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Miscellaneous - 80 PATTON LANE 4/30/2018 (2)
�i i' oO l � Z 0' C BENCHMARK BOTTOM OF SIDING ----Z:: ELEV. 100.00' / 1500 GAL. SEPTIC TANK1 D -BOX �\ X 96, 4 FIELD TP -2 �✓ h P-1 / SCHEDULE OF PIPE INVERTS T 1� LOCATION SEPTIC SYSTEM CLIENT: Mark Palmer 80 Patton Lane N. Andover, MA 01845 INVERT HOUSE OUTLET D Br JMK y.JMK 98.14' SEPTIC TANK INLET 80 PATTON LANE 97.84' SEPTIC TANK OUTLET BIT. 97.54' DISTR. BOX INLET DRIVE 97.21' DISTR. BOX OUTLET ",So 136,646 S.F. 97.04' DISTR. FIELD 96.90' BOTTOM OF FIELD O 96.32' BENCHMARK BOTTOM OF SIDING ----Z:: ELEV. 100.00' / 1500 GAL. SEPTIC TANK1 D -BOX �\ X 96, 4 FIELD TP -2 �✓ h P-1 / • 3 T 1� U W wJ SEPTIC SYSTEM CLIENT: Mark Palmer 80 Patton Lane N. Andover, MA 01845 ' 6,q5 I 4 .45 0 96 80 PATTON 0 / Map No, 106A 9 .1 / Parcel No 0167 2 98.23 3 / g7 SEPTIC SYSTEM CLIENT: Mark Palmer 80 Patton Lane N. Andover, MA 01845 / 1 5/30/06 AS -BUILT D Br JMK y.JMK Rev. Date Description W-11 Chkd. By. DMC Chkd. 80 PATTON LANE By M / BIT. 7. 9 DRIVE / 96. C O ",So 136,646 S.F. -6 11 O C�' O obi CP 91.0 �h w 3Q C 0) M X96.6 B ff W-7 i f 91/68 a' x 93.7 96.1 LOC. PNT. A PNT. B / 9 42 , / f 95. 6 -P,94.55 4 7 °' 5 4 1 17.4' 21.6' HYD. f W 13 6 2 20.7; 23.8; W-8 X 9 .78 8 O • �' i /o c� / f W x 89.91 � f BIT. W 9 i DRIV 94,80 ,f 94.41 f 90.08 93. 5 � f -10f W 2 x 95.48 3 I SEPTIC SYSTEM CLIENT: Mark Palmer 80 Patton Lane N. Andover, MA 01845 se Deane 1 5/30/06 AS -BUILT D Br JMK y.JMK Rev. Date Description W-11 Chkd. By. DMC Chkd. 80 PATTON LANE By M X 9 .17 I/LOT 6C x 93. 0 PA'fTON 94.33 ",So 136,646 S.F. 11 9 .13 -12 94.32 BIT. B A DRIVE a' x 93.7 2 3 LOC. PNT. A PNT. B 9 42 , -P,94.55 4 7 °' 5 4 1 17.4' 21.6' HYD. W 13 6 2 20.7; 23.8; 95.453 24.2 6.5 I 18.71 4 33.6' 29.1' t Q�'f�h a 94.58 I 5 38.5 28.4' 6 34.2' 32.2' JANES M. I I 85.5 77.8' S KA CIV LUGH N0I RECTIED. 79.3' ' . 33766 c I I PATTON 94.34 J LANE ; UN I I 2 2 2006 7 $ TOWN OF NORTH AND 1i Pp a 0 E No. 40426 JAMS KAVANAUGH, RE 14 Shady Hill Drive N. Reading, MA 01864 Tel.(978)664-2925 Custom Homes - Remodeling - Septic System Designs Excavation/Installation Services SEPTIC SYSTEM CLIENT: Mark Palmer 80 Patton Lane N. Andover, MA 01845 se Deane 1 5/30/06 AS -BUILT D Br JMK y.JMK Rev. Date Description Dm. By. JMK Chkd. By. DMC Chkd. 80 PATTON LANE By M Date 5/30/06 5t910 YK 'aanopud W 9u7I u044'9d OS aatui8d 3I-119YQ :,LNa IO Widla-S_ iN]V JVdCl HHi�V]H �13AOONt! H1�iUN �0 NMOl SBDIAJBS U0ljDhhD;SUI/U014DAD0X3 sublsaa Wa}slS 311daS — 6ullapoway — sawOH wo}sn0 SZ6Z-b99(8L6)'lal b99L0 b'W '6ulpnay •N 9AP0 IM AP04S tL Q mfr I'd `HJf 1VNdll�i ' N 11 1 90OZ 90/Di/9 ijca SHVZ NO,LlVd 08 t -•I 2 of rl ; o XIN('.xe -eddy '� aW� uoladlJDsaa 9100 •Aaa XWrA :49 „s,a AM s a nne—Sd 90/0£/S l HOZ=•, t loos 1 anO 3Sf10H 9ZtOt 3AI303N 9t" b 0 ,Z2'96 01314 d0 W01108 90OZ 9 9 Nnr ,tO'L6 8 JZ -L6 131N1 X08 '2i1S10 ,tS'L6 13ano ANb'1 OI1d3S ,t8 -L6 13IN1 ANb'1 3I1d3S ,t L'86 1 anO 3Sf10H i83AN1 3AI303N Sid3AN1 3dld d0 31n(J3HOS h i I I 3NVI NOli` d �'6L 8'b8 8 i I 99�8�E�ON r ,8'LL ,5'58 L 9 i I H�nIlnndx'� ,t�'8Z ,S'8� 5 i 8s't6 •�R 'w s3nVr � h I t IL' 8 s•;,���0 9'9Z Z•-vZ 2 i O.IH ,8'2Z,L'OZ Z 9 ; 2L M n ,9' LZ ,t'L L L S o 8 '1Nd IV 'i Nd -0m w zb 6 Z L'66 x L � 3A I 0 d 8 I I '118 I Z8'b6 `O O � /L 'd'S 919'92 L 81 6 '86 88'b6 � Noiidd p9 / 0 x 09 101 / L1' 6 x m8b'S6 x {OL 1 6'6 S E6 i 80'06 .9 Ib'b6 r2lm L 1 r 08',6 n 118 L -d i �i 16'68 x / c`O 10 '4 w� stn n� Z -dl ami / 8L' 6 x 8-M r '96 i / 1'96 0�31d 89/T6 b '96 x L—M 9'96 x1 J i ' N W •A Ih tQ 1 f+l 01'16 CP O 9- . O ti 96 X08-0 /3^118 'L " NNb'1 011d3S / 6 lvo 009L / n / L6 ONIOIS o00W01108 / E2'86 L910 'oN IaoJod M WHON38 / 1' 6 V90L 'oN dDw / 96 0 N011b'd 08 9t" b 0 ,Z2'96 01314 d0 W01108 ,06'96 0131d '81S10 ,tO'L6 13iino X08 '81SI0 JZ -L6 131N1 X08 '2i1S10 ,tS'L6 13ano ANb'1 OI1d3S ,t8 -L6 13IN1 ANb'1 3I1d3S ,t L'86 1 anO 3Sf10H i83AN1 NOLV001 Sid3AN1 3dld d0 31n(J3HOS BENCHMARK BOTTOM OF SIDING ELEV. 100.00' 0 1500 GAL. SEPTIC TANK_ -- D -BOX x96.4 FIELD TP -2 h� �o P 4 80 PATTON q6 Map No. 106A Parcel No. 0167 97 ro v 0 0 o)0 096. 13' 98.23 BIT, DRIVE 96.1 95,7 X 9.78 45 9 .1 / / )T 7. 9 / -6 95 91.ho � 1 , rn ' 1 r W-7 i , 91/68 r , W-8 �O , ,W x 89.91 , BIT DRIV. W 9 94,80 , 1 94.41 � 90,08 s' U V93. 5 1 i 99 cc W-10 w x 95,48 Q 3 W-11 X 9 .17 � LOT 6C x 93, 0 , so PATTON 94.33 9 13 136,646 S.F. moo. -12 LO 94.32 1 rn 1 BIT. 1 B A DRIVE 1 � 1 42 x �3,7cu _ 3 LOC. PNT, A PNT. B 94,55 4 7 °' 5 4 1 17.4' 21.6' W 13 / 6 2 20.7' 23.8' HYD. / 3 24.2' 26.5' 8 .71 4 33.6; 29.1' JANI ' a;s M. "�-� 94,58 I 5 38.5 .28.4 K 0 CIV HUGH I 1 �' 1 6 34.2' 32.2' '4 387 1 °� I 1 7 85.5' 77.8' fN,v 84.8' 79.3' aCEIVED 6 PATTON 94.34 i a LANE I 1 UN 2 2 2006 1 I 8 T��nrni i i n F 7 l i o N SCHEDULE OF PIPE INVERTS LOCATION SEPTIC SYSTEM CLIENT: Mark Palmer 80 Patton Lane N. Andover, MA 01845 INVERT HOUSE OUTLET Desn. By. JM 98.14' SEPTIC TANK INLET 80 PATTON LANE 97.84' SEPTIC TANK OUTLET 97.54' DISTR. BOX INLET 97.21' DISTR. BOX OUTLET 97.04' DISTR. FIELD 96.90' BOTTOM OF FIELD 96.32' BENCHMARK BOTTOM OF SIDING ELEV. 100.00' 0 1500 GAL. SEPTIC TANK_ -- D -BOX x96.4 FIELD TP -2 h� �o P 4 80 PATTON q6 Map No. 106A Parcel No. 0167 97 ro v 0 0 o)0 096. 