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Home My WebLink AboutPASS - Title V Inspection Report - 100 OLD CART WAY 10/15/2026 Commonwealth of Massachusetts ............... OWN* 'Zl IPA Tintle 5 uO"'Iti"ci*al Inspectimon For Subsurface Sewage Disposal System Form, Not for Voluntary Assessments 100 Ol!d Cart Wa, k J11- P ro pe rty Ad d ress Owner's Name Information is No. Andover MA 01845 10/15/2026 required for every .11.............. ............. page. City Town State Z,ip 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, own of Nofth An,dover Important:When filling out forms A. Inspector Information on the computer, John L. DiVince�nzo OCT 2 2 2026 use only�the tab, key to,move your Name of Inspector cursor-do not J & S D.Welopmenit/Stewart's, Se iq Service use the return —------ key. Company Name 58 So. Kimball Sit., ........... ....... .......................... .............................. ..................... Com�pany Address Bradford MA 011835, ......................................11- -I'llK-I'll"..-11....,........�................. .............................................. .......................................------------ ................................... ....... City/Town State ip Code 97'8-372-7471 S113386 Telephone Number License Number B. Certification I certify that: I am a DE P approved system inspector in full compliance with Section 15.3401 of Title 5 (310 CMR 151.0100); 1 have personally inspected the sewage disposal system at the property address listed above, the information reported below is true, accurate and, complete as of the time of my inspection; and the inspection was performed based on my train�ing and experience in the proper function and: maintenance of on-site sewage disposal systems. After conductingthis inspection I have determined that the system.* 1. Passes, 2. Conditionally Passes 3. Need's Further Evaluation by the Local Approving Authority 4. Fails 10/151/20,26 .........------- .............................. Ins ect s Sigin 1 U Ce- Date tio he system inspector shall submit a 7coppy olf'cithis, inspection report to the Approving Authority (Boiard of Health or DEP),within 30 days, of completing, this inspection. If the system has,a design flow of 101000 g�pid or greater, the inspector and the system owner sh;all' submit the report to the appropriate reglionaloffice of the DER The oirig�inal form should be sent to the system ow,n�er a,nd copies sent to the buyer, if applicable, an di the approving authority. Please note-, 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. t5insp,doc-rev,7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal Systerni-Page 1 of 18 Commonwealth of Massachusetts, TFA ta p ion rA 01 t e 5 tAwt'Awm: I Ins-ect' For Subsurface Sewage Disposal System Form Not for Voluntary Assessments 100 Old Cart Wa ............. Property Address Erb, ............... ........... Owner Owner's Name information is No. Andover MA 01845 10/15/2026 required for every ............. ............................... ................ page. City/Town State Zip Code Date of Inspection C., Inspection Summary Inspection Surn ire ary: Complete 1, 21 3, or 5 and all of 4 and 6. 1) System Passes: I have not found any information which indicates that any of the failure criteria described 1 in 310: CMR 15.,30!3 or in 31 xist. Any failure criteria not evaluated are iindicated below'. Comment& Replaced distribution box ............. .......- ................. .............. .......................... ........................................... ........................... 2) System Conditionally Passes.- O "Conditional Pass" section need to be ne or more system components,as described in the repilaced or,repaired. The system, upon completion of the replacement or repair, as approved by the Board of Healt,h�, will pass. Check the box for it yes", "no" or"not determined" for the following statements. If"not determined,�j please explain. The septic tank is metal and over 20 years, old* or the septic tank (whether,metal or not) is, struCtUrally unsound, exhibit u t nti ll 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 willl pass, inspection if it is structurally sound, not leaking and if a Certificate of Compliance, indicating that the t nk is less than 20 years of is, available. El Y N [I ND (Explain below)- .............. ....... -------------- ............... ................. ........... ....... .............. ..................... .............. ............I............................. ............__................ ............................... t5 i n sp.d oc-rev.7/26/2�ll B Title 5 Official Inspection Form:Subsurface Sewage Disposal Systerni-Page 2 of 18 MassachusettsCommonwealth of For u T �" .... .. e icia 1� Inspection: ° nSubsurface Sewage DIsposa,l System Form Not forVoluntary Assessments ,d. _.n._ w .... ... ........... ... .........-_...._ ,.m_.n,............... ... Property d! res Owner w .- _.. ..... _.- ........ i " information . n-_.. No over 26 r air for r .......... ,.__... _,,_ __.._�........... .�. _......_.... . .... ............... .... _ ... I w ............................................. pity/'T State �i e to I s ctl n Inspecfion results o f, be subm'Itted on this form., Inspection f forms, Inot be altered way. P'leas,e see completeness, 1'l f atthe end of'the form, Important":When filling out tale A. Inspector Information own on the computer, use only the t _��.,. M_� DiVi c n ....,.: . _w..a,..... ._ .......... _,...._._.w.. .... ....w. .............__.............._....._... ..... key to move your Dame of Inspector OCT 22 2026 cursor-do,not op n to Service uset return ... _ m--------------�. . .. _ _._..............� .... ..... .........- Company 518 So. Kimball St. ................ ........................ -- ------------------ --lie-alth-D e- plaftment- tab Company Addlresis VQ 01 835 _.__..Bradford _....... .................. ._ ..-.._-.._ ............ _m.,,... City/Town State Zip Code Telephone Number License Number' i ion B. Certificat' I certify thiat: I am a D!EP approved system, ilns,pector "in III compliance _. t lisiposal systemthe piroplertyaddress listed' above- the information repoirted below i r , accurate and completetime of my inspection; and the inspection r e y training an experience in the proper u�ncti and maintenance of i Iisposal system�s. After coinducting th�is inspection I have determined that the system- 1. ' i es . Conditionally 31, 0 Needs Further Evaluation by t roving Authority 4. it 9 3 2026 The, system inspector s,hall submit C of this inspection report to the Appir,ovinlg A �t rity (Board of Health or DEP) within days ays I c m letiing this inspection. If the system has,a design flow of 1010100,gpd or,greater,, the inspector and the system owner shall submit the report to the appropriate regilo al office of they DES. The,original form should be sent to, the system owner and copies sent to; the buyer, if applicable, and the approving a t' rit��ly. P"le�as,e tofu This report only escri"bee condlifflons of the time of'inspee�c,flon and under the condiflons of use at that time. This inspection does not address how the system l e r n the future under the same or different conditions of use. t5insp.d -rep.7'/2612018 Tibe5 Official hspection Form:Subsurface Sewage Dsp satl Sys,te Page 1 of 18 Commonwealth of Massachusetts T tie, 5 ial Inspectiaon Form Not for Voluntary Assessment's Subsurface Sewage, Di'sposal System Form 100 Old Cart Way Property Address Er L nn Owner ....................... ..... -----.......---------- .......... ................------ ................... Owner's Name information is, No Andover MA 018451 09/30/20261 requ�i�red for ev�ery ...................------ ..........',,_,............- ...... ....... page. City/Town State Zip,Code Date of Inspection C., Inspection Summary Inspection Summary,- Complete 1, , or 5 and allof 4 and 6., 1) System Passes'.: D I snot,found any information which indicates that anly of the failure criteria described in 310 CIVIR 1'5.303 oir in 310, CMR 15-31014, exist. Any failure criteria not evaluated are indicated below. Comments: .......... ................. ....................... .................. ..............-------------- ........... ................................... .......... ----------------- ................ ............................... ............. ................... ................. 2) System Conditionally Passes: One or m1ore system components,as described in t'he "Conditional Pass," section need to, be replaced or repaired. The system, upon completion of the replacement or repair,i as ap,pirolved by I the r lit h will pass,,Boad of Hea �, it Check the box for yels", "no"oir"not determined" (Y, N, ND,) for the following sta,temenitsi, If"not determined,I$ please it in. The septic tank is metal and over 2110, years, ol the septic tank (whether metal o,r not) is structurally unsiound, exhibits substantiall, infiltration or exfiltration or tank failure is imminent. System,will pass inspection if the existing tank is repil it a complying septic tank as, approved by the Board of Health. A metal septic tan�k will pass inispec,tioln if it is structurally sou�nd, not leaki if a Certificate of' Compliance indicating that t t is less than 20 years old is ava,illable,, 0 Y Di N ND (Explain below), ............... ........................... .............. ................... . .......................... ........... ...... ...... .............. .......