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Home My WebLink AboutMiscellaneous - 237 CARLTON LANE 4/30/2018N 19.7 B/ /.�-/OZp f 2-t 41 i 04/06/1997 15:02 5083736611 STEWART/ANDOVER PAGE 01 6 lVar41 Arvtbver Q a 4. - )ab 83�tYICL Ns rtl A nc�al•i- 47 , Mh 01035 Wmw1 LI& to-ooµ �ns'�o 1 L►� � p,Q-� 478"372-7172 Mn or REPORT PMqumaP !o° S Svt �� BQnnar► fir. �aoa 0?3 -7 (2ir/ far» lane_ 1.5do g-�)Sao w'i t vm 7 OWN /060 g'� 105 �dclC ldep no Durn 5`I Oo 1,6,.-) Id ern �� 1660 rm Dirt eon or- r �a vcrn l ilp665 15d� " l 091 rd TO: NORTH ANDOVER, MASS —D C �6 19 BOARD OF HEALTH FROM: DESIGN ENGINEER Re: Soil Absorption Sewage System Inspection This is to certify that I have inspected the construction of the said disposal system at 46'7' -44) /9 /NC North Andover, Mass. SITE LOCATION The gradesand construction a.re'as,'spec'ified in I�.plans and specifications dated O C. t IVE.V,-- �¢Sse Ciao Cr— t0-34� c�i�z— ,-JOT - ,-Ja i Nod &Lm bfr or -OUT FiU-f Fin -rx of&P !Ut�J7 fro XTP ArJ-r 46c& P(� Board of Health North Andover,Mass .Y $UBSORFACE DISPOSAL DESIGN CHECK DIST LOT J qZ Q�IV 'J APPROM DATE - ZI -Fy DISAPPROPED DATEr Providdds Reasonss h ' Title V FAIL Ob ; Reg 2.5 The submitted plan must show as a minimums a) the lot to be served -area, dimensions lot #,abutters 4Ib location and log deep observation holes -distance to ties location and results percolation tests -distance to ties d design calculations & calculations show required leaching area e) location and dimensions of system-inclg reserve area r/ f) existing and proposed contours g) location any ret areas within 100' of sewage disposal system or disclaimer -check Wetlands mapping (h) surface and subsurface drains within 100' of sewage disposal system or disclaimer (i) location any drainage easements within 100' of sewage disposal system or disclaimer -Planning Board files (j) known sources of water supply within 200, of sewage disposal a system or disclairter (k) location of any proposed well to serve lot -1001 from leaching facilit (1) location of water lines on property -101 from leaching facility � ) location of benchmark -driveways - o). garbage-- isposah M_ p no PVC to be used -in construdtion - Q) profile of system -elevations of basement. plumbs pipe, septic tank, _distribution box inlets -and ontleta,-distribution-field piping and --Other elevations 4_0 A&A=m-ground-vaater_-elevation in area sewage_ disposal system ) . plan must be prepared by a Pro%§s3i�onal -Engineer or=Other ` professional authorized by law to prepare such plans Reg 6 otic Tanks _ (a) capacities 50% of flow, water table, tees, depth of tees; -- a.CcC�-,, p` ring (b) cleanout 101 from cellar uall or inground sidmrd.ng pool 251 from subsurface drains Reg 10.2 Distribution Boxes (a) slope greater than 0.08 Reg 10.4 (-b) -sU Board of Health North Andoyeerr2Haas. SEP'T'IC STSTEH .INSTALLATICK 'CHBCK LIST ;aeonst 5-r. HwRt: LOT ` j y Z �LTDitJ E) AVATION OK FAIL 1. Distance Tot a. Wetlands b. Drains c.. Well 2. W ter Line Location 3. No PVI; Pipe 4. Se.,tic Tank a. Tees -_Length & To Clean Out Covers b. Cement Pipe to Tank -Gln Both Sides of Tank 5. Di-tribution Box a. Covers k Box - No Cracks b. All Lines Flo-Ang Equal Amounts c. No Back Flow 6. Leach Field or Trench a. Dimensions b. Stone Depth c. Capped tiids d. Clean Double Washed Stone 7. Leach Pits a. Dimensions b. Stone Depth c. Splash Pads C. Tees e. C, .ant Pipe to Pit - Both Sides f. Clean Double Washed Stone 8. Nc Garbage Disposal 9. r jaj Grading Inspection 10. BEcricading Covered System 11. As Built Submitted a. Lot Location b. Dimensions of System c. Location with Regard -to Perc Test d. Elevations e.' Water Table —._Board of Health Nor;.Y.: .mdover, Mas s APPROM DATE _Z 1 Provided: Title V I FAIL I Ob Reg 2.5 SUBSURFACE DISPOSAL DESIGN CHECK LIST LOT f 1 C L2a�_..._ DISAPPROVED DATE Reasons: The submitted plan must show as a minimums a) the lot to be served -area dimensions lot #,abutters b location and log deep observation hoes -distance to ties c location and results percolation testa -distance to ties d design calculations & calculations showing required leaching area e) location.and dimensions of system -including reserve area f) existing and proposed contours g) location any wet areas within 100' of