13' 98.23 BIT, DRIVE 96.1 95,7 X 9.78 45 9 .1 / / )T 7. 9 / -6 95 91.ho � 1 , rn ' 1 r W-7 i , 91/68 r , W-8 �O , ,W x 89.91 , BIT DRIV. W 9 94,80 , 1 94.41 � 90,08 s' U V93. 5 1 i 99 cc W-10 w x 95,48 Q 3 W-11 X 9 .17 � LOT 6C x 93, 0 , so PATTON 94.33 9 13 136,646 S.F. moo. -12 LO 94.32 1 rn 1 BIT. 1 B A DRIVE 1 � 1 42 x �3,7cu _ 3 LOC. PNT, A PNT. B 94,55 4 7 °' 5 4 1 17.4' 21.6' W 13 / 6 2 20.7' 23.8' HYD. / 3 24.2' 26.5' 8 .71 4 33.6; 29.1' JANI ' a;s M. "�-� 94,58 I 5 38.5 .28.4 K 0 CIV HUGH I 1 �' 1 6 34.2' 32.2' '4 387 1 °� I 1 7 85.5' 77.8' fN,v 84.8' 79.3' aCEIVED 6 PATTON 94.34 i a LANE I 1 UN 2 2 2006 1 I 8 T��nrni i i n F 7 l i o N Pro} No. 40426 JAM M . KAVANAUGH, P.E. 14 Shady Hill Drive N. Reading, MA 01864 Tel.(978)664-2925 Custom Homes - Remodeling - Septic System Designs Excavation/Instal lotion Services SEPTIC SYSTEM CLIENT: Mark Palmer 80 Patton Lane N. Andover, MA 01845 Scale 1"=20' 1 5/30/06 AS -BUILT Desn. By. JM Rev. Date Description Drn. Br• JMK cnkd. Br•DMC 80 PATTON LANE Appd. BYJMK Dote 5/30/06 Owner information is required for every page. Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 80 Patten Lane Property Address Mark Palmer Owner's Name North Andover City/Town MA 01845 State Zip Code 08/22/2013 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. A. General Information 1. Inspector: Warren R. Pearce Jr. Name of Inspector Pearce Construction Company Name 196 Park Street JAN 27 M4 TOWP4 OF NCRTH ANDOVER HEAL.i;7 DEPARTnnl=nnr Company Address North Reading MA 01864 City/Town State Zip Code 978-664-5264 S11959 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000). The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority Inspector's Signature 9���—�� Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP) within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ""This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins • 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 1 of 17 Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 80 Patten Lane Property Address Mark Palmer Owner's Name North Andover Cityfrown B. Certification (cont.) MA 01845 State Zip Code 08/22/2013 Date of Inspection Inspection Summary: Check A,B,C,D or E / always complete all of Section D A) System Passes: ® 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. Check the box for "yes", "no" or "not determined" (Y, N, ND) for the following statements. If "not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. * A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins • 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 2 of 17 w =vel= Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 80 Patten Lane Property Address Mark Palmer Owner's Name North Andover MA 01845 08/22/2013 Citylrown State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if (with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if (with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b) that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins • 3113 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 3 of 17 Owner information is required for every page. Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 80 Patten Lane Property Address Mark Palmer Owner's Name North Andover Citylrown B. Certification (cont.) MA 01845 08/22/2013 State Zip Code Date of Inspection 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: ** This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or "No" to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than % day flow t5ins • 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 4 of 17 ❑ ❑ The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either "yes" or "no" to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area — IWPA) or a mapped Zone II of a public water supply well If you have answered "yes" to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins • 3/13 Title 5 Oficial Inspection Form: Subsurface Sewage Disposal System • Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 80 Patten Lane Property Address Mark Palmer Owner information is Owner's Name required for North Andover MA 01845 08/22/2013 every page. Citylrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ❑ The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either "yes" or "no" to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area — IWPA) or a mapped Zone II of a public water supply well If you have answered "yes" to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins • 3/13 Title 5 Oficial Inspection Form: Subsurface Sewage Disposal System • Page 5 of 17 Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 80 Patten Lane Property Address Mark Palmer Owner's Name North Andover CityfTown C. Checklist MA 01845 State Zip Code 08/22/2013 Date