HomeMy WebLinkAboutMiscellaneous - 72 PATTON LANE 4/30/2018 (2)Ds`
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Board of Health Pennit No
No
* North Andover BHP -2006-007--
f P.I. FEE
IIII X334 US F.I. $125.00
-----------------
Disposal Works Construction Permit
Permission is hereby granted Todd Bateson
---- ------ -
to (REPAIR -D -BOX & T BAFFLE) an Individual Sewage Disposal System.
at No 72 PATTON LANE- - - -
-
----=---------------------------------------------------------------------------
as shown on the application for Disposal Works Construction Permit No. BHP -2006-007 Dated April_ 04, 2006
- - ..------------
Issued On: Apr -04-2006 - 89rd IL1
..................................................................................................................................................................
L—J.
° oTh qti Application fbr Septic Disposal System
ei. ^ o
pConstruction Permit - TOV N OF
s .;15y NORTH ANDOVER, MA 01845
Important:
When filling out
forms on the
computer, use
only the tab key
to move your
cursor - do not
use the return
key.
/Phpl1 '
TODAY'S D TE
$ 250.00 — Full Repair
$125.00 - Component
Application is hereby made for a permit to:
❑ Construct a new on-site sewage disposal system*
❑ Repair or replace an existing on-site sewage disposal system*
repair or replace an existing system component -- /yz/x/
A. Facility Information
7,)-
Address or Lot #
City/Town
2.- *TYPE OF WTIC SYSTEM*:
❑ Pump E54ravity (choose one)
***If pump system, attach copy of electrical permit to application***
❑ Conventional System (pipe and stone system)
❑ Infiltrator or Biodiffuser (Gravel -Less) (Attach a copy of your certification to install this type of system.
❑ Pressure Distribution S.A.S. (No D -Box) (Attach Draft Maintenance Agreement)
❑ Pressure Dosed (D -Box Present) S.A.S.
2. Owner Information
Name �[.(
�% �- l?, T /y, psi!
Address if different from above)
City own State Zip Code
--- --- -------------
Telephone Number
3. Installer Information
-_
Name
Name of Company
Address
City/Town State Zip Code
Telephone Number (Cell Phone # ifpossible please)
4. Designer Information
Name Name of Company
Address
City/Town State Zip Code
Telephone Number (Best # to Reach)
Application for Disposal System Construction Permit • Page 1 of 2
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INSTALLER PROJECT MANAGEMENT OBLIGATIONS
As the North Andover licensed installer for the construction of the septic system for the
property at
Pa lye,✓ L,-, relative to the application
// and
of M Wl� t5oN dated .3—�" for plans by
dated with revisions dated
----
I understand the following obligations for management of this project:
} , As the installer 1 am obligated to obtain all permtian a$O`eHealth of plans
to performing any work on a site. I must have the pans and the permit on site
when any work is being done. If homeowner, project
2. As the installer I must call for any and all iC spmcttoot ny schedules an inspection and the
manger, or any other person not associated with y P
system is not ready then item three shall be applicablework completed prior to the applicable
3. As the installer I am required to have the necgssary P Pout
inspections as indicated below. I understand tthe Board of Health Regulations requesting an inspection, hmay
completion of the items in accordance with Tile 5 and
result in a•$50.00 fine being levied against my company.
a) Bottom of Bed - generally first inspection unless there is a retaining wall which should be done
first. Installer must request the inspection but does rift have to be present.or
st b)' Final inspection — Engineer mubefirst itinspection
etc.
submitted to Boardelevations,
of Health after which installers allstfor
verbal OK from engineer must
inspection time. Installer must be present for this inspection. With pump system all electrical
and able to cause pump to work and alarm to function.
work must be ready quest inspection when all grading is complete. Does not have to be
c} Final Grade —Installer must re
on site. perform the work (other than simple excavation)
4. As the installer I understand that only I may p
required to complete the installation of the system identified in the attached application for
installation. I further understand that work b den al s of linen s atemto ,n and/or prev canontic s or
in
North Andover can constitute reasons f
suspension of my license to operate in the Town of North Andover; significant fines to all
persons involved are also possible.
5. As the Installer I understand that I must be on site during the performance of the following
construction. steps:
a) Determination that the proper elevation of the excavation has been reached.
b) Inspection of the sand and stone to be used.
c) Final inspection by Board of Health staff or consultant -um chamber, retaining wall and other
d) Installation of tank, D -box, pipes, stone, vent, p p
components.
6. As the installer I understand that I instructions b
am llyle for the aclation ontrac�orthor any other
e system as
per the approved pians. No ins to Y the homeowner, general
persons shall absolve me of this obligation.
Undersigned Lic s Septic Installer
<0
Disposal Works Construction Permit #
a TOWN OF NORTH ANDOVER f NORTH
Office of COMMUNITY DEVELOPMENT AND SERVICES
HEALTH DEPARTMENT p
'? 400 OSGOOD STREET
NORTH ANDOVER, MASSACHUSETTS 01845
�CNUS
Susan Y. Sawyer, REHS/RS 978.688.9540 — Phone
Public Health Director 978.688.8476 — FAX
G
ONSITE WASTEWATER SYSTEM CONSTRUCTION NOTES
LOCATION INFORMATION
ADDRESS: 7z ,�,�-t� Lz-� MAP: LOT:
INSTALLER:
DESIGNER:
PLAN DATE: `
BOH APPROVAL DATE ON PLAN:
INSPECTIONS
TANK INSPECTION:
DATE OF BED BOTTOM INSPECTION:
DATE OF FINAL CONSTRUCTION INSPECTION:
DATE OF FINAL GRADE INSPECTION:--�-�
C
SITE CONDITIONS
❑Existing ptic tank properly abandoned
❑Internal plu ing all to one building sewer
F]Topography no preciably altered
Comments:
SEPTIC TANK
,p�"v t'�✓
q
2
❑D
Bottom of tank hole has 6" stone base
Weep hole plugged
500 gallon tank has been installed
\tee
Monolithic construction
ss of tank has been achieved
( cuum Test or Water held for 24hrs)
I lledt red under access ports baffle o�ffluent filter) installed,
centered un
24" inch cover
is port
in 6" of final grade installed over
one access port, mist be over outlet of tank if effluent
filter is present
Hydraulic cement arou
Wastewater System Documentation — Feb 2006
Page I of 6
let & outlet _--
TOWN OF NORTH ANDOVER t NORTh
Office of COMMUNITY DEVELOPMENT AND SERVICES
HEALTH DEPARTMENT p
400 OSGOOD STREET
NORTH ANDOVER, MASSACHUSETTS 01845 �'Ss�cHust�
Susan Y. Sawyer, REHS/RS 978.688.9540 — Phone
Public Health Director 978.688.8476 — FAX
ONSITE WASTEWATER SYSTEM CONSTRUCTION NOTES
LOCATION INFORMATION
ADDRESS: 72- Fxf� MAP: LOT:
INSTALLER:
DESIGNER:
PLAN DATE:
BOH APPROVAL DATE ON PLAN:
INSPECTIONS
TANK INSPECTION:
/D - "E-7�
DATE OF BED BOTTOM INSPECTION:
DATE OF FINAL CONSTRUCTION INSPECTION:/
DATE OF FINAL GRADE INSPECTION:
C
SITE CONDITIONS
❑Existing ptic an properly abandoned
❑Internal plu ing all to one building sewer
❑Topography no appreciably altered
Comments:
SEPTIC TANK
01
i ri
u
Bottom of tank hole has 6" stone base
Weep hole plugged
500 gallon tank has been installed
0 loading Monolithic construction
a tightness of tank has been achieved
( sA or Vacuum Test or Water held for 24hrs)
I et tee *V
l.edce- gt red under access port
utlet tes baffle or ffluent filter) installed,
centered unci
24" inch cover
s port
in 6" of final grade installed over
one access port, nl'u.st be over outlet of tank if effluent
filter is present
Hydraulic cement arou
Wastewater System Documentation — Feb 2006
Page 1 of 6
et & outlet ,
4 TOWN OF NORTH ANDOVER pt°RTH
Office of COMMUNITY DEVELOPMENT AND SERVICES 3?