sewage disposal system or disclaimer -check wetlands mapping h) surface and subsurface drains within 100' of sewage disposal system or disclaimer i) location any drainage easements within 1100' of sewage disposal system or disclaimer -Planning Hoard files J) known sources of water supply within 2001 of sewage disposal o . system or disclaimer k) location of any proposed well to serve lot -1001 from leaching facility 1) location of water lines on property -20' from leaching facility m) location of benchmark n) driveways o) garbage disposals p no PVC to be used in construction ;q) profile of system -elevations of basement, plumb, pipe, septic tank, distribution box inlets and outlets, distribution field piping and Other elevations 'r) maximum ground water elevation in area sewage disposal system s) plan mast be prepared by a -Professional Engineer or other professional authorized by law to prepare such plans Reg 6 Septic Tanks (a) capacities -T50% of flow, water table, tees, depth of tees, access, pumping (b) cleanout (c) 101 from cellar wall or inground swimming pool (d) 251 from subsurface drains Reg 10.2 Distribution Boxes I(&) slope greater UMM 0.08 Reg 10.4 b) sump .L-A SSACHfJ,�FT~rc- .., ''.liit'i:'^l1.7; n;1/i_l' '•;'j;;`i11�V j'�rr'. ,. - DE4,,ub provid b 11 e ubmlOeed thla form (or uoo by local Boards of Health, The System Pumping d to the local Board of H alm or other a e pproving authority, A; Faclllty lnfoftaticn .JrT1 iiM1_� 'I p out .':1,�: Syswm Lou Uon: ` �' the tsb k4y Address i/Vl/"" +oaoPQly CI /T Lw t.1/ f1wrT1 :;'?t`'... „ S ll r'�III �,•�:.sy.,�r„ 2 ;�: YI, , �; v coca ;r.' j11'stl rr' 6, M Owner ,:l I �ii;s, �� :'., i'•f •�1�r'.'<":):r!'r r'�li�: i',. �:l,il,('( i r� AddrdlHersnl frwlouUQn) umping 0rd. Dat�'of Pumpinp`„QuanU Dile 2• ty Pumped ,3,: ',TYP.a Pf.syslarn; ❑ C93spool(s) Septic T ank ;:;❑ %011ier (dascflbe�; ;� ----- ibl'h:�;l�,'i%��",v„'��'r�)'il.:�w'ylf�Y'..viUr',fv -•' Effluan.l Tae; FIIIe( ,Prp,senl?' ❑ yes - ,�t1,, „..,�•,�,\1,!�!�1.1' �11(.+,i;1%; rlil s'6,f�' Co�dl�lon Q.(;8 ; m- rr r Y . \'.I' 7/.' �.;�':' I'�iJ'�/I'j't`��'f('rjhdr•t;�y,1)i�,l�yj ',, (\/S� i0�1,. ',l tv.,•r,,, 1. W ❑ TI9ht Tank If yes, was It cleaned? ❑ ye� rlr�,,, ,•+�r'i.��,'1rl(i��q`,r.,�t�i,ti fH'�r�A� l\'�)a'7,��v�4 d,�1'f,��l�ij't�i''•"ir�''(f�l�i, �., fr ;. 1: 7'}, on wh@re co�leriLs' are di t r, I,; rr �,�. rr Ic/ ��l .S, 'rrl:. V � r� ,,',i,:•ll,ti ,��-.�''!'y ��..,,. I .. h'LIY f • hi�l:.�.:r',,. Slpna,lur� QI H+ule(; ,,pr•••',.:••'+ • Ool� � maaler/a pp. rQ.yovorms,hLm#Inspect '. .. Syllam PwnpinQ Recon ' - TOWN OF NORTH ANDOVEJ, /UA 1'� SYSTEM PUMPING RF-CoRj,, SYSTEM OWNER,-&* AD DRESS SYSTE;MLOICATTON Ac .............. L)ATF.0FP(JMPtNG:-., .--QUANTITY PUMPED: �1-3SPOOL NO___ _4--�YES ScPuvlarjkNO, NA WRh O ; 'SERVICE: Kou'rINE MEKQENf,-, UbShRVA CIONS. GOOD CONDITION FULL ro COVER HEAVY GREASE BAFFLES IN PLACE - ROOTS LEACHM1,I) RUNBACK EXCESSWE SOLIDS FLOODED Sol -ID CARRYOVER OTHER EXPLAIN 7a rre Pwnp-,d by COMMtNY-,, .. RECEIVED YL's CON I'4N FS I-KANSf ERREL) I S -Av, J/— AUG 0 9 2004 q OF NORTH ANDOVER =1d1= Owner information is required for every page. Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. _ I row Commonwealth of Massachusetts B,,,p 0-�- 4-&- A - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments copy 237 Carlton Lane Property Address Joline McGaunn Owner's Name North Andover MA 01845 1/27/2017 City/Town State Zip Code Date of Inspection nt� Inspection results must be submitted on this form. Inspection forms may not be al lsuy way. Please see completeness checklist at the end of the form. ve A. General Information 1. Inspector: Warren Pearce Jr Name of Inspector Pearce Construction Company Name 196 Park Street Company Address North Reading MA Cityrrown State 978-664-5264 S11959 Telephone Number B. Certification License Number 01864 Zip Code 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 ❑ Needs Further Evaluation by the Local Approving Authority c ,- r 3r Inspector's 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. t5ins • 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System . Page 1 of 17 P/( 1 Commonwealth of Massachusetts _ W - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 237 Carlton Lane Property Address Joline McGaunn Owner Owner's Name information is required for North Andover MA 01845 1/27/2017 every page. 