of Inspection Check if the following have been done. You must indicate "yes" or "no" as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of been determined based on: this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not approximation of distance is unacceptable) [310 CMR 15.302(5)] available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner (and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 4 Number of bedrooms (actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x # of bedrooms): 440 t5ins - 3113 Title 5 Official Inspection Fonn: Subsurface Sewage Disposal System - Page 6 of 17 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 80 Patten Lane Property Address Mark Palmer Owner Owner's Name information is required for North Andover MA 01845 08/22/2013 every page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: Does residence have a garbage grinder? ❑ Yes 0 No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Yes ❑ No Laundry system inspected? ❑ Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage d 9 ( Y 9 (gP )) approx. 56 gal/day average Detail: Sump pump? Last date of occupancy: Commercial/industrial Flow Conditions: Type of Establishment: Design flow (based on 310 CMR 15.203): Basis of design flow (seats/persons/sq.ft., etc.): Grease trap present? Industrial waste holding tank present? Non -sanitary waste discharged to the Title 5 system? Water meter readings, if available: Gallons per day (gpd) ® Yes ❑ No current Date ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No t5ins - 3/13 Title 5 official Inspection Form: Subsurface Sewage Disposal System - Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments wM 80 Patten Lane Property Address Mark Palmer Owner Owner's Name information is required for North Andover MA 01845 every page. Cityrrown State Zip Code D. System Information (cont.) Last date of occupancy/use: Date Other (describe below): General Information Pumping Records: Source of information: Was system pumped as part of the inspection? If yes, volume pumped: How was quantity pumped determined? Reason for pumping: no records available gallons 08/22/2013 Date of Inspection ❑ Yes ® No Type of System: Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Altemative technology. Attach a copy of the current operation and maintenance contract (to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other (describe): t5ins • 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 80 Patten Lane Property Address Mark Palmer Owner Owner's Name information is required for North Andover MA 01845 08/22/2013 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: Installed in 2005 per Board of Health Records Were sewage odors detected when arriving at the site? Building Sewer (locate on site plan): Depth below grade: 18"feet Material of construction: ❑ cast iron ® 40 PVC ❑ other (explain): — Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): All ok inside Septic Tank (locate on site plan): Depth below grade: Material of construction: ® concrete ❑ metal Ei feet ❑ Yes ® No ❑ fiberglass ❑ polyethylene ❑ other (explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 10'6"x 5"8" x 5" deep Sludge depth: 6" t5ins • 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 9 of 17 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments •�y 80 Patten Lane Owner information is required for every page. t5ins • 3/13 Property Address Mark Palmer Owner's Name North Andover City[Town D. System Information (cont.) MA 01845 State Zip Code Septic Tank (cont.) Distance from top of sludge to bottom of outlet tee or baffle 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 27 4" 5„ 12" 08/22/2013 Date of Inspection 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 os ok. Outlet tee is filtered. Liquid level is proper. The tank appears ok. Grease Trap (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal Dimensions: Scum thickness feet ❑ fiberglass ❑ polyethylene ❑ other (explain): Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Title 5 official Inspection Form: Subsurface Sewage Disposal System • Page 10 of 17 Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 80 Patten Lane Property Address Mark Palmer Owner's Name North Andover MA 01845 Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 08/22/2013 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: Design Flow: Alarm present: Alarm level: gallons gallons per day ❑ Yes ❑ No Alarm in working order: Date of last pumping: Date Comments (condition of alarm and float switches, etc.): ❑ Yes ❑ No * Attach copy of current pumping contract (required). Is copy attached? ❑ Yes ❑ No t5ins - 3f13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 11 of 17 Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 80 Patten Lane Property Address Mark Palmer Owner's Name North Andover City/Town D. System Information (cont.) MA 01845 08/22/2013 State Zip Code Date of Inspection Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 