HEALTH DEPARTMENT 41
ti p
400 OSGOOD STREET 4 ° ,>� •'
NORTH ANDOVER, MASSACHUSETTS 01845 "SS;;CN„5 <tg
Susan Y. Sawyer, REHS/RS 978.688.9540 — Phone
Public Health Director 978.688.8476 — FAX
PUMP CHAMBER
Comments:
Bottom of tank hole has 6" stone base
Weep hole plugged
Combo Tank installed. Size:
1000 gallon Pump Chamber installed
H-10 loading
Monolithic construction)
Inlet tee installed, centered under access port
❑ Pump(s) installed on stable base
❑ larm float working
ElP p On/Off floats working
❑ Se rate on/off floats
11
❑■
u
Comments:
Drain ole in pressure line
24" inc cover to within 6" of final grade installed over
pump acc ss port
Water tightn ss of tank has been achieved
Visual testing
Hydraulic cement around inlet & outlet
ADVANCED TREATMENT TECHNOLOGY
❑ Type of treatment device:
Comments:
❑ Installed per manufacturers requirements
❑ All components working in accordance with
manufacturer's requirements
Wastewater System Documentation — Feb 2006
Page 2 of 6
TOWN OF NORTH ANDOVER f NORTH 1
Office of COMMUNITY DEVELOPMENT AND SERVICES
HEALTH DEPARTMENT
400 OSGOOD STREET
NORTH ANDOVER, MASSACHUSETTS 01845"Ss^CMUSt
Susan Y. Sawyer, REHS/RS 978.688.9540 — Phone
Public Health Director 978.688.8476 — FAX
D -BOX
Installed on stable stone base
Inlet tee (if pumped or >0.08'/foot)
Oydraulic cement around inlet & outlets
bserved even distribution
Speed levelers provided (not required)
Comments:
SOIL ABSORPTION SYSTEM
❑ Bottom of SAS excavated down to soil layer, as
Comments:
ovided on plan
El Si of SAS excavated as per plan
❑ Title sand installed, if specified on plan
F-13/4-1 ' " double washed stone installed
E]1/8-1/2" veastone) double washed stone installed
❑ Laterals installed and ends connected to header
❑ Laterals ven d if impervious material above
❑ Orifices @ 5 & o'clock positions
❑ Gravel-less.disp al systems: type, number and
location as per plan
❑ Elevations of laterals i tailed as on approved plan
❑ 40 Mil HDPE barrier insta d
❑ Retaining wall (boulder / con rete / timber/ block)
❑ Final cover as per plan
Wastewater System Documentation _ Feb 2006
Page 3 of 6
COMMONWEALTH. OF MASSACHUSETTSm
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
DEPARTMENT OF ENVIRONMENTAL PROTECTION'
TITLE 5
OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
CERTIFICATION
Property Address: 72 Patton Lane _
—North Andover_
Owner's Name: _Brian Neill
Owner's Address: _498 Jenifer Court
_ Santa Rosa, CA 95404 _
Date of Inspection: _8/7/2008 _
Name of Inspector: Neil J. Bateson_
Company Name: _Bateson Enterprises Inc._
Mailing Address: _111 Argilla Road_
_Andover, MA 01810_
Telephone Number: _ (978) 475-4786_
CERTIFICATION STATEMENT
I certify that I have personally inspected the sewage disposal system at this address and that the information reported
below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my
training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP
approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000). The system:
_X Passes
Conditionally Passes
Needs Further Evaluation by the Local Approving Authority
Al
F 'is
Inspector's Signature: Date: 8/71/2008 _
The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or
DEP) within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000
gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the
DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving
authority.
Notes and Comments:
****This report only describes conditions at the time of inspection and under the conditions of use at that
time. This inspection does not address how the system will perform in the future under the same or different
conditions of use.
Title 5 Inspection Form 6/15/2000 page 1
Page 2 of 11
OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 72 Patton Lane _
—North Andover_
Owner•_ Neill
Date of Inspection: _8/7/2008 _
Inspection Summary: Check A, B, C, D or E / ALWAYS complete all of Section D
A. System Passes:
X I have not found any
information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304
exist. Any failure criteria not evaluated are indicated below.
Comments:
B. System Conditionally Passes:
One or more system
components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon
completion of the replacement or repair, as approved by the Board of Health, will pass. Answer yes, no or not
determined (Y,N,ND) in the for the following statements.
The septic tank is
metal and over 20 years old* or the septic tank (whether metal or not) is structurally unsound, exhibits substantial
infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced
with a complying septic tank as approved by the Board of Health.
*A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance
indicating that the tank is less than 20 years old is available.
ND explain
Observation of
sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or
due to a broken, settled or uneven distribution box. System will pass inspection if (with approval of Board of
Health):
broken pipe(s) are replaced
obstruction is removed
distribution box is leveled or replaced
ND explain:
The system
required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if
(with approval of the Board of Health):
broken pipe(s) are replaced
obstruction is removed
ND explain:
Title 5 Inspection Form 6/15/2000
Page 3 of 11
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 72 Patton Lane _
_ North Andover_
Owner: _Neill
Date of Inspection: 8/7/2008 _
C. Further Evaluation is Required by the Board of Health:
Conditions exist which require further evaluation by the Board of Health in order to determine if the system
is failing to protect public health, safety or the environment.
1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b) that the
system is not functioning in a manner which will protect public health, safety and the environment:
_ Cesspool or privy is within 50 feet of a surface water
_ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh
2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the
system is functioning in a manner that protects the public health, safety and environment:
_ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a
surface water supply or tributary to a surface water supply.
The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply.
_ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well.
The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a
private water supply well**. Method used to determine distance _
**This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform
bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and
the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other
failure criteria are triggered. A copy of the analysis must be attached to this form.
3. Other:
Title 5 Inspection Form 6/15/2000
Page 4 of I 1
OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 72 Patton Lane_
_ North Andover_
Owner: _Neill_
Date of Inspection: _8/7/2008 _
D. System Failure Criteria applicable to all systems:
You must indicate "yes" or "no" to each of the following for all inspections:
No— Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool
_No— Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or
clogged SAS or cesspool
No_ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or
cesspool
_No_ Liquid depth in cesspool is less than 6" below invert or available volume is V2 day flow.
_No_ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).
Number of times pumped
_No_ Any portion of the SAS, cesspool or privy is below high ground water elevation.
—No— Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface
water supply.
_No_ Any portion of a cesspool or privy is within a Zone 1 of a public well.
No— Any portion of a cesspool or privy is within 50 feet of a private water supply well.