------ ...... .......... ..................................... t5insp,doc-rev 7/2612018 Title 5 Offjc4 Inspection Form:Subsurface Sewage Disposal System-Page 2,of 18 Commonwealth i TI"tIe 5 Olff'*icilal Inspection For m Subsurface Sewage Disposal System Form Not for Voluntary Assessments, w Property r s .::..:., :.. _m__mm......... _........................ _w .... _..m...mm.... ....._...u.._.. ..., _..m..wm.mm. _........._..w._. ........... _ . .._.... Owner Owner's Name information is Andover MA 01 1845 6 req�ui r d� r eves" m....w. ----- .._....mW. -.--------- . page. City/Town StateCity/To I ode Date o Inspe' ti C. Inspection Slumma,ry (conit.) Conditilonally Passes (cont.): 0 Pump r pum,ps/alarms not operational, System will pass withr t Healt roval it pumps,/alarms arerepaired. E] Observation ' r break out or high tic water level in the distributionboy due t broken or obstructed i r u.� tobroken, r uWu� vvdistributiont i l l pass inspection it(with appiroval of r of t broken pipe(s) are repila,c,ed Y N ND ire below): obsitruct,ionis removed'! (Explain below)- distribution box is leveled or replaced in m. : n r t corrosion a r w .._t outlet r ......... . - system required pu i ore than 4 times a year due to broken robstructedi systemill inspection it(with approval of the Board of It r brokein ipe(s) are replaced (Explain ll obstruction is removed El Y [I N 0 ND (Elxpilaiin bell Further Evaluation is Requiredy the BoardHealth-. Conditions exist which r uir�e further evaluation by the Boardof Health in order to determ�in�e i the star is failing t protect� � lic heath, safety oir the e i�lronmr ent. a. System wllIl pass unless Board of Health determines in acc r�da, ce with 31'0 CMR 15.3 3 1 b� that the system is not functioning li a manner which will protect public health,i ,safety and the envl"r rime : t i sp.doc.rep,7/2612018 Title 5 Official Inspection Form:subsurface Sewage Disposad System-Page 3 of 1 Commonwealth of Massachusetts ecti"on For Ti icia utle 5 Off I Ins tvp 40 Subsurface Sewage Dilsposall System Foirm Not for Voluntary Assessments 1010, Oild Cart Way_ Property Address Erb,,,Lynn Owner .. ........... ...... ............ ............................. ........ —------------ Owner's Nara inform:atiioln is No. Anover MA 0 1'84 51 09/30/2026 required for ever�y d ......................... ................ -------- page. City/'Town State Zip,Code Date of Inspection C,. Inspection Su�mmary (con�t,.) Cesspool or pir,iivy is within 50 feet of a surface water Cesspo,oll or privy is iilt in 50 feet of a blorder'ng vegetated wetland or a salt marsh b. System wilill fall unless,the, Board of Heiallth and Public Water Suppfler, ff anly), dltiter m'i n es that the system is functioning: in a manner that protects the pubillic health, safety,and enviironment: E] The systems has a septic,tank and s,oil absorption, system (SAS) and the SAS is within 10101 feet of'a s,u�rface water supply or tributary to,a su,rface water s,uppily�, [:] The system has, a septic tank and SAS and the SAS is wi�thin a Zone I of a public water supply. E] 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 sepitic t,ank and SAS and the SAS is lies s than 100 feet but 50,feet or more,from a private water supipily well". Method used to determine distalnce�� -1.11--.......... This systern passes It the well water analysis, perfoirmed at a DEP certified laboratory, to fecal c,oliform bacteria in�dica,tes absent and the presence of ammonia nitrogen and' nitrate nitrogen is equal to or less than! 5 ppm,, providedI: that no other failure criteria, are triggered, A,copy of the ainalysis must be attached to this form, c., Other- .......................-IIIIIIIIIII..................... ........................------- ..................... ....................... --------- .................. .......... ................. ...................... ............... ............ .............. .......................... ................ ....... ....... .......... ...................... .................................... ............... ...................-------- ........ ...... ....................