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: ® 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. s: 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. ❑ Y ❑ N ❑ ND (Explain below): t5ins • 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 2 of 17 Y a Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 237 Carlton Lane Property Address Joline McGaunn Owner Owner's Name information is required for North Andover MA 01845 1/27/2017 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 obstruction is removed distribution box is leveled or replaced ❑ Y ❑ Y ❑ Y ❑ N ❑ N ❑ N ❑ ❑ ❑ ND (Explain below): ND (Explain below): 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. 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 t5ins - 3/13 Title 5 Official Inspection Forth: Subsurface Sewage Disposal System • Page 3 of 17 I Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 237 Carlton Lane Property Address Joline McGaunn Owner's Name North Andover MA 01845 1/27/2017 Citylrown 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 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 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 '/2 day flow t5ins - 3/13 Title 5 Official Inspection form: Subsurface Sewage Disposal System - Page 4 of 17 Commonwealth of Massachusetts u . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 237 Carlton Lane Property Address Joline McGaunn Owner Owner's Name information is required for North Andover MA 01845 1/27/2017 every page. City/Town 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, 000g pd. ❑ ® 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 If 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 Forth: Subsurface Sewage Disposal System - Page 5 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 237 Carlton Lane Property Address Joline McGaunn Owner Owner's Name information is required for North Andover MA 01845 1/27/2017 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 ❑ ® 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? ® ❑ 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: A Number of bedrooms (design): Number of bedrooms (actual): AAA DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x # of bedrooms): t5ins - 3113 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 6 of 17 Commonwealth of Massachusetts N d Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 237 Carlton Lane Property Address Joline McGaunn Owner information is required for every page. Owner's Name North Andover MA 01845 1/27/2017 City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 2 ❑ No Does residence have a garbage grinder? ® Yes ❑ No Is laundry on a separate sewage system? (Include laundry system inspection information in this report.) ❑ Yes ® No Laundry system inspected? ❑ Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd))� Attatched Detail: Sump pump? ❑ Yes ® No Last date of occupancy: CurrentDate 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: Gallons per day (gpd) ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No t5ins • 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 7 of 17 Owner information is required for every page. Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 237 Carlton Lane Property Address Joline McGaunn Owner's Name North Andover City/Town D. System Information (cont.) Last date of occupancy/use: Other (describe below): Pumping Records: Source of information: MA 01845 State Zip Code Date General Information Was system pumped as part of the inspection? If yes, volume pumped: How was quantity pumped determined? Reason for pumping: 1/27/2017 Date of Inspection Pumped 2014 - Stewarts gallons Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ n% 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 • 3/13 Title 5 Official Inspection Form: 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 237 Carlton Lane Property Address Joline McGaunn Owner information is required for every page. Owner's Name North Andover MA 01845 1/27/2017 Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: Design plan dated 8-10-1984 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer (locate on site plan): Depth below