No_ Any portion of a cesspool or privy is less than 100 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 coliform bacteria and volatile organic compounds
indicates that the well is free from pollution from that facility and the presence of ammonia
nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria
are triggered. A copy of the analysis must be attached to this form.]
No— (Yes/No) The system fails. I have determined that one or more of the above failure criteria exist as described
in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to
determine what will be necessary to correct the failure
E. Large Systems:
To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000
gpd.
You must indicate either "yes" or "no" to each of the following:
(The following criteria apply to large systems in addition to the criteria above)
yes no
the system is within 400 feet of a surface drinking water supply
_ the system is within 200 feet of a tributary to a surface drinking water supply
the system is located in a nitrogen sensitive area (Interum Wellhead Protection Area — IWPA) or a mapped
Zone II of a public water supply well
If you have answered "yes" to any question in Section E the system is considered a significant threat, or answered
"yes" in Section D above the large system has failed. The owner or operator of any large system considered a
significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR
15.304. The system owner should contact the appropriate regional office of the Department.
Title 5 Inspection Form 6/15/2000
Page 5 of 11
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: 72 Patton Lane _
_ North Andover _
Owner: _Neill_
Date of Inspection: _8/7/2008_
Check if the following have been done. You must indicate "yes" or "no" as to each of the following:
Yes No
Yes_ Pumping information was provided by the owner, occupant, or Board of Health
No_ Were any of the system components pumped out in the previous two weeks ?
_Yes_ Has the system received normal flows in the previous two week period ?
_No_ Have large volumes of water been introduced to the system recently or as part of this inspection ?
_Yes_ _ Were as built plans of the system obtained and examined?
Yes_ _ Was the facility or dwelling inspected for signs of sewage back up ?
_Yes_ _ Was the site inspected for signs of break out ?
Yes_ _ Were all system components, excluding the SAS, located on site ?
_Yes_ _ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the
condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of
scum ?
_Yes_ _ Was the facility owner (and occupants if different from owner) provided with information on the
proper maintenance of subsurface sewage disposal systems ?
The size and location of the Soil Absorption System (SAS) on the site has been determined based on:
Yes No
_Yes_ _ Existing information.
_Yes_ _ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of
distance is unacceptable) [310 CMR 15.302(3)(b)]
Title 5 Inspection Form 6/15/2000
Page 6 of 11
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: _557 Boxford Street_
_ North Andover–
Owner: _Kim _
Date of Inspection: _8/1/2008_
FLOW CONDITIONS
RESIDENTIAL
Number of bedrooms (design): _4 _ Number of bedrooms (actual): _4_
DESIGN flow based on 310 CMR 15.203 N/A _
Number of current residents: _0
Does residence have a garbage grinder (yes or no): Jes _
Is laundry on a separate sewage system (yes or no): _No _
Laundry system inspected (yes or no):
Seasonal use: (yes or no): No_
Water meter reading: _Yes _
Sump pump (yes or no): _No_
Last date of occupancy: _ House vacant three days _
COMMERCIAL/INDUSTRIAL
Type of establishment:
Design flow (based on 310 CMR 15.203): ___Pd
Basis of design flow (seats/persons/sgft,etc.):
Grease trap present (yes or no):
Industrial waste holding tank present (yes or no):
Non -sanitary waste discharged to the Title 5 system (yes or no):
Water meter readings, if available: —
Last date of occupancy/use:
OTHER (describe):
GENERAL INFORMATION
Pumping Records
Source of information: _Pumped 2007, owner _
Was system pumped as part of the inspection (yes or no): _Yes_
If yes, volume pumped: _1500 gallons -- How was quantity pumped determined? _Measured tank_
Reason for pumping: _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)
_ Innovative/Altemative technology. Attach a copy of the current operation and maintenance contract (to be
obtained from system owner)
Tight tank _ Attach a copy of the DEP approval
Other (describe): _
Approximate age of all components, date installed (if known) and source of information 23 years old, 7/8/1985, as
built plan_
Were sewage odors detected when arriving at the site (yes or no): _No_
Title 5 Inspection Form 6/15/2000 6
.Page 7 of 11
OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: _72 Patton Lane
_ North Andover _
Owner: _Neill
Date of Inspection: _8/7/2008
BUILDING SEWER _ X _ (locate on site plan)
Depth below grade: _20"
Materials of construction: _X _ cast iron _X 40 PVC _other
Distance from private water supply well or suction line:
Comments (on condition of joints, venting, evidence of leakage, etc.) _ 4" Cast iron thru wall, 3" PVC in house
no leaks visible
SEPTIC TANK: X
Depth below grade: _8"_
Material of construction: X concrete — metal _fiberglass _polyethylene
_other(explain)
If tank is metal list age: _ Is age confirmed by a Certificate of Compliance (yes or no): , (attach a copy of
certificate)
Dimensions: 10' x 5' x 4'
Sludge depth 4"_
Distance from top of sludge to bottom of outlet tee or baffle: 23"_
Scum thickness: _4"_
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: 17"_
How were dimensions determined: _
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels
as related to outlet invert, evidence of leakage, etc. _Pumped septic tank Inlet tee clogged, cleaned it. Outlet tee
ok Depth of liquid at outlet invert. No evidence of leakage. _
GREASE TRAP: _(locate on site plan)
Depth below grade: _
Material of construction: _concrete _metal _fiberglass polyethylene _other
(explain):
Dimensions:
Scum thickness:
Distance from top of scum to top of outlet tee or baffle:
Distance from bottom of scum to bottom of outlet tee or baffle:
Date of last pumping:
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels
as related to outlet invert, evidence of leakage, etc.):
Title 5 Inspection Form 6/15/2000 7
Page 8 of 11
OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 72 Patton Lane
_ North Andover–
Owner: _Neill
Date of Inspection: _8/7/2008 _
TIGHT or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan)
Depth below grade:
Material of construction: concrete metal fiberglass _polyethylene other(explain):
Dimensions:
Capacity: gallons
Design Flow: gallons/day
Alarm present (yes or no):
Alarm level: Alarm in working order (yes or no):
Date of last pumping:
Comments (condition of alarm and float switches, etc.):
DISTRIBUTION BOX_X_
Depth below grade —4" _
Depth of liquid level above outlet invert: _ 0"_
Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of
leakage into or out of box, etc.) _ D -box level & distribution equal, has flow levelers. No evidence of leakage.