51 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 is level. The distribution is equal. The D -box is in good shape. Mininmal solids. Pump Chamber (locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins • 3113 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 12 of 17 Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 80 Patten Lane Property Address Mark Palmer Owner's Name North Andover City/Town D. System Information (cont.) Type: MA 01845 State Zip Code 08/22/2013 Date of Inspection ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ® innovative/alternative system Type/name of technology: 9.5' x 50' infiltraor field Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): No surface sign of problems. No sign in D -box of back up. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth — top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins - 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 80 Patten Lane 08/22/2013 Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins • 3113 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 14 of 17 Property Address Mark Palmer Owner Owner's Name information is required for North Andover MA 01845 every page. CirylTown State Zip Code 08/22/2013 Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins • 3113 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 14 of 17 in Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 80 Patten Lane Property Address Mark Palmer Owner's Name North Andover Cityrrown D. System Information (cont.) MA 01845 State Zip Code 08/22/2013 Date of Inspection Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ❑ hand -sketch in the area below ® drawing attached separately t5ins - 3113 Title 5 Official Inspection Forth: Subsurface Sewage Disposal System - Page 15 of 17 a h SVo� Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 80 Patten Lane Property Address Mark Palmer Owners Name North Andover Cityfrown D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: MA 01845 08/22/2013 State Zip Code Date of Inspection 4' below system feet Please indicate all methods used to determine the high ground water elevation: ►/ /1 0 Obtained from system design plans on record If checked, date of design plan reviewed: 10/2004 to 01/2005 Date Observed site (abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health - explain: review files ❑ Checked with local excavators, installers - (attach documentation) ❑ Accessed USGS database - explain: You must describe how you established the high ground water elevation: Test hole data from design plan dated Oct. 2004 by James Kavanaugh P.E. Site slopes down to rear to an elevation below bottom of system. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins • 3113 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 16 of 17 Owner information is required for every page. t5ins - 3/13 Commonwealth of Massachusetts Title 5 Official Inspection Form 's Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 80 Patten Lane Property Address Mark Palmer Owner's Name North Andover MA 01845 08/22/2013 Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist Q Inspection Summary: A, B, C, D, or E checked Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information — Estimated depth to high groundwater �j Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 17 of 17 4ta. N. , N �p^ •ww4 _ q, .p_ cocwcHewu. PUBLIC HEALTH DEPARTMENT Community Development Division C�12II�ICA7IE OAF C09l�LANCE As of: dune 30, 2006 This is to cert that the individuafsu6surface disposal system was Tuffy Repaired by: Warren Pearce 80 Patton .Gane North Andover, WA 01845 The Issuance of this certificate shall not be construed as a guarantee that the system wiff function satisfactorily. "Susan 1Y. Sawyer Public Wealth Director 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthondover.com TOWN OF NORTH ANDOVER SEWAGE DISPOSAL SYSTEM INSTALLATION CERTIFICATION The undersigned hereby certify that the Sewage Disposal System.(.) constructed; ( ) repaired; a by. located at ep o loci A __ L9, e - was installed in conformance with the North Andover Board of Health approved plan, System Design Permit # , plan dated /��% , with a design flow of YiN gallons per day. The materials used were in conformance with those specified on the approved plan; the system was installed in accordance with the provisions of 310 CMR 15.000, Title 5 and local regulations, and the final grading agrees substantially with the approved plan. All work is accurately represented on the As -built which has been submitted to the Board of Health. Bed inspection date: Final inspection date: � o Installer: Engineer Representative It Vj Engineer Representative eill- 2ouy`0IgS' Date: 16, / y"I( Lic.