grade: 14 inches 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.): PVC to cast iron in the wall. All appears to be in good shape. Septic Tank (locate on site plan): Depth below grade: Material of construction: ® concrete ❑ metal 6 inches feet ❑ 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: 10'6" x 5'8" x 5' deep Sludge depth: 5 inches 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 GSM 5• 237 Carlton Lane Property Address Joline McGaunn Owner Owner's Name information is required for North Andover MA 01845 1/27/2017 every page. Cityrrown 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 No Tee Scum thickness 1 inch Distance from top of scum to top of outlet tee or baffle No Tee Distance from bottom of scum to bottom of outlet tee or baffle No Tee 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.): Inlet baffle is in place. Outlet tee has been rotted off. Liquid is at the proper level. Tank appears to be in good shape. t5ins • 3/13 Grease Trap (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal feet ❑ 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: Date Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 10 of 17 Commonwealth of Massachusetts m Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 237 Carlton Lane Owner information is required for every page. Property Address Joline McGaunn Owner's Name North Andover MA 01845 1/2712017 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 Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 237 Carlton Lane Property Address Joline McGaunn Owner's Name North Andover MA 01845 1/27/2017 City/Town 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 -1/8" scum build 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 appears level. Distribution is equal. D -box is in fair shape. 2 inches of solids in D -box (No outlet tee). 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 r Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 237 Carlton Lane Property Address Joline McGaunn Owner Owner's Name information is required for North Andover MA 01845 1/27/2017 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: (3) 5 x 8 feet ❑ 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.): No surface sign of problems. No sign in D -box of backup. 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 W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 4�M 237 Carlton Lane Owner information is required for every page. Property Address Joline McGaunn Owner's Name North Andover MA 01845 1/27/2017 Cityfrown 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.): 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.): t5ins - 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 14 of 17 Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 237 Carlton Lane Property Address Joline McGaunn Owner's Name North Andover City/Town MA 01845 State Zip Code 1/27/2017 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 t5ins • 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 15 of 17 Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 237 Carlton Lane Property Address Joline McGaunn Owner's Name North Andover Cityrrown D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated de th t hi In d t AAA 01845 Zip Code 8 feet 1/27/2017 Date of Inspection p o g group VY ca er. feet Please indicate all methods used to determine the high ground water elevation: 1 Obtained from system design plans on record If checked date of desi n Ian reviewed 8-10-84 g p Date Observed site (abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health - explain: Reviewed Files ❑ Checked with local excavators, installers - (attach documentation) ❑ Accessed USGS database - explain: You must describe how you established the high ground water elevation: Test hole data from design plan dated 8-10-84. Test hole date is 6-8-82. The site slopes down to the right to an elevation well below the bottom of the system. No evidence of standing water. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins • 3113 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 16 of 17 Commonwealth of Massachusetts r Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 237 Carlton Lane Property Address Joline McGaunn Owner Owner's Name information is required for North Andover MA 01845 1/27/2017 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 ® System Information — Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins • 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 17 of 17 Summary Record Card generated on 112512017 12:54:10 PM by Tara Hudey Page 1 Town of North Andover Tax Map # 210-107.A-0210-0000,0 Parcel Id 18040..1(1 237 CARLTON LANE �� d MC GAUNN, M JOLINE Since Jan 2003 (1 i' qe 237 CARLTON LANE �. NORTH ANDOVER, MA 01845 Class 101 Single Family Property Type 1 Residential Zoning2 i Residential Zoning3 1 Residential Size Total 1.03 Acres FY 2017 UB Mailing index Name/Address Type Loan Number Activelinact. From Until MCGAUNN, PAUL Payor 237 CARLTON LANE N. ANDOVER, MA 01845 UB Account Maint. Account No Cycle Occupant Name Activelinactive Bldg Id. 14173.0 - 237 CARLTON LANE Last Billing Date 12/6/2016 2100159 02 Cycle 02 Active UB Services Maint. Account No. 2100159 Service Code Rate Charge Multiplier/Users MISCFEE ADMIN FEE 0.635/8 7.82 1/ WTR WATER 01 ALL METER SIZE 375.70 /1 UB Meter Maintenance Account No. 2100159 Serial No Status Location Brand Type Size YTD Cons 13242666 a Active ERT HH METE METE w Water 0.63 0.63 1114 Date Reading Code Consumption Posted Date Variance 11/1/2016 1921 aActual 74 12/19/2016 17% 8/2/2016 1847 a Actual 63 9/21/2016 600% 5/3/2016 1784 aActual 9 6/21/2016 -9% 2/2/2016 1775 a Actual 10 3/28/2016 -91% 11/2/2015 1765 a Actual 112 12/30/2015 324% 8/4/2015 1653 a Actual 27 9/14/2015 277% 5/4/2015 1626 a Actual 7 6/22/2015 -28% 2/3/2015 1619 a Actual 10 3/20/2015 -72% 11/3/2014 1609 a Actual 37 12/15/2014 -4% 8/1/2014 1572 a Actual 36 9/11/2014 360% 5/5/2014 1536 a Actual 8 6/12/2014 -22% 2/4/2014 1528 a Actual 11 3/17/2014 -80% 10/31/2013 1517 a Actual 51 12/20/2013 32% 8/1/2013 1466 aActual 39 9/18/2013 340% 5/1/2013 1427 aActual 8 6/18/2013 -12% 2/7/2013 1419 a Actual 11 3/13/2013 -78% 10/30/2012 1408 a Actual 44 12/13/2012 57% 8/2/2012 1364 a Actual 29 9/26/2012 136% 5/2/2012 1335 a Actual 12 6/20/2012 24% 2/2/2012 1323 a Actual 10 3/14/2012 -77% 1111/2011 1313 a Actual 43 12/15/2011 -11% 811/2011 1270 aActual 48 9/14/2011 359% 5/2/2011 1222 aActual 10 6/13/2011 -1% 2(4/2011 1212 a Actual 11 3/15/2011 -85% 11/1/2010 1201 aActual 71 12/13/2010 -11% 8/312010 1130 a Actual 82 9/13/2010 576% 5/3/2010 1048 a Actual 12 6/9/2010 9% Irk e* dy`• 4Y # F s 6� .40)11 tJ w �Q LZ - "� �4�yr 1.`:-L . 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"!''K t 0 uj i[ •433 : +°4'-,,'.N, I Li Lo 4 a m --1 z o m = 0 co y ° Z Z T� 0 c 0 D0 :3z a 0 CD 1 m// r\r^ V/ c cr 3 (A _N O TI CD m N N N O a (n Cn O O 00 C) O 4 - 9t NORT11ti 7776 4th\> :\• F , 9 Town of North Andover `;•-�;:; «,' HEALTH DEPARTMENT ,SSACNUStA CHECK #:r7 DATE: LOCATION: ) H/O NAME: 4n�C�•cJ/)� CONTRACTOR NAME: Type of Permit or License: (Check box) ❑ Animal $ ❑ Body Art Establishment $ ❑ Body Art Practitioner $ ❑ Dumpster $ ❑ Food Service - Type: $ ❑ Funeral Directors $ ❑ Massage Establishment $ ❑ Massage Practice $ ❑ Offal (Septic) Hauler $ ❑ Recreational Camp $ ❑ Sun tanning $ ❑ Swimming Pool $ ❑ Tobacco $ ❑ Tras4lSolid Waste Hauler $ ❑ Well Construction $ SEPTIC Systems: ❑ Septic - Soil Testing $ ❑ Septic - Design Approval $ ❑ Septic Disposal Works Construction (DWC) $ Septic Disposal Works Installers (DWI) $ ffz r� Title 5 Inspector $ `; y ❑ Title 5 Report $ ❑ Other: (Indicate) $ SSS HeaWh Agent Initials White - Applicant Yellow - Health Pink - Treasurer 1� �• 9 Town of North Andover HEALTH DEPARTMENT �SS�cHus°� CHECK #: DATE: LOCATION: �� 7 C !- � H/O NAME: �Zn c (5�Q,uA6 � n CONTRACTOR NAME: � aZCje. Co/n,5:// T_yRe of Permit -or License: (Check box) ❑ Animal $ ❑ Body Art Establishment $ ❑ Body Art Practitioner, $ ❑ Dumpster $ ❑ Food Service - Type: $ ❑ Funeral Directors $ ❑ Massage Establishment $ ❑ Massage Practice $ ❑ Offal (Septic) Hauler $ ❑ Recreational Camp $ ❑ Sun tanning $ ❑ Swimming Pool $ ❑ Tobacco $ ❑ Trash/Solid Waste Hauler $ ❑ Well Construction $ SEPTIC Systems: ❑ Septic - Soil Testing $ ❑ Septic - Design Approval $ ❑ Septic Disposal Works Construction (DWC) $ Septic Disposal Works Installers (DWI) $ Title 5 Inspector $ Sd ❑ Title 5 Report $ ❑ Other: (Indicate) $ �Q,55 HeJ4,hLAgent Initials White - Applicant Yellow - Health Pink - Treasurer