Evidence of light carryover. _
PUMP CHAMBER: _ (locate on site plan)
Pump in working order (yes or no): _
Alarm in working order (yes or no): —
Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.):
Title 5 Inspection Form 6/15/2000
.Page 9 of 11
OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 72 Patton Lane
_ North Andover_
Owner: _Neill
Date of Inspection: _8/8/2008_
SOIL ABSORPTION SYSTEM (SAS): _X_ (locate on site plan, excavation not required)
If SAS not located explain why:
Type
— Leaching pits, number: _
Leaching chambers, number:
Leaching galleries, number:
Leaching trench, number, length: _
— Leaching field, number, dimensions:
Overflow cesspool, number:
Innovative/alternative system Type/name of technology:
Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation,
etc.):_ Soil ok. Vegetation ok. No sign of ponding to surface, _
CESSPOOLS:
Number and configuration:
Depth — top of liquid to inlet invert: —
Depth of sludge layer: —
Depth of scum layer: _
Dimensions of cesspool:
Materials of construction:
Indication of groundwater inflow (yes or no): _
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.):
PRIVY: (locate on site plan)
Materials of construction:
Dimensions:
Depth of solids:
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.):
Title 5 Inspection Form 6/15/2000
Page 10 of 11
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 72 Patton Lane
_ North Andover—
Owner: _Neill
Date of Inspection: _8/7/2008_
SKETCH OF SEWAGE DISPOSAL SYSTEM
Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or
benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building
D -
Box
Septic Tank
3 2 1
B
Driveway
Title 5 Inspection Form 6/15/2000 10
Deck
I1
Porch
Water Meter
A to 1 = 1715'
Ato2=21'1"
Ato3=24'8"
Bto1=18'
Bto2=15'3"
Bto3=12'4"
B to D -Box = 33'
C to D -Box = 43'3"
. Page 11 of 11
OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 72 Patton Lane _
_ North Andover_
Owner: _Neill
Date of Inspection: _8/7/2008 _
SITE EXAM
Slope _ No _
Surface water _ No
Check cellar _ Yes _
Shallow wells No
Estimated depth to ground water
Please indicate (check) all methods used to determine the high ground water elevation:
_X_ Obtained from system design plans on record - If checked, date of design plan reviewed: _5/25/1983_
Observed site (abutting property/observation hole within 150 feet of SAS)
Checked with local Board of Health -explain: _ _
Checked with local excavators, installers- (attach documentation)
Accessed USGS database -explain: _ _
You must describe how you established the high ground water elevation: _ As per design plan test pit info _
Title 5 Inspection Form 6/15/2000 11
•� Commonwealth of Massachusetts
City/Town of
System Pumping Record
Form 4
Important:
When filling out
forms on the
computer, use
only the tab key
to move your
cursor - do not
use the return
key.
ISI
DEP has provided this form for use by local Boards of Health. Other forms may be used, but the
information must be substantially the same as that provided here. Before using this form, cheat with your
local Board of Health to detemdne the form they use. The System Pumping Record must be submitted to
the local Board of Health or other approving authority.
A. Facility Information
1. Syste Location:
Address _ �-
2. System Owner.
Name f /
Address (if different from!;
City/Town
c�-e�-r�
State
�J'.�_� � �
Zip Code
os'q �
State
Telephone Number
B. Pumping Record 'S�7—off
1. Date of Pumping
3. Type of system: ❑
❑ Other (describe):
Date
2. Quantity Pumped: Gallons
Cesspool(s) eptic Tank ❑ Tight Tank
4. Effluent Tee Filter present? ❑ Yes 2191 ' If yes, was it cleaned? ❑ Yes ❑ No P
5. Condition of System: 1 I� _ GC `
PIZ
6. System, Pumped By:
Name y Vehicle License Number
Company
7. Location where content re disposed:
t5form4.doc• 06103 System Pumping Record • Page 1 of 1
Class- --
Size Total
FY
Town of North Andover
Tax Map # 210-106.A-0090-0000.0
Parcel Id 17235
72 PATTON LANE
NEILL, BRIAN & JENNIFER
498 JENIFER COURT
SANTA ROSA, CA
95404
101 Single Family Property Type
3.1 Acres
2008
UB Mailing Index
Name/Address
NEILL, BRIAN & JENNIFER
498 JENIFER COURT
SANTA ROSA, CA
95404
UB Account Maint.
Account No Cycle
Bldg Id. 17373.0 - 72 PATTON LANE
3170043 03 Cycle 03
UB Services Maint.
Service Code
MISCFEE ADMIN FEE
WTR WATER
UB Meter Maintenance
Type Loan Number Active/Inact. From
Payor
Occupant Name Active/inactive
Last Billing Date 7/8/2008
Active
Rate Charge Multiplier/Users
0.635/8 7.82 1/
01 ALL METER SIZE 447.84 /1
Serial No
Status
Location
13242393
a Active
ERT HH
Date
Reading
Code
6/4/2008
601
a Actual
3/7/2008
513
a Actual
12/10/2007
443
a Actual
9/4/2007
400
a Actual
6/14/2007
363
a Actual
3/13/2007
335
a Actual
12/6/2006
307
a Actual
9/8/2006
284
a Actual
6/12/2006
276
a Actual
3/6/2006
249
a Actual
12/16/2005
225
a Actual
9/14/2005
196
a Actual
6/9/2005
170
a Actual
3/18/2005
141
a Actual
12/9/2004
107
a Actual
9/15/2004
81
a Actual
6/10/2004
53
a Actual
4/12/2004
35
a Actual
12/5/2003
0
n New Meter
Brand
Type
METE METE
w Water
Consumption
Posted Date
88
7/16/2008
70
4/11/2008
43
1122/2008
37
10/12/2007
28
7/20/2007
28
4/16/2007
23
1/19/2007
8
10/20/2006
27
7/10/2006
24
4/17/2006
29
1/17/2006
26
10/14/2005
29
7/15/2005
34
4/5/2005
26
1/14/2005
28
10/8/2004
18
7/30/2004
35
5/17/2004
0
12/5/2003
size
0.63 0.63
1 Residential
Until
YTD Cons
88
Variance
24%
79%
-2%
50%
4%
12%
184%
-67%
-8%
-4%
16%
-23%
2%
12%
6%
-5%
12%
0%
0%
Tel: (978) 475-4786
Fax: (978) 475-5451
B ATE S ON ENTERPRISES, INC.
Excavating -Water& Sewer Lines -Septic Systems & Pumping Service
111 Argilla Road Andover, Mass. 01810
Title 5 Inspection Report
Property Address: 72 Patton Lane, North Andover
Owner: Neill
Date of Inspection: 8/7/2008
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.
t -
COMMONWEALTH OF MASSACHUSETTS
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
DEPARTMENT OF ENVIRONMENTAL
RECEIVED
MAY 2 2 2006
TOWN OF NORTH ANDOVER
HEALTH DEPARTMENT
TITLE 5
OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
CERTIFICATION
Property Address: 72 Patton Lane_
—North Andover_
Owner's Name: _Brain Neill_
Owner's Address: _72 Patton Lane
_ North Andover, MA 01845_
Date of Inspection: _4/11/2006
Name of Inspector: Neil J. Bateson_
Company Name: Bateson Enterprises Inc._
Mailing Address: _111 Argilla Road_
_Andover, Ma. 018145
Telephone Number: _( 978 ) 475-4786_
CERTIFICATION STATEMENT
I certify that I have personally inspected the sewage disposal system at this address and that the information reported
below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my
training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP
approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000). The system:
_X Passes
Conditionally Passes
Needs Further Evaluation by the Local Approving Authority
F'
M
Inspector's Signature: "�' Date: _4/11/2006_
The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or
DEP) within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000
gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the
DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving
authority.
Notes and Comments: After permit from B.O.H., install new d -box & outlet tee, inspection from B.O.I1L, septic
system now passes Title 5 Inspection.