----------- 4) System Failure Criteria Applicable to All Systems: You must, indlilcate "Yes" or"No" to each of the following for all inspe ctions.", Yes No Blacku�p of'sewage into facility or syste pin t to overloaded oir c i log�ged SAS, or cesspool E] Z Discharge or ponding of effluent to the surface of the ground or surface waters d i llue to,an overloaded or clogged SAS or cesspool t5insp.doc-irev.7/26/201!81 Tfile 5 Oifficial Inspection Forte:Subsurface Sewage Disposal Sy sit e�m-Page 4 of 18 Commonwealth of Massachusetts �21) Tive 5 Off'inciolal Insj*ftjecti4on Fo:rm� pa�, Subsurface Sewage Disposal System Form Not for Volun�tary Assessments Z47 'k 100, Old, Cart Wa Property Address _...�....�. n Owner - ........w....... .................u._ .u._.......... ....._........ ... _...n.n...............................m....._,_ --_..,._._.. ......... _._._._. w, ........................... ................................. ................... Ow ne 's Name inform�ation is Andover ' 2026 required for .. -__ _m.. _m.. __- .m.......................-- __.... ......... State Zip o Date of Inspection C. Inspection Summ�ar,y (cont.) 4) System Faillurer t ri lice lI to,All Systemsi: n . StaticYes No liquid El EI r l icesspool' Liquid depth in cesspool is less t "" b below invert or available volium,e is less than Y2 flow Required pumpling more than 4 times in the last year NOTd�ue to clogged or pumped- Anyrt of the m ces,splooll or privy is belowl r elevation. 1:1 z An:y portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply, El E Any wwithin we I El' Z n n �t of r privy is, it t of'a privatewater supply well. El 1:1 Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from rivat ter supply well' itl no ace t l water qu�alilty analys,is. system! lases if the well water analysis, r laboratory, for fecall l r act rig indicates sent and the presence, r nitrogen, nitrate trr a i quall r than 5 ppm,, ided t o ether aillure criter'a are,triggered. copy o " analysis, and, chain of custody must be attached toform.] 1:1 z The system is a l serving a facility it i The system fails,. I have de termined n r more of the i 1:11 zi criteria exit as,described in, 31110 CIVIR 15.,3103, therefore the systemfails. system owner should contact the Board of Healith, to determine what will be necessary to coirrectt failure. 5) Large Systems-, To be, considered a large system the,system must serve a,facilifty with a, design flow of , to , p . r large to you must inid'icate either yes"' r"no" to each of the following, in additionto,the questions, InSection . Yes No systemthe t 400 feet of a surfacedrinking water supply t I ithin 2,00 feet of a tributary to a surfacerinl t r supply El El the systemlocated in a nitrogen ti r (Interim l l' d Protection r — I r a mapped Zoin,eII of a plublicwater s,u l ll ties-revs,7/26/2018 Title 5 OffidW Inspection Form,Subsurface'Sewage DisposW S ter -Page 5 of 1 Commonwealth of Massachusetts A oTitle 5 urricial Inspection Foirm 0 Su�bisurfac,e Sewage Disposal System Form Not for Voluntary Assessments 100 Old Cart Way w Property Address Own Erbl, nn ... _...w. ,_4... -_-___._........m........_ ..._ _..._..._ --------------------- ��" ........----- .......... -----------................................ wer's, acme information is 26 required forever �.... �....�. __ .....�� ..... �...�..�.._. .... .. � _. . .._.-_ page. City/Town State Zip Code Dia,te of Inspection a� Inspection Summary (cont.) If you have answered "yes"' to any 'I tl in ctl l the systeml red a s,ignif'icant threat, r a,nswered ",yes" to any questionin the large tfa,iled. The lowneir r operator olf any large t r significant r t under l r failed under Section CA shall upgrade the systemin accordanceit ' The system r shouldrat t the appropriate regional f l the Department. indicate 1 r " r each of the following for all n p c �on Yes, No El ion was, provided by t r, oiccupant, or Board of Health E] Eli Were anyof the syst �poneints plumped t in the previous,two weeks? 11 E] Has the system received normal flows, in, the, previousrl large volumles of water bieen introduc,e tothe system recently it as part of this, inspection? 4� r t plans of the systemtyre 1 if they,were Eli 11 available not Z El s the fa,ci,lity or lii inspected for signs of sewage back Was the siteinspected for s s,of break ut E] Were all systemr t & xcl the SAS, located or It z E] Were the septic t les uncovered, opened, and the interior of the to inspected for the conditionf the bafflesor tees, material of constru ction, dimensions, depth of li Dui , depth of siludge and diepith of El El Was the facility own roccupants, It different from rwith information othe proper maintenance of subsurface sewage disposal t The size and location ofthe Solil Absorption Systern (SAS) on, the site been determined ti g information, r example, a plan � r Health. Determined in the field ( I r criteria 1 t t Part i t ` i Nr approximation of distance Is unacceptable) [310 CMIR 15,. t ins,p,dc -rev,7/26/2018 Ties 5 Officiall inspection Fore:Subisurface Sewage Dsposal System-Page 6,olf 18 + :r, �m Commonwealth of Massachusetts st,le on o�ff! R d1 0 icia tioln Form I Inspeic Subsurface Sewage Disposall System Flo,rm Not for Voluntary 100, ild Cart m_.._.._.._..... .