, Massachusetts BOARD OF HEALTH HORTM 1 --1 9 r F 9 DISPOSAL WORKS CONSTRUCTION PERMIT ,SSACMUs� - -- - TELEPHONE ApplicantDDRESS NAME Site Location an Individual Soil Absorption Permission is hereby granted to Construct ( _. or Repair ( ) �� Sewage Disposal System as shown on the Design Approval S.S. No-A_ �- CHAIRMAN, BOARD OF HEALTH Sa Fee �� D.W.C. No. ,ORTN 3? BOARD OF HEALTH a ` 120 MAIN STREET TEL. 682-6483 �9SZACMUSNORTH 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 on ecember 1, 1994 the North Andover Board of Health voted to d �' e approval of the septic system designs for Lots 1, 2 J4 5 , 6, 7 , 8 , 9, 10, 11, 12 , 14 , 16, 20 and 21 for one year to cem er 1, 1995. If you have any questions, please call the office at the above number. Sincerely, ) T Sandra Starr, R.S. Health Administrator cc: File fr ` k t `•. MORTIy Ot «ao .a,ti° 3? BOARD OF HEALTH ti p + i 120 MAIN STREET TEL. 682-6483 CMuSE`ty NORTH ANDOVER, MASS. 01845 Ext. 32 j il � January 22, 1993 Les Godin -,�'�Y 0410E Merrimack Engineering Services, Inc. 66 Park Street Andover; MA 01810 Dear Les: This is to confirm that at the Board of Health meeting held on January 21, 1993, the Board granted variances to North Andover regulations: 2.14-4, minimum design flow for single family dwellings, for Lots 1 and 18 Old Cart Way; 17 . 03 , spacing between leach trenches for Lots 8, 10, 11, and 14 Old Cart Way; 4 . 18 distance to a catch basin for Lot 5 Old Cart Way; 4 . 14 to allow a twenty minute design rate. With these variances, all current lots on Old Cart Way have been approved, specifically, Lots 1, 2 , 4, 5, 6, 7, 8, 9, 10, 11, 12 , 13, 14, 15, 16, 17, 18, 19, 20 and 21. If you have any questions, please do not hesitate to call.- Sincerely, V Sandy Starr FORM U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction on have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable local or state law, regulations or requirements. ****************Applicant1, fills out this section***************** APPLICANT: 7 1 W a Phone2- LOCATION: Assessor' s Map Number /07 gParcel -1-7 Subdivision Lot(s) S Street 0/4 C Ac." St. Number ************************Official Use Only************************ RECOMMENDATIONS OF TOWN AGENTS: Date Approved Conservation Administrator Date Rejected Comments Date Approved Town Planner Date Rejected Comments Date Approved Food Inspector-Health Date Rejected Date Approved Sep is Inspector-Health Date Rejected Comments r Public Works - sewer/water connections - driveway permit Fire Department Received by Building Inspector Date DATE �1` Sheet of BOARD OF HEALTH TOWN OF NORTH ANDOVER SUBSURFACE DISPOSAL DESIGN REVIEW FEEPERMIT # '5�93 DATE RECEIVED �6 Z APPLICANT ASSESSOR'S MAP / Z5 ADDRESS PARCEL # 7 LOT # STREET /2 AY ENGINEER _ effeel �[ ADDRESS PLAN DATE REVISION DATEr� CONDITIONS OF APPROVAL: APPROVED DISAPPROVED -` Nb- 19IM iw ovTe�� U l Z IUI� . ��,�• �,� �T��G-T �.�"�-/�v C� � �'Es�2Y� n�oT<s-d ' _7D moq�/U) J PLAN REVIEW CHECKLIST ADDRESS 6/-9,e7-Z ,V ENGINEER A�1?1Pj/n,e9 cid GENERAL 3 COPIES STAMP LOCUS L/ NORTH ARROW SCALE CONTOURS PROFILE ✓ SECTION Com'' BENCHMARK'f 0'( SOIL & PERC INFO ELEVATIONS WETS. DISCLAIMER WELLS & WETLANDS WATERSHED? )10 DRIVEWAY c--�(Elev) WATER LINE o v rFAL 1. FDN DRAIN ELEV SCH40_Le::I-- TESTS CURRENT? /qg!! S7 SEPTIC TANK /�,� ' MIN 1500G. . 17 INVERT DROP t GARB. GRINDER�fo (+200% EDF) 251 TO CELLAR -'�� MANHOLE TO GRADE UAffELEV GW D-BOX c SIZE V U-3 # LINESFIRST 2' LEVEL STATEMENT INLET/,j¢.q? - OUTLET1 .7 = /7 (2" OR . 17 FT) TEE REQ'D?/YO LEACHING RESERVE AREA 4' FROM PRIMARY? t//100' TO WETLANDS �2% SLOPE 100' TO WELLS i/' 35' TO FND & INTRCPTR DRAINS L,-' 4' TO S.H.GW 325' TO SURFACE /H2O SUPP 4' PERM. SOIL BELOW FACILITY MIN 12" COVER/ FILL? L--,(25' if above natural elev; 10' ' below) BREAKOUT MET? TRENCHES MIN 660. gpd U/" SLOPE (min . 005 or 611/1001 )_ � >3 ' COVER? - VENT SIDEWALL DIST. 2X EFF. W OR D (MIN 61 ) �( IS RESERVE BETWEEN TRENCHES? y IN FILL? �l MUST BE 10' MIN. 4" PEA STONE?l7/C.. BOT 3� X LDNG �3 + SIDE qDd X LDNG AA _ TOT ,��,�/ ,�� (L x. W x #) (G/ft2) (DxLx2x#) i MERRIMACK ENGINEERING SERVICES INC. LIETTEQ OF TQ° ZEDUML Engineers • Surveyors • Planners 66 Park Street ANDOVER, MASSACHUSETTS 01810 DATE JOB NO. (617) 475-3555 ATTENTION ,�/ TO /V eP4W X AM d-OWL /' L6A90 � " 1/' A� RE. (/�.