****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.
N
r
COMMONWEALTH OF MASSACHUSETTS
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
DEPARTMENT OF ENVIRONMENTAL PROTECTION
TITLE 5
OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
CERTIFICATION
Property Address: 72 Patton Lane _
North Andover_
Owner's Name: _Brian Neill_
Owner's Address: 72 Patton Lane
_ North Andover, MA 01845_
Date of Inspection: _3/23/2006_
Name of Inspector: Neil J. Bateson_
Company Name: Bateson Enterprises Inc._
Mailing Address: 111 Argilla Road_
_Andover, Ma. 01810_
Telephone Number: _( 978 ) 475-4786_
APR 0 3 2006
TOWN OF NORTH ANDOVER
HEALTH DEPARTMENT
CERTIFICATION STATEMENT
I certify that I have personally inspected the sewage disposal system at this address and that the information reported
below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my
training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP
approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000). The system:
Passes
X Conditionally Passes
Needs Further Evaluation by the Local Approving Authority
&-A�-�
Inspector's Signature: 's Date: _3/23/2006_
The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or
DEP) within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000
gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the
DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving
authority.
Notes and Comments:
****This report only describes conditions at the time of inspection and under the conditions of use at that
time. This inspection does not address how the system will perform in the future under the same or different
conditions of use.
Page 2 of 11
OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 72 Patton Lane_
North Andover
Owner• —Neill—
Date
NeillDate of Inspection: 3/23/2006
Inspection Summary: Check A,B,C,D or E / ALWAYS complete all of Section D
A. System Passes:
I have not found any information which indicates that any of the failure criteria
described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below.
Comments:
B. System Conditionally Passes:
X One or more system components as described in the "Conditional Pass"
section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by
the Board of Health, will pass. Answer yes, no or not determined (Y,N,ND) in the for the following statements.
If "not determined" please explain .Outlet tee in septic tank & d -box needs replaced.
N The septic tank is metal and over 20 years old* or the septic tank
(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is
imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by
the Board of Health.
*A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance
indicating that the tank is less than 20 years old is available.
ND explain:
N Observation of sewage backup or break out or high static water
level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution
box. System will pass inspection if (with approval of Board of Health):
broken pipe(s) are replaced
obstruction is removed
distribution box is leveled or replaced
ND explain:
N The system required pumping more than 4 times a year due to
broken or obstructed pipe(s). The system will pass inspection if (with approval of the Board of Health):
broken pipe(s) are replaced
obstruction is removed
ND explain:
Page 3 of 11
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: _72 Patton Lane
—North Andover—
Owner: _Neill
Date of Inspection: 3/23/2006
C. Further Evaluation is Required by the Board of Health:
Conditions exist which require further evaluation by the Board of Health in order to determine if the system
is failing to protect public health, safety or the environment.
1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b) that the
system is not functioning in a manner which will protect public health, safety and the environment:
_ Cesspool or privy is within 50 feet of a surface water
Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh
2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the
system is functioning in a manner that protects the public health, safety and environment:
_ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a
surface water supply or tributary to a surface water supply.
The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply.
The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well.
The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a
private water supply well". Method used to determine distance _
"This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform
bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and
the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other
failure criteria are triggered. A copy of the analysis must be attached to this form.
3. Other:
Page 4 of 11
OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 72 Patton Lane _
_ North Andover_
Owner: _Neill
Date of Inspection: 3/23/2006
D. System Failure Criteria applicable to all systems:
You must indicate "yes" or "n&' to each of the following for all inspections:
_No_ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool
_No_ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or
clogged SAS or cesspool
_No_ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or
cesspool
No Liquid depth in cesspool is less than 6" below invert or available volume is '/2 day flow.
_No_ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).
Number of times pumped
_No Any portion of the SAS, cesspool or privy is below high ground water elevation.
_No_ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface
water supply.
_No_ Any portion of a cesspool or privy is within a Zone 1 of a public well.
_No_ Any portion of a cesspool or privy is within 50 feet of a private water supply well.
_No_ Any portion of a cesspool or privy is less than 100 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 coliform bacteria and volatile organic compounds
indicates that the well is free from pollution from that facility and the presence of ammonia
nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria
are triggered. A copy of the analysis must be attached to this form.]
No (Yes/No) The system fails. I have determined that one or more of the alcove 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.
You must indicate either "yes" or `iso" to each of the following:
(The following criteria apply to large systems in addition to the criteria above)
yes no
the system is within 400 feet of a surface drinking water supply
_ the system is within 200 feet of a tributary to a surface drinking water supply
the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area — IWPA) or a mapped
Zone II of a public water supply well
If you have answered "yes" to any question in Section E the system is considered a significant threat, or answered
"yes" in Section D above the large system has failed. The owner or operator of any large system considered a
significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR
15.304. The system owner should contact the appropriate regional office of the Department.
Page 5 of 11
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: 72 Patton Lane _
_ North Andover _
Owner: _Neill
Date of Inspection: 3/23/2006_
Check if the following have been done. You must indicate "yes" or "no" as to each of the following:
Yes No
Yes _ Pumping information was provided by the owner, occupant, or Board of Health
_ _No Were any of the system components pumped out in the previous two weeks ?
Yes _ Has the system received normal flows in the previous two week period ?
No Have large volumes of water been introduced to the system recently or as part of this inspection ?
Yes _ Were as built plans of the system obtained and examined?
Yes _ Was the facility or dwelling inspected for signs of sewage back up ?
Yes_ _ Was the site inspected for signs of break out ?
Yes _ Were all system components, excluding the SAS, located on site ?
_Yes_ _ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the
condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of
scum ?
_Yes_ _ Was the facility owner (and occupants if different from owner) provided with information on the
proper maintenance of subsurface sewage disposal systems ?
The size and location of the Soil Absorption System (SAS) on the site has been determined based on:
Yes no
_Yes_ , Existing information.
_Yes_ _ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of
distance is unacceptable) [3 10 CMR 15.302(3)(b)]
Page 6 of 11
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 72 Patton Lane_
_ North Andover_
Owner: _Neill
Date of Inspection: 3/23/2006_
FLOW CONDITIONS
RESIDENTIAL
Number of bedrooms (design): _4_ Number of bedrooms (actual): _4_
DESIGN flow based on 310 CMR 15.203 _N/A
Number of current residents: _4
Does residence have a garbage grinder (yes or no): Yes
Is laundry on a separate sewage system (yes or no): _No_
Laundry system inspected (yes or no): _
Seasonal use: (yes or no): _No
Water meter reading: _Yes_
Sump pump (yes or no): Yes_
Last date of occupancy: -
Current-COMMERCIAL/INDUSTRIAL
Type of establishment:
Design flow (based on 310 CMR 15.203): _gpd
Basis of design flow (seats/persons/sgft,etc.): _
Grease trap present (yes or no): _
Industrial waste holding tank present (yes or no):
Non -sanitary waste discharged to the Title 5 system (yes or no): _
Water meter readings, if available:
Last date of occupancy/use:
OTHER (describe):
GENERAL INFORMATION
Pumping Records
Source of information: Pumped 2004, owner_
Was system pumped as part of the inspection (yes or no): _No_
If yes, volume pumped: gallons -- How was quantity pumped determined? _
Reason for pumping:
TYPE OF SYSTEM
X Septic tank, distribution box, soil absorption system
_ Single cesspool _ Overflow cesspool
_ Privy
_ Shared system (yes or no) (if yes, attach previous inspection records, if any)
_ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract (to be
obtained from system owner)
Tight tank _ Attach a copy of the DEP approval
_ Other (describe): _
Approximate age of all components, date installed (if known) and source of information: 21 years old, 7/8/1985,
as built plan _
Were sewage odors detected when arriving at the site (yes or no): _No
Page 7 of 11
OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 72 Patton Lane_
_ North Andover _
Owner: Neill
Date of I_nspection: 3/23/2006_
BUILDING SEWER — X _ (locate on site plan)
Depth below grade: _20"
Materials of construction: _X_ cast iron _X_40 PVC _other
Distance from private water supply well or suction line:
Comments (on condition of joints, venting, evidence of leakage, etc.) 4" Cast iron thru wall. 3" PVC in house,
no leaks visible
SEPTIC TANKS: X
Depth below grade: _8" _
Material of construction: X concrete — metal _fiberglass _polyethylene
_other(explain)
If tank is metal list age: _ Is age confirmed by a Certificate of Compliance (yes or no): _ (attach a copy of
certificate)
Dimensions: 10' x 5' x 4' _
Sludge depth: 3"_
Distance from top of sludge to bottom of outlet tee or baffle: _N/A _
Scum thickness: _3"
Distance from top of scum to top of outlet tee or baffle:—N/A N/A cutlet tee wrong size
Distance from bottom of scum to bottom of outlet tee or baffle: N/A
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 tee ok. 3" PVC outlet tee with pipe jammed down 4"
PVC pipe. Outlet tee needs replaced with proper pipe. Liquid level at outlet invert. No evidence of tank
leaking.