#: Engineer: Date: /y v RECEIVED JUN 2 2 2006 1_0A%VN OF NORTH ANDOVER r'H DEPARTMENT Page 1 of 1 DelleChiaie, Pamela From: Dan Ottenheimer [info@millriverconsulting.com] Sent: Wednesday, November 30, 2005 2:37 PM To: amcbrearty@millriverconsulting.com; Lisa Kozel LeVasseur; DelleChiaie, Pamela; Sawyer, Susan Subject: Construction Inspections Attached are: C�) 80 Patton La h had no issues. Installer -needs to-put-manholeto-grade-overoutlet side of septic-tank'which goti-s. ould-see-on the final grade inspection. Boston Street Lot 10 which had some issues. They had no water at the site so we could not confirm tightness of septic tank (though it looked fine) nor even flow from d -box. He will leave d -box open to be checked at final grade inspection. The benchmark was moved by someone and we had no way of co ming its accuracy. I would suggest getting some type of letter or plan from the designer confirming this. s done correctly. Dan I Daniel Ottenheimer, President Mill River Consulting, Inc. Septic System Management Services 2 Blackburn Center Gloucester, MA 01930-2259 978-282-0014 or 1-800-377-3044 fax: 978-282-0012 www.millrive.rconsultina.com dano@millriverconsulting.com 11/30/2005 ALI f� bpdL U � f • TOWN OF NORTH ANDOVER of pORTM 1 Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT 400 OSGOOD STREET NORTH ANDOVER, MASSACHUSETTS 01845 ��sSncHug t Susan Y. Sawyer, REHS/RS 978.688.9540 —Phone Public Health Director 978.688.9542 — FAX ADDRESS: 80 Patton Lane MAP: LOT: INSTALLER: Warren Pearce DESIGNER: PLAN DATE: Rev: 12/18/04 BOH APPROVAL DATE ON PLAN: 1/20/05 DATE OF BED BOTTOM INSPECTION: DATE OF FINAL CONSTRUCTION INSPECTION: 11/29/05 DATE OF FINAL GRADE INSPECTION: SITE CONDITIONS Comments: SEPTIC TANK ®Existing septic tank properly abandoned ®Internal plumbing all to one building sewer []Topography not appreciably altered ❑ Bottom of tank hole has 6" stone base ❑ Weep hole plugged ® 1500 gallon tank has been installed H-20 loading Monolithic construction ® Water tightness of tank has been achieved (Visual) ® Inlet tee installed, centered under access port ® Outlet tee (gas baffle or effluent filter) installed, centered under access port ® 24" inch cover to within 6" of final grade installed over one access port, must be over outlet of tank if effluent filter is present ® Hydraulic cement around inlet & outlet Comments: Effluent filter as per plan. Contractor notified to install manhole to grade over outlet access port for access to effluent filter as required by approval letter for effluent filter. Page 1 of 3 TOWN OF NORTH ANDOVER NORTH Of to �{ Office of COMMUNITY DEVELOPMENT AND SERVICES ►°3r s'ba� ° A HEALTH DEPARTMENT 400 OSGOOD STREET NORTH ANDOVER, MASSACHUSETTS 01845 ��Ss�CHU �h Susan Y. Sawyer, REHS/RS 978.688.9540 — Phone Public Health Director 978.688.9542 — FAX D -BOX Comments: SOIL ABSORPTION SYSTEM El In Comments: Installed on stable stone base Inlet tee (if pumped or >0.08'/foot) Hydraulic cement around inlet & outlets Observed even distribution Speed levelers provided (not required) Bottom of SAS excavated down to soil layer, as provided on plan Size of SAS excavated as per plan Title 5 sand installed, if specified on plan 3/4-1 %" double washed stone installed 1/8-1/2" (peastone) double washed stone installed laterals installed and ends connected to header (and vented if impervious material above) Orifices @ 5 & 7 o'clock positions Gravelless disposal systems: type, number and location as per plan Elevations of laterals installed as on approved plan 40 Mil HDPE barrier installed Retaining wall (boulder / concrete / timber/ block) Final cover as per plan Page 2 of 3 TOWN OF NORTIfI ANDOVER cE NOR7M Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT 400 OSGOOD STREET NORTH ANDOVER, 1CHU MASSACHUSETTS 01845 �'�s "°'<� S�`+ Susan Y. Sawyer, .REHS/RS 978.688.9540 —Phone Public Health Director 978.688.9542 — FAX SYSTEM ELEVATIONS Benchmark: 100.00 Rod at Benchmark: 0.60 Height of Instrument: 100.60 INVERT ON DESIGN PLAN INVERT ELEVATION Building Sewer OUT 98.00 98.17 Septic Tank IN 97.70 97.86 Septic Tank OUT 97.45 97.55 Distribution Box IN 97.15 97.21 Distribution Box OUT 96.95 97.04 Lateral 1 Inv 96.85 96.93 Lateral 1 Top 97.30 97.34 Lateral Inv 96.85 96.93 Lateral 2 Top 97.30 97.36 Lateral 3 Inv 96.85 96.93 Lateral 3 Top 97.30 97.33 Page 3 of 3 ;FINAL GRADE INSPECTION Date: l Address: - Xg L 'b LOAMED? v SEEDED? COVER PER PLAN? Other: qW DelleChiaie, Pamela From: Grant, Michele Sent: Thursday, May 25, 2006 8:12 AM To: DelleChiaie, Pamela Subject: RE: Patton Lane. Thank you -----Original Message ----- From: DelleChiaie, Pamela Sent: Wednesday, May 24, 2006 2:02 PM To: Grant, Michele Subject: Patton Lane Hi Michele, I received a call from Jan Neill of 72 Pat n'Cane S eh is in he�process of trying to sell her home, but lost a sale due to the condition of the property next d rat 80 Patton Lane, ow d by Sue and Paul. There was septic work done at that property but installer did not comp te_Final Gradin caping. Installer was Warren Pearce. Ms. Neill stated that you were out at the property previous ith her personally, and she is getting back to you regarding this information. I did not have time to pull files or look through records, as I have to get over to the blood drive. Will do tomorrow. 