�,,.... Property Address Owner ....... .......... . ......... .......... ...... ............ .............. .. _... He 's Name information is No. Andover MA 01845 0191/30/20,26 required for eve pa e�. i /T State Zip Code Date of Inspection D,. Syste�m Information 1. Res*i 1*a1 Flow CondiMi s: 4 N ber e r oms desi n 4 �r Num� er of bedrooms (actual),. DESIGN flow based3110 CIVIR 15.203 example*xa Ie* 110 gpd x#o bedr ms, . 66.......... 0 Descr�iptio Number Curren re�siden s; Does res,i en�ce have a garbage grinder? Yes N Does residence have a water treatment,unit? Yes No If yesscas, rr Is laundry one a separate sewage siystem? (Include laundry systems inspection El Yes N information! in �is report.) Laundry n s No Seasonalu � No Water meter readings, it lyears, Detai lI Sump PUMP? El YesMNo Last date of occupancy: te tiros . oc,rev.7/26,/2018 Tulle 5 Offidall Inspection Form,Subsurface Se,wagie Disposal System-Page 7 of'1 Commonwealth of Massachusetts �Vlk. ............ ille 5 Official lnspecti*on Floir Subsurface Sewage Disposal System Form Not for Voluntary Assessments 10 0 0 1 d C a rt .............. .......------- .................................. ------ ............ P�roplerty Address Erb, Owner Owner's Name information is No. Andover MA 018,45 0191/30/20,26 required for every -1-1-1-11-111111............ ........... ....... .......... page. City/Town State Zip Code Dal,te of Inspection D., S�ystem Infoirmati�on (cont.) Commercial/Industrial Fllolw Conditions: Type, of Establishment,- Design flow (biased on, 3�'1 ........ .....-------- Gallons per day(gpd)i Basis of des,ign flow (seats/peirsons/sqft, eitc.)- ........... ........... .................... Grease trap presen�t? El Yes [:1 No Water treatment unit present? El Yes E] No If yeis, Industrial waste holding tank presen�t? Yes No Non-sanitary waste discharged to the Title 5 system?, El Yes [:1 No Water meter readings, if available- Last to of occu �n use- ................. ....... Date Other (describe beloiw'), ...............- .............. ..................................- ................................ ............................. ..................................... ....................... .................. -- ........................... .............................. 3. Pumping Records:, Source of information: -.............. .......... ... ............. ......... Was system pumpied a's part of the inspection,? Y e s E] N o 1500 Ifyies, volurri purnpied- ................................ ......-------------- g�allo,ns How,was quantity, pure' rmiin�ed? r I n spect ta n k .......... --------- Reason fo pumping'- t5iinsp.doc rev.7/26/20 18 Title 5 Offic4 Inspedoin Fcirm:Subsurface Sewage Di l System-Page 8 of 18 ,4k Commonwealth of Massa,chusetts .......... Tl'tle 5 " ff" I I'nspect*ion For Subsurface Sewage Diispostill System Form Not for Voluntary Assessments 1010, Oild Cart Wa .......... ......... ........................ ....................... Property Address Erb,, Lypp Owner ...... .......... Owner's Nlame information is No,., Andover MA 01 8�45 09/30/20126 required for every . ......... ..................... ...... ....... ..................... pag�e, City/Tolw,n Sit,ate Zip Code Dia!te of Inspection U, System I nformation (c,ont.,) 4., Type &System.- El Septic tank, distribution box, soil absorption system El Siing�le cesspool Overflow cesspooll Privy Shared system no) (if yes, attach previous inspection records if any) ,yes or I El Innovative/Alternative technology, Attach a copy of the current operation and maintenance contr,act (to be obit�ained from s,ys,t,emil owner) and a copy of latest I I inspection of the I/A system by system operator u,nder contract, Tight,tank. Attach a copy,of the D,EP appir I. Other(des,crible)� ............ Approximate age of all colm�ponents, date installed (if knowni) and source ofinformation: November 16,1 19915 ................ ........................ ...... ........... ......... Were s,ewagle odors detected when arriving at the site? D Yes Z No 5. Bul"Idi"ng Sl r(locate on site pilan�).- 2011 Depth to grade, "I ---- Material of construction, El cast it E] 40 PVC El other(explain),� ... ....------ Distance from! private water su pply wel l! or suction l ine, fee t Comments (oni, con di ion of joilets,, venting, evidence of leakage, etc.), ................ .............. ............ .................................... .............................................. ......... .............. ....... ...................... ............... --------- .............. t5insp,doc-rev,7/26/2018, Tftlie 5 Official Inspection Form,Subsurface Sewage Disposal System-Page 9 of 18 Commonwealth o�f Massachusetts h�. ............ T'Itle 5� Offi'ci'al Inspecti'on For Subsurface Siewia a Di's osal System Form Not for' l �nitar Asse�s, m 100 Old Cart._-_ __.__.. _...... _...,......m..._.... ..... _..........m_.m. ..... __...........� w..w... _..........,_....._. _ ... Property Address, Erb, Lynn _�.. .... ...�._... ��..,. ._.. _.m..m �' er's 'ar e in�formatiloin is _ _..�_... �._.e a ired i e � _.mm ..mmmm. ................... - .._....._.........�...........mm........ pag�e. C�ity/Tow�n State Zip Code Date of Inspection DO S,y�stem Information 6. Septic ankle locate on site, pIa �.� Depth below g r e feet Material of construction,. metalE concre�tle D El fiberglassr If tank is metal!,, list age', ...... __..... ......_......m ... years Is,age firmCertificate 311 Silud'ge depth, µ...w.w... .._ ___._.... ___.m...... _....... ... 27111 Distance from top of sludge to bottom of olutlet tee or baffle --- Scum i n s, -�___........... ..... ...._........... _ .....�................................... Distance from top, of scum to top of outlet tee o�r baffle 611f 11 Distance fromoutlet r baffle How were j�?pe meas,ur�e/'slud e j�4ge n _. Comments n pumping recommendations,, inlet and outletteel' i i , structural integrityl liquid levels as rellated ,to outlet invert, dence of leakage, Both, baffles ... , i level t5ins ,doc'*rev.7/26/2018 Tifle5 Official Inspection Form:Subsurface Sewage Disposal sal System Page 10 o,f 1 s 1Commonwealth of Mas,s,achus,et�ts von Fo,rm Til NIA, ._ ''i le 5 afficial lnsp00%ec Subsurface, Sewage, Disposal System Form, Not for Voluntary Assessments 100 Old Cart Wa, Property Address Erb, L Owner yqP ................................... Owner's Name infoirma,tion is No Andover MA 5 9 3 2�026 reuire for eves .... . _..»�..__.._ ... _._m_��..._...... n .�_..........._......�.. � .�... ........... _.- w....�............. .. ------------ . page. City/Town State Zip Code Date of Inspection D. Sys,te�m Information (cont) 7. Grease "rap, (locate on site n grade,Depth below Material tr ct El concrete metal Dlimensions�� Scum th�ic,kness __.......m . .. mm..w Distance ro top of scum to,top of outlet', r t m r to _ _. _µ ..--. Diistan�ce r m. Date oflast ate Comm�enits (ors pumping recommendations, inlet and outlet tee,or baffle coinditi n�,, structural integrity, i u�id level's as relatedto outlet invertI nce of leakage, etc.): . Tlight or Hold i , n (tank must be pumpedt t,ime of inspection) t n site r Depthto r ., ... -- _m. ... .........m Material tr El concrete 0 metol E] fiberg1lass piolI t,hylene other (explain)- . gallons Designl _ .... _ ......... ...... -_..............__................................... ... . gallons per day t5 ns . l r rev. /2612 1 , Title 5 Officiai Inspection Fora.Subsurface Sewage Disposal System-Page 11 of 1 Commonwealth of Massach�uselfts N Title 5� uOl*&fficial Inspection For �01 Subsurface Sewage Dlisposall System For Not for Voluntary Assessments, 1010! 011d Cart Way- ------------------- ...... Property Address Erb, L nn Own�er ------------ ............................ ............. —------- Owner's Name infoirmat ion i�s, required fo!r every No., Anidlol /30/2026 page. City/Town S�tate Zip Code Date of Inspection D. System Information (cont.,) 8�. T11gftt or Holding 'Tank (cont.) Alarm preselnt- El Yels El N 01 Alarm, l�level�,� Alarm in working order: Yes No Date of last pumping- -Da I t-e ------------------------------- Colmmilents (condition of alarml and float switchels, etc-)* ................... ------------- ...............---------- ............................. .............................. ................ .......... ............ ............- ........... .............................. Attach copy of current pu�m�ping contract (required). Ills copy attached? Yes N o 9. Dl'strl*lblutlion if pr locate on site plan). 0 Depith of liquid level above outlet inv,ert -------- Comments (note if'box its level and' distribution to outlets,equal, any evidence, of sol!i�ds carryover, any evidence of leakage into or o�u�t of box, Box needs re l M acing due to corrosion causin leakage arOUnd 'the outlet invertsp no, solids carr over. .............. .................. "" .-1-.1 1 ............. .............................................. ........... ............. .............. ...... .............. .................... ...................... .............. ....... ........