GREASE TRAP: _(locate on site plan)
Depth below grade: _
Material of construction: _concrete _metal _fiberglass __polyethylene _other
(explain):
Dimensions:
Scum thickness:
Distance from top of scum to top of outlet tee or baffle:
Distance from bottom of scum to bottom of outlet tee or baffle:
Date of last pumping:
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels
as related to outlet invert, evidence of leakage, etc.):
Page 8 of 11
OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 72 Patton Lane_
_ North Andover_
Owner• _Neill
Date of Inspection: 3/23/2006_
TIGHT or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan)
Depth below grade:
Material of construction: concrete metal fiberglass _polyethylene other(explain):
Dimensions:
Capacity: gallons
Design Flow: gallons/day
Alarm present (yes or no):
Alarm level: Alarm in working order (yes or no):
Date of last pumping:
Comments (condition of alarm and float switches, etc.):
DISTRIBUTION BOX: _X_
Depth below grade _4"_
Depth of liquid level above outlet invert: 0"
Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of
leakage into or out of box, etc.):_D-box level & distribution not equal. Evidence of carryover. Evidence of
leakage, bad corrosion holes in d -box. D -Box needs replaced. Cover broken replaced it. _
PUMP CHAMBER: _ (locate on site plan)
Pump in working order (yes or no): _
Alarm in working order (yes or no): _
Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.):
Page 9 of 11
OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 72 Patton Lane_
_ North Andover
Owner: _Neill
Date of Inspection: 3/23/2006
SOIL ABSORPTION SYSTEM (SAS): _X (locate on site plan, excavation not required)
If SAS not located explain why:
Type
leaching pits, number: _
leaching chambers, number: _
leaching galleries, number:
_ leaching trenches, number, length:
_X leaching field, number, dimensions: _ 1 field 20' x 45'_
overflow cesspool, number:
innovative/alternative system Typetname of technology:
Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation,
etc.): _ Soil ok. Vegetation ok. No sign of ponding to surface. _
CESSPOOLS:
Number and configuration: _ _
Depth — top of liquid to inlet invert:
Depth of sludge layer:
Depth of scum layer: _
Dimensions of cesspool: _
Materials of construction:
Indication of groundwater inflow (yes or no): —
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): _
PRIVY: (locate on site plan)
Materials of construction:
Dimensions:
Depth of solids:
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.):
,Page 10 of 11
OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 72 Patton Lane_
North Andover_
Owner• _Neill
Date of Inspection: 3/23/2006
SKETCH OF SEWAGE DISPOSAL SYSTEM
Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or
benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building.
Ato1=17'5
Ato2=21'1"
Ato3=24'8"
Bto1=18'
Bto2=15'3"
Bto3=12'4"
B to D -Boz = 33'
C to D -Boz = 43'3"
Page 11 of 11
OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 72 Patton Lane _
_ North Andover—
Owner: _Neill
Date of Inspection: 3/23/2006
SITE EXAM
Slope
Surface water
Check cellar
Shallow wells
Estimated depth to groundwater _ 4' —
Please indicate (check) all methods used to determine the high ground water elevation:
X Obtained from system design plans on record - If checked, date of design plan reviewed: _5/25/1983_
Observed site (abutting property/observation hole within 150 feet of SAS)
Checked with local Board of Health -explain: _
Checked with local excavators, installers- (attach documentation)
Accessed USGS database -explain: _
You must describe how you established the high ground water elevation: As per design plan, test pit data _
Summary Record Card generated on 3123/2006 1:56:57 PM by Elaine Barclay Page 1
Town of North Andover
Tax Map # 210-106.A-0090-0000.0
" 72 PATTON LANE
NEILL, BRIAN & JENNIFER
72 PATTON LANE
NORTH ANDOVER, MA
01845
Class 101 Single Family Property Type 1 Residential
Size Total 3.1 Acres
FY 2006
UB Mailing Index
Name/Address Type Loan Number
NEILL, BRIAN & JENNIFER Payor
72 PATTON LANE
NORTH ANDOVER, MA
01845
UB Account Maint.
Active/Inact. From
Account No
Cycle
Occupant Name
Active/Inactive
Bldg Id. 17373.0 - 72 PATTON LANE
Last Billing Date 1/10/2006
3170043
03 Cycle 03
Active
UB Services Maint.
Service Code
Rate
Charge
Multiplier/Users
MISCFEE ADMIN FEE
0.635/8
7.82
1 /
WTR WATER
01 ALL METER
SIZE 114.66
/1
UB Meter Maintenance
Serial No Status
Location
Brand
Type Size
13242393 a Active
ERT HH
METE METE
w Water 0.63 0.63
Date
Reading
Code
Consumption
Posted Date
3/6/2006
249
a Actual
24
12/16/2005
225
a Actual
29
1/17/2006
9/14/2005
196
a Actual
26
10/14/2005
6/9/2005
170
a Actual
29
7/15/2005
3/18/2005
141
a Actual
34
4/5/2005
12/9/2004
107
a Actual
26
1/14/2005
9/15/2004
81
a Actual
28
10/8/2004
6/10/2004
53
a Actual
18
7/30/2004
4/12/2004
35
a Actual
35
5/17/2004
12/5/2003
0
n New Meter
0
12/5/2003
Until
YTD Cons
0
Variance
-4%
16%
-23%
2%
12%
6%
-5%
12%
0%
0%
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: 72 Patton Lane, North Andover
Owner: Neill
Date of Inspection: 3/23/2006
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.
Town of North Andover
Office of the Health Department
Community Development and Services Division
27 Charles Street
North Andover, Massachusetts 01845
Sandra Starr
Health Director
August 8, 2002
Bryan and Jennifer Neill
72 Patton Lane
North Andover, MA 01845
Re: Application for a sunroom addition to an existing home
Dear Mr. and Mrs. Neill:
Telephone (978) 688-9540
Fax(978)688-9542
Your application for a sunroom addition at 72 Patton Lane has been reviewed by the Health Department.
The application was denied on August 8, 2002 for the following reasons:
1. X Missing information,
2 9 Pass;,. Title 5 inspeetio of septie system may be ,..,.,.i fed.