8¢gf Ro#atds, AV414004 D¢.4.00C MA0 Health Department Assistant Town of North Andover 1600 Osgood Street Building 20, Suite 2-36 North Andover, MA o1845 978.688.9540 - Phone 978.688.8476 - Fax http://www.townofnorthandover.com healthdept@townofnorthandover.com DelleChiaie, Pamela From: DelleChiaie, Pamela Sent: Monday, November 28, 2005 2:10 PM To: 'Daniel Ottenheimer (E-mail)'; 'Lisa LeVasseur (E-mail)'; 'McBrearty Andrew (E-mail)' Cc: Grant, Michele Subject: Construction Notes - 80 Patton Lane Importance: High Hi, Here are the notes from the BB Inspection on Friday, 11/18/05. Please look at the comments -- very important before you go to the site for the Final Const. Insp. Michele - FYI Pw�yaBa D¢BB¢G�lfiaie Health Department Assistant Town of North Andover 400 Osgood Street North Andover, MA 01845 978.688.9540 - Phone 978.688.8476 - Fax http://www.townofnorthandover.com healthdept@townofnorthandover.com jb. TOWN OF NORTH ANDOVER E gpRT#j Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT 400 OSGOOD STREET NORTH ANDOVER, MASSACHUSETTS 01845 �'1ss',CHuse<�' Susan Y. Sawyer, REHS/RS 978.688.9540 — Phone Public Health Director 978.688.8476 — FAX SEPTIC SYSTEM CONSTRUCTION NOTES LOCATION INFORMATION ADDRESS: 80 Patton Lane MAP: LOT:_ INSTALLER: Warren Pearce DESIGNER: Jim Kavanaugh PLAN DATE: 10/22/05 BOH APPROVAL DATE ON PLAN: 1/20/05 INSPECTIONS TANK INSPECTION. 11/15/05 (& 12:45 P.M. — Michele Grant DATE OF BED BOTTOM INSPECTION: 11/18/05 — Michele Grant DATE OF FINAL CONSTRUCTION INSPECTION: DATE OF FINAL GRADE INSPECTION: SELECT SYSTEM TYPE 1. GRAVITY DISTRIBUTION ... 0 2. PRESSURE DISTRIBUTION... ❑ 3. PRESSURE DOSING... ❑ 4. HOLDING TANK... ❑ 5. ADVANCED TREATMENT... ❑ 6. OTHER... ❑ PUMP SYSTEM COMPONENT SUMMARY FROM PLAN 1. GALLON TANK = 1500 2. LOADING OF SEPTIC TANK = 3. GALLON PUMP CHAMBER = 4. LOADING OF PUMP CHAMBER = 5. TYPE OF SAS = Standard Infiltrator Chambers 6. DIMENSIONS AND DETAILS OF SAS: 59.5 x 19.5 with overdig Comments: Please check the level of the inside of the tank. Page 1 of 4 l 1 TOWN OF NORTH ANDOVER NORTH Office of COMMUNITY DEVELOPMENT AND SERVICES 10- s ' p HEALTH DEPARTMENT 400 OSGOOD STREET NORTH ANDOVER, MASSACHUSETTS 01845 �cHus Susan Y. Sawyer, REHS/RS 978.688.9540 — Phone Public Health Director 978.688.8476 — FAX SITE CONDITIONS 1. Existing septic tank properly abandoned... ❑ 2. Internal plumbing all to one building sewer... ❑ 3. Topography not appreciably altered... ❑ SEPTIC TANK 1. Bottom of tank hole has 6" stone base... ❑x 2. Weep hole plugged... ❑ 3. Tank has been installed (H-20) Tank Size: 1,500 2 -piece ... ❑x - H-40 4. Water tightness of tank has been achieved (Visual)... ❑ 5. Inlet tee installed, under access port... Ex 6. Outlet tee (gas baffle or effluent filter) installed, under access port... ❑ 7. Cover to within 6" of final grade installed over one access port, must be over outlet of tank if effluent filter is present - Inches of Tank... ❑ 8. Hydraulic cement around inlet & outlet... ❑ ****Comments: **** Advised Warren to fill tank with water before Mill River gets out to do a Final. Asked Warren not to put anything larger than 1.5' crushed stone under any tank. Note: Warren used an H-40 Tank. PUMP CHAMBER - n/a 1. Bottom of tank hole has 6" stone base... ❑ 2. Weep hole plugged... ❑ 3. Pump Chamber Installed _Combo tank Gallons; (H-20) (Monolithic) 4. Inlet tee installed, under access port... ❑ 5. Pump(s) installed on stable base... ❑ 6. Alarm Float Working... ❑ 7. Pump On/Off Float Working... ❑ 8. Total # of Floats... 9. Drain hole in pressure line... ❑ 10. Cover to within 6" of final grade installed over one access port... ❑ 11. Water tightness of tank has been achieved — Visual or Vacuum Test or Water held for 24 hours (circle) 12. Hydraulic cement around inlet & outlet... ❑ Comments: Page 2 of 4 TOWN OF NORTH ANDOVER OE NORTIf Office of COMMUNITY DEVELOPMENT AND SERVICES F? �'� ���� °�°tp HEALTH DEPARTMENT too 400 OSGOOD STREET "► I,. NORTH ANDOVER, MASSACHUSETTS 01845 9Ss;;�NU <� Susan Y. Sawyer, REHSIRS 978.688.9540 — Phone Public Health Director 978.688.8476 — FAX D -BOX 1. Installed on stable stone base... ❑ 2. Inlet tee (if pumped or >0.08'/foot)... ❑ 3. Hydraulic cement around inlet & outlets... ❑ 4. Observed even distribution... ❑ 5. Speed levelers provided (not required) ... ❑ - Comments: SOIL ABSORPTION SYSTEM 1. Bottom of SAS excavated down to C Soil Layer, as provided on plan... ❑x 2. Size of SAS excavated as per plan... ❑x 3. Title 5 sand installed, if specified on plan... ❑x 4. 3/4-1 1/2" double washed stone installed... ❑ 5. 1/8-1/2" (peastone) double washed stone installed 6. Laterals installed and ends connected to header (and vented if impervious material above) 7. Gravel -less disposal systems: type, number and location as per plan......... ❑ 8. Elevations of laterals installed as on approved plan... ❑ 9. 