------ ......... ............... .......... .................. ..................................--.................................. --------------------- ---------------------------- t5i,nsp.doc-rev,7126/2018 T tle 5 Official Inspection,Form Subsurface Sewage Disposal System-Page 12 of 18 ; 2� ici'al Inspect*ion " Nun n Subsurface Sewage Disposal' S� item Form Not for Voluntary ntar Assessment's k vm100 Old art Wa tl .w�� ..m w..�ri.m .........................�.,_ �..,.,,...........,...,..,., ,«........,....,..,,,.,,,.. ,.......,,,.,,..._.._,,,m,........,...,...,..�.�...,,.�.,.....,;......,,,,,,.,.,..,.m.., �.,,,...,.,. ...,.,,.,.....,.,,,.. ��.,. mm...��. .. .,...._._..,..,,,m....,. .,.,... ,..__...........,.. ..,. ,.......,,. .....,,, ....,..,.,,.......... w�..,.,.:,,.,__.,,..._.._.,,....,.,,,.,,m .....,, ....... -..m.-..-.,,....... ................�...... r y Address Erb,Owner .......................wLynn .....m.W_. m,e...._. _ ._ .. _....r mm... ..........--------------- -- --- Owner's Name infoirmation is N . Andover MA 845 9 3 2 ,26 required r eves �... ._ ....... ., .�®w.�.w......�.._ __�_.�...._ ��.�...�.�. . .�.__ �._... . . ...w. �.n..�..�_�._._.._-_�e..�. .�.. ..�_.�U�...��..... _ ..a--- age /down State Zip Codes Date of Inspection M ) imp Chamber,(locate on site pilan), Pumps in w,orkin�g AlIairms, in working '* Yes No Cornments (note condition u' , condition of'pumpis an nce�s,, ---- If pumps oir all ini I , system is a conditional 11. Soil Absorption System (SAS) (locate on site plan, excavation no�t required): I not located! explain why: Type* E] leaching i mde� ,-, �.... _.... ..w � _...��....... leaching chambers number: leaching galleries, number, leaching �trenches, tuber, Ie� ,� � �' 5411 ... .... mm............... leachiing fi l , dimensions- ...... overfl _.. .------- ........... i i i I ' Ty�pl L I _... _ ......... - .......................... _ ....... _ m__..... ..... . m ...... t5i s . c-rep,7/26/2018 Title5 ti iatl Inspection Fora:Subsurface Swage Disposal System.Page 13 of 18 Commonwealth of Massachusefts ,R2* Title 5 U"ff'ilcial Insmect'ion For Slu�bisu�rface Sewage Disposal' System Form Not for Voluntary Assessments, 100 Old Cart _y ........... ------ Property Address Erb, Lynn Owner 11-111----............ ------ ................ Owner's,Name information is, No. Andover MA 01845 09/3�01/2026 requili�re�d foir eve�ry .................. ............................. ........... ...... page. City/Town State Zip Code Date of Inspection D. System Information con .,) 11. Sol* Absorption System (SAS) (cont.) Comments (niote condition of soil, signs of hydraulic faillure,, level of ponding, darnip soil, condition of vegetation, etc.),, No.,,pondil,n no damp soils.,_.. . .... y aulic failure ............ .................... ......... ........... ............ .....--------------- .......................- ..................... ............................ ........... ......................... -............... ............................ ...................................... ............. ................ .............------ ------------ 12. Cesspools (cesspool must be pumped as part of inspe�ct,ion!,) (locate on site plian): Num�be�r and coinfig�uratioln Depth —top of liquid to inlet in ert Depthof sollids, layer ............ ............................... ................ Depth of scum lay�er Dimensions,of cesspool -------- Materials of co�nstruction Indic ation of ground ater inflow E] Yes El N ol Comments (note condition of soil) signs of hydraulic failure, level' of ponding�, condition; of vegetation, etc�.) ............. .............----------- ........................... ....................... ........................ .............--—----- ...................... ........ ------------ .................................................. ....................................... .................................... ....................................................... .............. ....... ---------- .............. t5,insp.doc-rev,7/26/2011 Tntlie 5 Offjc4 Iris on Forte:Suibs,urface Sewage Disposal System Page 14 of 18 'AA', Commonwealth o�f Massachusetts 'N T �tle 5 Offi�cial Inspecti"on For �F�,,) Subsurface Sew�ag�e Disposa,l System Form Not for Voluntary Assessments 100 Old Cart Wa Property Address Erb,,' Lynn Owner --1111..........— 11.111--.......... ....... ......................... n. ....... Owner's Nam�e information is, No. Andover MA 01845 091/30�/2026 require�d for e�v�e�ry --------- .......... ...... ..........