To address the problem(s):
If #1 is checked, please supply:
a. Poor- plan of the eAsting dweUft and the proposed addifien,--
b. Certified plot plan showing the house, location of the septic system and the location
of the proposed sunroom addition.
If #2 is checked:
a. Have the septic system inspected by a certified Title 5 inspector to determine the size of the
system and whether it is operating properly: OR
b. Tie-in to municipal sewer.
If #3 is checked:
a. Relocate the project. The deck appears to traverse the septic line between the existing
dwelling and septic tank Covering an existing septic line with any type of structure is
not acceptable.
Please feel free to call the Health Office at 978-688-9540 with any questions you may have.
Sin ly,
A,
Br' J. LaGrasse, 2Health Inspector
Cc: Betterliving Patio Rooms, Attn: Andrew Malone 100 Otis Street, Northboro, MA 01532
Building Department
File
BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9534 NURSE 688-9543 PLANNING 688-9535
COMMONWEALTH OF MASSACHUSETTS
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS......
- , � H A��lDte,� . ,,
DEPARTMENT OF ENVIRONMENTA"JF:rcr�n�va-
t � 2 8 2002
f
TITLE 5
OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
CERTIFICATION
Property Address: 72 Patton Lane
North Andover, MA
Owner's Name: Stephen O'Neil
Owner's Address: S /A
Date of Inspection: 2/ 2 8/ 0 2
Name of Inspector: (please print) James Wright
Company Name:R. J . Inspections, Inc.,
Mailing Address:pne Osgood Street
Methuen, MA 01844
Telephone Number: 978-681 —8759
CERTIFICATION STATEMENT
I certify that I have personally inspected the sewage disposal system at this address and that the information reported
below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my
training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP
approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000). The system:
Passes
_ Conditionally Passes
_ Needs Further Evaluation by the Local Approving Authority
Fails
Inspector's Signature: Date:
The system inspector s�submit a copy of this inspection report to the Approving Authority (Board of Health or
DEP) within 30 days otficompleting this inspection. If the system is a shared system or has a design flow of 10,000
gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the
DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving
authority.
Notes and Comments
****This report only describes conditions at the time of inspection and under the conditions of use at that
time. This inspection does not address how the system will perform in the future under the same or different
conditions of use.
Title 5 Inspection Form 6/15/2000. page 1
Page 2 of I I
OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE�DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 72 Patton Lane
North Andover, MA
Owner: Btephen O'Neil
Date of Inspection: 2 _ 2 R _ 2
Inspection Summary: Check A,B,C,D or E / ALWAYS complete all of Section D
A. System Passes:
t, 1 have not found any information which indicates that any of the failure criteria described in 310 CMR
15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below.
Comments:
B. System Conditionally Passes:
One or more system components as described in the "Conditional Pass" section need to be replaced or
repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health,. will pass.
Answer yes, no or not determined (Y,N,ND) in the for the following statements. If "not determined" please
explain.
The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally
unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the
existing tank is replaced with a complying septic tank as approved by the Board of Health.
*A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance
indicating that the tank is less than 20 years old is available.
ND explain:
Observation of sewage backup or break out or high static water level in the distribution box due to broken or
obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if (with
approval of Board of Health):
broken pipe(s) are replaced
obstruction is removed
distribution box is leveled or replaced
ND explain:
The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will
pass inspection if (with approval of the Board of Health):
broken pipe(s) are replaced
obstruction is removed
ND explain:
Page 3 of 11
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 72 Patton Lane
North _Andover, MA
Owner: ate- n O' N i l
Date of Inspection: 2 _ 2 Ei _ 0 2
C. Further Evaluation is Required by the Board of Health:
Conditions exist which require further evaluation by the Board of Health in order to determine if the system
is failing to protect public health, safety or the environment.
1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b) that the
system is not functioning in a manner which will protect public health, safety and the environment:
_ Cesspool or privy is within 50 feet of a surface water
— Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh
2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the
system is functioning in a manner that protects the public health, safety and environment:
_ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a
surface water supply or tributary to a surface water supply.
_ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply.
The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well.
— The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a
private water supply well". Method used .to determine distance
"This system passes if the well water analysis, performed at a DEP certified laboratory,, for coliform
bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and
the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other
failure criteria are triggered. A copy of the analysis must be attached to this form.
3. Other:
3
Page 4 of 11
OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 72 Patton Lane
North Andover, MA
Owner: Si-pnhpn W Nei 1
Date of Inspection: 2_ 2 8_() 2
D. System Failure Criteria applicable to all systems:
You must indicate "yes" or "no" to each of the following for all inspections:
Yes No
/f _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 % day flow
Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number
of times pumped
4PAny portion of the SAS, cesspool or privy is below high ground water elevation.
WO Any -portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface
water supply.
410�Any portion of a cesspool or privy is within a Zone 1 of a public well.
/-V 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 coliform bacteria and volatile organic compounds
indicates that the well is free from pollution from that facility and the presence of ammonia
nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria
are triggered. A copy of the analysis must be attached to this form.]
, W(Yes/No) The system fails. I have determined that one or more of the above failure criteria exist as
described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of
Health to determine what will be necessary to correct the failure.
E. Large Systems:
To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000
gpd•
You must indicate either "yes" or "no" to each of the following:
(The following criteria apply to large systems in addition to the criteria above)
yes no
_ the system is within 400 feet of a surface drinking water supply
_ the system is within 200 feet of a tributary to a surface drinking water supply
the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area — I WPA) or a mapped
Zone II of a public water supply well
If you have answered "yes" to any question in Section E the system is considered a significant threat, or.answe red
"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.
4
Page 5 of 11
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: 72 Patton Lane
North Andover, MA
Owner:Stephen O'Neil
Date of Inspection: 2 _ 2 8 _ 0 2
Check if the following have been done. You must indicate "yes" or "no" as to each of the following:
Yes o
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 baffles or tees, material of construction, dimensions, depth of liquid, depth tof sludge and depth of scum clition
Was the facility owner (and occupants if different from owner) provided with information on thero er
maintenance of subsurface sewage disposal systems ? p p
The size and location of the Soil Absorption System (SAS) on the site has been determined based on:
Yes —
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) [3 10 CMR 15.302(3)(b)]
Page 6 of I 1
OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 72 Patton Lane
North Andover. MA
Owner: Stephen O'Neil
Date of Inspection: _9 _ ) R-0 2
RESIDENTIAL FLOW CONDITIONS
Number of bedrooms (design). L Number of bedrooms (actual):
DESIGN flow based on 310 C 15.203 (for example: 110 gpd x # of bedrooms):
Number of current residents: jjam�,�,,,�
Does residence have a garbage rinde (�es
no): -�01
Is laundry on a separate sewage system or no):"[if yes separate inspection required]
Laundry system inspected (yes or no): -
Seasonal use: (yes or no): /V4
Water meter readings, if ava §le (last 2 years usage (gpd)):
Sump pump (yes or no):�
Last date of occupancy:.
COMMERCIAL/INDUSTRIAL
Type of establishment:
Design flow (based on 310 CMR 15 203): bpd
Basis of design flow (se e 6 /s ,etc.):
Grease trap present so 0
Industrial waste holding to pre nt es or no):
Non -sanitary waste disch ged , e Title 5 system (yes or no):
Water meter readings, i available:
Last date of occupancy/use:
OTHER (describe):
Pumping Records GENERAL INFORMATION
Source of information: () Z4, -_Z�
Was system pumped as part of the inspection (yes or no):% 3'
If yes, volume pumped:40K-in -- How was quantity umped determined?