40 Mil HDPE barriers installed... ❑ 10. Retaining wall (boulder / concrete / timber / block) ... ❑ 11. Final cover as per plan ... ❑ *****Comments: ***** There was a lot of smearing on all sides of the holes. Asked Warren to rake sides (all) and bottom before continuing. CONTROL PANEL 1. Alarm & Pump are on separate circuits... ❑ 2. Alarm sounds when float is tripped...... ❑ 3. Location of control panel: 4. Rated for exterior if placed outside... ❑ Comments: Page 3 of 4 •' TOWN OF NORTH ANDOVER MORTh Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT 400 OSGOOD STREET NORTH ANDOVER, MASSACHUSETTS 0 184 3s'"CHU s�CHUS Susan Y. Sawyer, REHS/RS 978.688.9540 —Phone Public Health Director 978.688.8476 — FAX SYSTEM ELEVATIONS 1. Benchmark: 2. Rod at Benchmark: 3. Height of Instrument: Page 4 of 4 INVERT ON DESIGN PLAN INVERT ELEVATION Building Sewer OUT 199.96 199.65 Septic Tank IN 199.75 199.24 Septic Tank OUT 199.50 198.98 Distribution Box IN 208.95 D -Box OUT Manifold 208.73 Lateral 1 HIGH 208.80 209.16 Lateral 1 Inv 208.71 208.69 Lateral 2 HIGH 207.20 207.54 Lateral 2 Inv 207.11 207.09 Lateral 3 HIGH 205.60 205.99 Lateral 3 Inv 205.51 205.53 Page 4 of 4 \1 DelleChiaie, Pamela From: Grant, Michele Sent: Monday, November 28, 2005 10:59 AM To: DelleChiaie, Pamela; Sawyer, Susan; amcbrearty@millriverconsulting.com; info@millriverconsulting.com Subject: Just Communicating Good Morning Dan and Andy, 80 Patton Lane... Lots of notes... Tank is a monster - Its an H-40 -I could not get into the hole, it was so tight. At the bottom of the tank there was stone that looked more like rocks. I looked in Title and called Dan to get the correct information (3/4" and not larger than 1.5"). Called Warren to let him know, "Nothing larger than 1.5" stone. The hole at the bottom of Bed inspection was a nicely dug hole, however I did ask Warren to rake 'the sides of the hole because there was a huge amount smearing. I also told Warren that you would prefer to have the tank filled when you arrive. Qustions ????'s Please called me Thanks Michele JAMES M. KAVANAUGH, P.E. 14 Shady Hill Drive North Reading, MA 01864 Tel./Fax(978)664-2925 January 4, 2005 Board of Health Town of N. Andover 27 Charles Street N. Andover, MA 01845 Att: Susan Sawyer Re: Septic System Design 80 Patton Lane Ms. Sawyer: Environmental Consultant 11 ,4ORTH rQi,tALTH DE�PAJ • Engineering Consultant • Septic System Designs • Construction Services • Custom Home Builder Please find enclosed a copy of the buoyancy calculations for the above referenced project. The calculations demonstrate that no additional flotation provisions are required. If you have any question please do not hesitate to contact me at (978)664-2925. Sincerely, Ja es . Kavanaugh, P.E. JAN 06 2.005 l j 1 o v o1v c W-0, JAN © 6 2005 TOWN OF NORTH AWVIER HEALTH UE - %I` T t 0 Id �11- 10 r TOWN OF NORTH ANDOVER e MORT1� Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT 27. CHARLES STREET `► ", r NORTH ANDOVER, MASSACHUSETTS 01845 CH„5 Susan Y. Sawyer 978.688.9540 — Phone Public Health Director 978.688.9542 — FAX January 26, 2005 Mark Palmer 80 Patton Lane N. Andover, MA 01845 RE: Subsurface Sewage Disposal System Plan for 1094 Johnson -Street, Map 106D, Parcel 167, North Andover, Massachusetts Dear Mr. Palmer, The North Andover Board of Health has completed the review of the septic system design plans, for the above referenced property, submitted on your behalf by James Kavanaugh, Environmental Consultant dated October 22, 2004. (Final revision dated December 18, 2004). The design has been approved for use in the construction of a replacement onsite septic system. This approval is valid for three years from the date of this letter and during this time a licensed septic system installer must obtain a permit and complete this work, and a Certificate of Compliance must be endorsed by the installer, designer and the Town of North Andover. The time period for which this plan is valid is reduced to two years from the date of a septic system inspection which did not meet the acceptable criteria in the state regulations. In the event an imminent health problem such as sewage backup into the dwelling is occurring, the time period for which this plan is valid may be reduced by the North Andover Board of Health. The following request was approved at the January 20, 2005 Board of Health meeting. 1. To allow a reduction of the Soil Absorption System from bordering vegetated wetlands from 100 feet to 75 feet. This approval is subject to the following conditions: 1. If site conditions are found in the field to be different from those indicated on the design plan and/or soil evaluation, the originally issued Disposal System Construction Permit is void, installation shall stop, and the applicant shall reapply for a new Disposal Systems Construction Permit (3 10 CMR 15.020(1)). 