� �6 4� G✓K>�Z S r 17"A I,& - M,a/At d'r WE ARE SENDING YOU D/Attached ❑ Under separate cover via the following items: ❑ Shop drawingsPrints ❑ Plans ❑ Samples ❑ Specifications ❑ Copy of letter ❑ Change order ❑ COPIES DATE NO. DESCRIPTION THESE ARE TRANSMITTED as checked below: For approval E3 Approved as submitted ❑ Resubmit copies for approval ❑ For your use ❑ Approved as noted ❑ Submit copies for distribution ❑ As requested ❑ Returned for corrections ❑ Return corrected prints ❑ For review and comment ❑ ❑ FOR BIDS DUE 19 ❑ PRINTS RETURNED AFTER LOAN TO US REMARKS // __ S lI 7i� G au/ cf�f '6lzr c 71q-0 �. -7'�6'r Ju,1515- e7�/(//�/ COPY TO f)� SIGNED: PRODUCT2042 Ja IM,Groton,Mm man. If enclosures are not as noted, kindly notif,ys it nce` COMMONWEALTH OF MASSACHUSETTS EUCUTM OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE WINTER STREET,BOSTON MA 02108 (617)292-5500 I TRUDY COXE '9 ARGEO PAUL CELLUCCI DAVID B� Governor � SIUBSl1RiFACE SEWAGE DISPOSAL SYS713A NSpECT10N FORM PART A CERT ;1CA11ON i Property Address: 157 Old Cart Way,North Andover Name of Owner:Frazier Hamilton Address of Owner:157 Old Cart Way,North Andover,MA. 01845 Date of Inspection:3/7/2000 Name of Inspector:Nell J.Bateson I am a DEP approved system Inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000) Company Name:Bateson Enterprises Inc. Mailing Address:111 Argilla Road Andover,MA 01810 Telephone Number:(978)475-4786 I CERTIFICATION STATEMENT I certify that I have personally inspected the Sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on-site swage disposal systems.The system; X Passes Conditionally Passes Needs Further Evaluation By the Local Approving Authority "ita Inspector's Signature: Date:3/7/2000 TheSystem Inspector shathis inspection report to the Approving Authority(Board of Health or DEP)within thirty(30)days of completing this inspection.If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection.The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. NOTES AND COMMENTS MAR 1 0 revised 9/2/98 Page I of 11 Printed on Recycled Paper SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address:157 Old Cart Way,North Andover Owner:Hamilton Date of inspection:3/7/2000 INSPECTION SUMMARY: Check A, B, C,or D.- A. .A.SYSTEM PASSES: _X I have not found any information which indicates that any of the failure conditions described in 310 CMR 15.303 exist.Any failure criteria not evaluated are indicated below. COMMENTS: B.SYSTEM CONDITIONALLY PASSES: One or move 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. i Indicate yes,no,or not determined(Y,N,or NO).Describe basis of determination in all instances.If"not determined",explain why not. The septic tank is metal,unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance(attached)indicating that the tank was installed within twenty(20)years prior to the date of the inspection; or the septic tank,whether or not metal,is cracked,structurally unsound,shows substantial infiltration or exfiltration,or tank failure is imminent.The system will pass inspection if the existing Septic tank is replaced with a complying septic tank as approved by the Board of Health. Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken,settled or uneven distribution box.The system will pass inspection if(with approval of the Board of Health). broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced the system required pumping more than four 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 I I revised 912198 Page 2 of 11 ii SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address:157 Old Cart Way,North Andover Owner:Hamilton Date of Inspection: 31712000 C.FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health,safety and the environment. 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 THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of surface water. Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH AND PUBLIC WATER SUPPLIER,IF ANY)DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The System has a septic tank and sal absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and the SAS is within a Zone I of a public water supply well. The system has a septic tank and sal absorption system and the SAS is within 50 feet of a private water supply well. The system has a septic tank and sal absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well,unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the i nitrogen and nitrate nitrogen is equal to or less well is free from pollution from that facility and the presence of ammonia og og eq than 5 ppm.Method used to determine distance (approximation not valid). 