Reason for pumping: _���, s�`� �p�}
TYPF�OF SYSTEM
_/Septic tank, distribution box, soil absorption system
_ Single cesspool
_ Overflow cesspool
— Privy
Shared system (yes or no) (if yes, attach previous inspection records, if any)
_ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract (to be
obtained from system owner)
Tight tank — Attach a copy of the DEP approval
Other (describe):
Approx`m ptuge of all COTjyments, date installed (if known) and source of information:
Were sewage odors detected when arriving at the site (yes or no):"
Page 7 of I I
OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 72 Patton Tan
North Andover,— MA
Owner: Stephen n' NP; 1
Date of Inspection: 2 _
BUILDING SEWER (locate on site plan)
Depth below grade: -- '
Materials of construction: _cast iron _40 PVC _other (explain):
Distance from private water supply well or suction line:
Comments (on condition of joints, venting, evidence of leakage, etc.):
SEPTIC TANK: _ (locate on site plan)
Depth below grade: If
Material of construction: _/concrete _metal _fiberglass _polyethylene
—other(explain)
If tank is metal list age: — Is age confirmed by a Certificate of Compliance (yes or no): _ (attach a copy of
certificate)
Dimensions:_
Sludge depth:,
Distance from top of sludge to bottom of outlet tee or baffler
Scum thickness: g"
Distance from top of scum to top of outlet tee or baffle: �2 >l
Distance from bottom of scum to bottom of outlet tee or baffle: a
How were dimensions determined: /'O/�
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels
as related t9, outlet invert, eviayence of leakaSe, etc.).-
GREASE
tch
GREASE TRAP: _(locate on site plan)
Depth below grade: _
Material of construction: _concrete _metal _fiberglass _polyethylene _other
(explain):
Dimensions:
Scum thickness:
Distance from top of scum t top o 7ol tee or baffle:
Distance from bottom of scum to 0 om of outlet tee or baffle:
Date of last pumping:
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels
as related to outlet invert, evidence of leakage, etc.):
Page 8 d I I
f
I
OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Propert Address: 72 Patton Lane
North And Yer r MA
Owner: �{ PphPn n' NPi 1
Date of Inspection:?
—28-02
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):
liimensions:
Capacity:
Design Flow:
Alarm present (yes or no)
Alarm level: Al in i
Date of last pumping:
Comments (condition of alarm and
(yes or no):
switches, etc.):
DISTRIBUTION BOX: (if present must be opened)(locate on site plan)
Depth of liquid level above outlet invert:
Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of
leakage into or out of box, etc.): _
PUMP CHAMBER: (locate on site plan)
Pumps in working order (yes or no):
Alarms in working order (yes or n94:]
Comments (note condition of pum c
of pumps and appurtenances, etc.):
Page 9 of 11
OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 72 Patton Lane
North Andover, MA
Owner: Steph n O'Neil
Date of Inspection: a 2 8 _ 9 2
SOIL ABSORPTION SYSTEM (SAS): (locate on site plan, excavation not required)
If SAS not located explain why:
Type
leaching pits, number: _
leaching chambers, number:
leaching galleries, number:
__'7,14eikhing 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.):
1-1t d—�1-5, 0"z- e-- = -
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 or no):
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.):
PRIVY: (locate on site plan)
Materials of construction:
Dimensions:
Depth of solids:
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.):
" ' page 10 of 11
OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 72 Patton Lane
Nnrf-h Anr1-nUe- MA
Owner: Ft-- , ,,., n , r, � ,
Date of Inspection:. 2 8 A_
SKETCH OF SEWAGE DISPOSAL SYSTEM
Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or
benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building.
E
Page I 1 of 11
OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 72 Patton Lane
North Artr3nvPr- MA
Owner: St ep en Cl � Ned 1
Date of Inspection: ? _ 2 a _ p 2
SITE EXAM
Slope
Surface water
Check cellar
Shallow wells
Estimated depth to ground waterfeet
Please indicate (check) all methods used to determine the high ground water elevation:
q>tained from system design plans on record - If checked, date of design plan reviewed:
Observed site (abutting property/observation hole within 150 feet of SAS)
—ecked with local Board of Health -explain:
V Checked with local excavators, installers- (attach documentation) _
=,--"A'ccessed USGS database -explain: y/p��J �y , &//-74j
You must describe howou established thp high ground water elevation:
11
TO: NORTH ANDOVER, MASS 9
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
L0 11 ,P/I a /V North Andover, Mass.
SITE LOCATION
The grades and construction are as specified in A*y plans and specifications dated
CoAf
tv P- Vg 4'ssae'c--tes
9. nitorlan
S i IAs
rd of Health
lliu .,ndover,Mass
DISPOSAL DM(W CHECK LIST
LOT f_5
APPROVED DATE- DISAPPROVED DATE
Provided: Reasons:
1N5��i l-vJ T 1DtJ !�'t �C�tt S' i3� C
V Sim 2E'S�Zv�'-dZo4 , sHd� 3F '
Title V FAIL. I OK
Reg 2.5
Reg 6
Reg 10.2
Reg
The submitted plan must show as a minimum:
a) the lot to be served -area, dimensions lot #,abutters
b location and log deep observation holes -distance to ties
c location and results percolation tests -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 vet areas Athan 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 vithin 3.001 of serge disposal
-sy$tes� ar' disclaimer=Planning ' Aoard f1les
j) known sources of water supply within 2001 of sewage disposal e
system or disclaimer
;k) location of any proposed well to serve lot -1001 from leaching facilit,
;1) location. of. water lines. on property -10" 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,
distr#:bution,box inlets and outlets,. distribution field piping and
other elevations ..
,r) ma d=m ground'wat'er' "elevation 'in area sewage disposal system
;s) plan must be prepared by. a Professional Engineer or other
professional authorized by law to prepare such plans
. Septic Tanks
a) capac t es- 50�; of.flow,',water table, tees, depth of tees,
access, pumping
b) cleanout
c) 101 from cellar wall or inground summing pool
d) 251 from subsurface drains
Distribution Boxes
a) slope greater than 0.08
b). sump .
I,ubsuri
a
Desi
Check List Pae 2
FAIL
OK
Leaching pits are preferred where the installation is possible
leg 11.2
a)
calculations of leaching area -minimum 500 sq ft
11.4
I'd)
b)
spacing
11-10
c)
surface drainage 2%
11.11
cover material
e)
IIx2+a4" splash pad
f)
to_O_ at _elbow
g)
no bends in pipe from d -box to pipe
L eaching Fields
leg 15.1
a
no greater than 20 minutes/inch
b
area -minimum 900 s4 ft
15.4
c
construction of field
15.8
d)
surface drainage 2 %
3.7
e)
20t from cellar wall or ingrouand swimming pool
14.1
14.3
14.4
14.6
14.10
Reg 9.1
9.6
a) WOMEN ons of Teaching area -min 500 eq ft
b) spacing -4 ft min 6 ft with reserve between
c) dimensions
d) construction
e) stone
f) surface drainage 2%
Downhill Slope
a) s ope y xto be shown)
b) y/x x 150 - (to be shown)
EMS
a) approval
b) stand-by power