- page. City/Town State Zip Code Dart e of Inspection, D. System Information (c,o,nt.) i 131. Privy (locate on site plan): Materials of constru�ction, Dimensions .......... ....... Dielpth of solids, ------- ----------- ----------------------- Comments (note con itlion of soil,, signs ofhydraulic faill�ure, leve�l' of p�onding,, condition of'vegetation, etc): ............... ........................----............ ...... ..................................-11-11-..-.............. .............................. .......... ......................-....................------............... ..............................-------------......................... ................----—----------- .................................--................. ........... ..................- ............... t5linsp.doc-rev,7/26/2018 Tftle 5 Officj14 Inspecfion Fore:Subsurface Sewage Dsposal System-,Page 15 of I�8 Commonwealth of Massachusetts, ici" ns *i or Subsurface Sewage Disposal or Not for Voluntary Assessments Wa 100, O�ld Cart y ............. ...... ......... Property Address Erb,-L nn Owner1111-11 1111111-: --y-1111 11--111-11 I'll, -- -1-.... --------I.-----l-11111--I- ----- --- --- ---___--'-"---'"""" "- ----------- Owner's Name information is, No. Andover MA 0 1845 0 9/3 0/2026 requpired for every page. City/Town S�tate Zlilp Code Date of Inspection D, System Information (cont) 14. Sketch Of Sewage Disposal System: Provide a v,iew of the sewage disposal system, inc,l!udi ties to, at, least two permanent reference landmarks or benchmarks. Locate all wells within 1100 feet, Locate where plubilic wat�ler supply einters the building. Check one of the boxes below* hiand-sketch in the area below drawing attached separately t51nsp,doc-rev,,7126/20,1�8, Title 5 Officiall linspedi arm:.Subsurface Sewage Diispos,an Sys,te,rn-Pagie 16,of 18 Commonwealth of Massachusetts ic,i�a I Inspecti"on For T"I't I e 5 ff Property Address rµ r .m.....Owner Own _......... .............. .�._. __... _. eru ............ ..........s,Name infoirmatioln is .ver, it for vex . .. ... . page. ...................................... City/Town State Zip ode Date,of Inspection ecti D. System Information (c,on�t.) 5. S*! e Exam: [Z Check Slope 0 Surface water Check cellar. Shallow wells 5411 Estimated depth to high grOUnd water" I fe 11 e I t Please indicate all methods used to determine the high ground water elevation': Obtained m systems design llans on record l Ich ecked, date deli �lan r eviewed- 1 1 22 9 Observed86 D I ailte ------ it (abutting t ti l it t t Checked with local r Health,: l i Pulled files, ...........-........................... .................. Checked'wi'th local t rr , i r t l�l' r (attach nit ti r Accessed USGS database - explain: You L t descri tablishedthe h�igh groundt l tion: Taken from i s n............ r� __ ____....... .............. m....m... . ........ . Beforeifling thils, Inspectillon Report, pleasemChecklist on n�e�xt page. t5i -rev.7126J201 8 Ttle5 Offid4 Inspection,Form:SubSUrface Sewage DsposaN Syst -Fags 17 of 18 Commonwealth afMassachusetts I1TwItle 5 Subsurface Sewage u0"`,ff'ic*iaI DisposaltoVoluntary _ Way___.,.._. ..._.......... .....m......_........ _ .. -- _.. _...._._mm__._....,,..w w...... ---.._....---. ................. _..............................,...... ....,....... Property Address Owner __. ....w�..W a-. .-----,-... .-...._......_ _............... .._. �. .m....a.� �..a.......... ... er's game ver MA 01845 09/3�0/2026 lug for,every _....information is a. .._��U....�� ....�_._�. __...... ........w.uw.wu� _.�....mm...�. .............. .N...w.........��w.��.....__. .. .�....... _...�...�. Re d Corm eten�ess, C ecklis°�page. Cityrrown State Z,ip Code Date ofInspection E,. ��. Comiplet:e all w a section r sieve El A. Inspector Information: Complete all fields in this section. w Certification.- Signed C. inspection 9 M. ,I 3, or 5 completed as appropriate (FailuIre Criteria) I la D. Systern Information: For * Tight/HoldingconItract attached : Sketch of Sewage Disposal System drawnl For 15: Explanation of estimated de�pth to high groundwater incluided Sins , -cep.7/26/2018 Tina cila8 Inspecfion Form:Subsurface Sewage Ms s �System.Page 1 II 1t 11 It ICI&I5s; w 'Zl&•n2 11 It i, H O U &�S+....,.. la rr 8. i• 14 ce -80K- "r Z "r 70 I, I! I L 11 Irv/[ <b-8DX N (r7. ►rr] T WlX H Z 155'.11(r-t pi� 1 r r �. r wN aF 0 �►, no 1 loot r r r i 3 XYD t 14 � F io ` Ir i 6z oo! AS BUI OF . SUBSURFACE DISPOSAL SYSTEM WCATEC IN KJORT' A MW\/E:R 1 HA. AS PREPARED FOR LE:l\J (5ETT DATE: MbVV7M BER 16,,lqq S-,, SCALE: 1 140 MERRIMACK ENGINEERING SERVICES, INC. PROFESSIONAL ENGINEERS ■ LAND SURVEYORS • PLANNERS: /i PARK STREET + ANDOVER,MASSACHUSETTS 01110 0 TEL 00)475.3335,373•S721 e