3) OTHER revised 912198 Page 3 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address:157 Old Cart Way,North Andover Owner:Hamilton Date of Inspection:317/2000 D.SYSTEM FAILS: You must indicate either"Yes"or"No"to each of the following: _I have determined that one or more of the following failure conditions exist as described in 310 CMR 15.303.The basis for this determination is identified below.The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No Backup of sewage into facility or system component due to an overloaded or cogged 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. _ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone I of a public well. Any portion of a cesspool or privy is within 50 feet of a private water supply well. Any portion of a cesspool or privy is less-than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis.If the well has been analyzed to be acceptable,attach copy of well water analysis for coliform bacteria,volatile organic compounds,ammonia nitrogen and nitrate nitrogen. E.LARGE SYSTEM FAILS- You must indicate either"Yes"or"No"to each of the following: The following criteria apply to large systems in addition to the criteria above: The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: Yes No the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area @ IWPA)or a mapped Zone 11 of a public water supply well) The owner or operator of any such system shall upgrade the system in accordance with 310 CMR 15.304(2).Please consult the local regional office of the Department for further information. revised 9/2/98 Page 4 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address:157 Old Cart Way,North Andover Owner:Hamilton Date of Inspection:3/7/2000 Check if the following have been done:You must indicate either"Yes"or"No"as to each of the following: Yes No Pumping information was provided by the owner,occupant,or Board of Health. _X,_ None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. X As built plans have been obtained and examined.Note if they are not available with NIA. �X The facility or dwelling was inspected for signs of sewage back-up. _X The system does not receive non-sanitary or industrial waste flow.The site was inspected for signs of breakout. X All system components,excluding the Soil Absorption System,have been located on the site. X The septic tank manholes were uncovered,opened,and the interior of the septic tank was inspected for condition of baffles or tees, material of construction,dimensions,depth of liquid,depth of sludge,depth of scum. The size and location of the Soil Absorption System on the site has been determined based on: _X Existing information.For example,Plan at B.O.H. Determined in the field(if any of the failure criteria related to Part C is at issue,approximation of distance is unacceptable) [I 5.302(3)(b)] The facility owner(and occupants,if different from owner)were provided with information on the proper maintenance of SubSurface Disposal Systems. revised 912198 Page 5 of 11 I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address 157 Old Cart Way,North Andover Owner:Hamilton Date of Inspection:3/7/2000 FLOW CONDITIONS RESIDENTIAL: Design flow_165_ .g.p.d./bedroom. Number of bedrooms(design):-4_ Number of bedrooms(actual- 3-Total DESIGN flow 660_ Number of current residents:–2 – Garbage grinder(yes or no):_Yes_ Laundry(separate system)(yes or no): No_If yes,separate inspection required Laundry system inspected(yes or no) Seasonal use(yes or no): No_ Water meter readings.97 to 99=28,900 if x 7.5=216,750 gals./730 days=297 gals./day Sump Pump(yes or no):_No Last date of occupancy:_Current COMMERCIALIINDUSTRIAL: Type of establishment: Design flow: god(Based on 15.203) Basis of design flow 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: OTHER:(Describe) Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: Never pumped,owner System pumped as part of inspection:(yes or no)_Yes_ If yes,volume pumped:_1500_gallons Reason for pumping:Never pumped,inspect tank&tees. TYPE OF SYSTEM ,_X Septic tank/distribution box/soil absorption system Single cesspool Overflow cesspool Privy Shared system(yes or no)(if yes,attach previous inspection records,if any) I/A Technology etc.Attach copy of up to date operation and maintenance contract Tight Tank Copy of DEP Approval Other APPROXIMATE AGE of all components,date installed(if known)and source of information:4 years old.Oct.1 1996,as built plan. i Sewage odors detected when arriving at the site:(yes or no)_No i revised 9/2/98 Page 6 of 11 r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:157 Old Cart Way,North Andover Owner:Hamilton Date of Inspection:3/7/2000 BUILDING SEWER:X (Locate on site plan) Depth below grade:20" Material of construction: cast iron_X 40 PVC other(explain) Distance from private water supply well or suction line: Diameter:4" Comments:4"PVC thru wall to Septic tank.3"PVC in house. SEPTIC TANK:X (locate on site plan) Depth below grade:8" Material of construction:—X— concrete_metal _Fiberglass Polyethylene other(explain) If tank is metal,list age_Is age confirmed by Certificate of Compliance_(Yes/No) Dimensions:10'x 5'x 4' x 7.5=1500 gallons. Sludge depth:10" Distance from top of sludge to bottom of outlet tee or baffle:17" 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.15" How dimensions were determined:Subtract scum&sludge depths to tee length. Comments:Pumped septic tank,inlet tee&outlet tee ok.Depth of liquid at outlet invert.No evidence of leakage. GREASE TRAP:None (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: j Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments: revised 912198 Page 7 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:157 Old Cart Way,North Andover Owner:Hamilton Date of Inspection:3/7/2000 TIGHT OR HOLDING TANK:_None (Tank must be pumped prior to,or at time of,inspection) (locate on site plan) Depth below grade: Material of construction: concrete metal_Fiberglass Polyethylene_other(explain) Dimensions: Capacity: gallons Design flow:_gallons/day Alarm present Alarm level: Alarm in working order:Yes No Date of previous pumping: Comments: DISTRIBUTION BOX._X_ (locate on site plan) Depth of liquid level above outlet invert:0 Comments:D-box level.Distribution equal.Evidence of solid carryover.Pumped d-box to clean.No evidence of leakage. PUMP CHAMBER: None,gravity system_. (locate on site plan) Pumps in working order.(Yes or No) Alarms in working order(Yes or No) Comments: Revised 912198 Page 8 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued)) Property Address: 157 Old Cart Way,North Andover Owner:Hamilton Date of Inspection:3/7/2000 SOIL ABSORPTION SYSTEM(SAS):X (locate on site plan,if possible;excavation not required,location may be approximated by non-intrusive methods) If not located,explain: Type: leaching pits,number. leaching chambers,number: leaching galleries,number: leaching trenches,number,length:2 trenches 50'6"long. leaching fields,number,dimensions: overflow cesspool,number: Altemative system: Name of Technology: Comments:Soil ok.Vegetation ok.No sign of ponding to surface. CESSPOOLS:None (locate on site plan) Number and configuration: Depth-top of liquid to inlet invert: Depth of solids layer. Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater: inflow(cesspool must be pumped as part of inspection) Comments: PRIVY:None (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments: revised 912198 Page 9 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:157 Old Cart Way,North Andover Owner.Hamilton Date of Inspection:3/7/2000 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent reference landmarks or benchmarks locate all wells within 100' (Locate where public water supply comes into house) House Driveway Garage Water Meter B 3 2 1 D- Box i Ato 1=38'3" Ato2=35'2" Ato3=32'4" A to D-box=40'4" B to 1 =35'8" Bto2=39'3" B to 3=42'6" B to D-box=61'6" revised 9/2/98 Page 10 of 11 + SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:167 Old Cart Way,North Andover Owner:Hamilton Date of Inspection:3/7/2000 NRCS Report name Soil Type_ Typical depth to groundwater USGS Date website visited Observation Wells checked Groundwater.depth: Shallow Moderate Deep SITE EXAM Slope Surface water Check Cellar Shallow wells Estimated Depth to Groundwater 4 Feet Please indicate all the methods used to determine High Groundwater Elevation: X Obtained from Design Plans on record —X—Observed Site(Abutting property,observation hole,basement sump etc.) —X—Determined from local conditions X Checked with local Board of health Checked FEMA Maps Checked pumping records Checked local excavators,installers Used USGS Data I Describe how you established the High Groundwater Elevation.(Must be completed)As per design plan. revised 91219.8 Page 11 of 11 i Tel: (978) 475-4786 Fax: (978)475-5451 BATESON ENTERPRISES, INC. Excavating-Water.& Sewer Lines-Septic Systems&Pumping Service 111 Argilla Road Andover, Mass. 01810 Title 5 Inspection Report Property Address: 157 Old Cart Way, North Andover Owner: Hamilton Date of Inspection: 3/7/2000 i My report contained herein does not constitute a guarantee of future usage and the functionality of the existing septic system. Such report issued herewith is merely based upon my observations, and I hereby disclaim any further operation of your current septic system. Neil J. Bateson Bateson Enterprises, Inc. I i TOWNQF NQRTH ANDOV BOHRI?OF HEALTH APR •2 6 6 � d 0 7/8 IT,115: Ae• 6ASEME,rf S0�L///DLA ';VO By/Glj D T" . 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