2. It is the responsibility of the applicant and/or the applicant's septic system designer, septic system installer or other representative to ensure that all other state and municipal requirements are met. These may include review by the Conservation Commission, Zoning Board, Planning Board, Building Inspector, Plumbing Inspector and/or Electrical Inspector. The issuance of a Disposal System Construction Permit shall not construe and/or imply compliance with any of the aforementioned requirements. Your effort to provide a properly functioning septic system for your dwelling is greatly appreciated. The Health Department may be reached at 978-688-9540 with any questions you might have. Sin , /Susan Y. Sawyer, REHS/RS Public Health Director { TOWN OF NORTH ANDOVER Ot NORTN Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT 400 OSGOOD STREET '� ", •� NORTH ANDOVER, MASSACHUSETTS 01845 Susan Y. Sawyer, REHS/RS 978.688.9540 — Phone Public Health Director 978.688.9542 — FAX December 6, 2004 James M. Kavanaugh, P.E. Environmental Consultant 14 Shady Hill Drive N. Reading, MA 01864 Re: 80 Patton Lade, Map 106A, Lot 0167 Dear Mr. Kavanaugh: The proposed septic system design plans for the above site dated October 22, 2004 and received on November 17, 2004 has been reviewed. Unfortunately, it cannot be approved until the following items are corrected. Each item is followed by the specific section in Title 5: 310 CMR 15.000, or North Andover regulations which is not met by this design. XPlease provide the location and elevation of the foundation drain. If there is no drain, / please make a statement to that effect on the plan. (NA 8.02y) ` 2 The scale (1"=20') is not stated on the site plan. -220(4) The soil test data should also state the name of the witness to the soil evaluation: %`Leslie Whelan".-220(4)(h)&(i) W Some of the legal boundaries of the property are missing from the plan. -220(4)(x) f The site plan is missing the distances from the septic tank to the property line and from the soil absorption system to the dwelling. -8.02z 6. 'OA note is required stating the building sewer shall be laid on a compact, firm base, and on,g continuous grade, in a straight line. (3 10 CMR 15.222(5)&(7)) Please s ecify that if the existing tank is to remain, it must be inspected by a Title 5 Inspe o �aqd certification provided to the Board of Health that the tank meets the follo ' g criteria: a. the tank is watertight . 2-3" drop from inlet to outlet. (3 10 CMR 15.227(5)) c. minimum of 4'liquid depth. (3 10 CMR 15.223(2)) d. there is 9" minimum and 36" maximum of cover material over the tank (3 10 CMR 15.221(7) and 228(1)) e. the tank has a loading ofH-10 (3 10 CMR 15.226(3)) �5. Additionally, if the existing tank is to remain, please specify that the tees and manhole �j risers are to comply with Title 5: a.) The inlet tee to the septic tank must extend 10" minimum below the flow line and "1 the outlet tee must extend 14" below the flow line. (3 10 CMR 15.227(6)) b.) Tees must extend 6" above the flow line. (3 10 CMR 15.227(1)) c.) Tees must have 3" air space above them. (3 10 CMR 15.227(4)) d.) One manhole must be brought to within 6" of final grade. If the cover is located at grade, it must be secured to prevent unauthorized access. (3 10 CMR 15.228(2)) e.) The inlet and outlet tees must be located directly under the manholes. (3 10 CMR 15.227(1)) 0the septic tank is to be replaced, the plan should provide: uoyancy calculations for the septic tank. Regarding Note 13, if a pad is needed, please provide specs. -221(8) b. a minimum liquid depth of 4'. -223(2) c. a description of the proper method to abandon the existing septic tank (or reference to the section of the code). -354 Regarding the effluent filter, Note #I I should provide a filter maintenance schedule, Also, the filter type/name should be noted on the manhole cover. V4. A notation is needed regarding the d -box outlets. The elevations must all be the same, and the pipes must be level for 2' after the d -box. -232(3)(b) & (c) i9. A notation is needed regarding the d -box being watertight. Note number 10 should (/ include d -box. -221(1) �i`0. Please specify the proper size (< 1-1/2") for stone that is to be used beneath the distribution box. — 221(2) 11. efore construction begins on the system, a minimum of one deep hole in the vicinity of the leaching field will be required to determine that the soils are consistent with ,,,,--)those found in the design. If soil is determined to be less pervious than the design, construction will be halted and a new design will have to be submitted. —102(2) A written request to be on the agenda of the Board of Health meeting for the local variances must be submitted. The reduction to ground water must be explained in detail. If approved a draft 4 -bedroom deed restriction must be submitted prior to approval. Please feel free to contact the office with any questions you may have. We look forward to working with you to obtain a septic system which will be in compliance with all regulations and assure protection of public health and the environment of North Andover. SincereI u an Y. Sawyer, REHS/RS Public Health Director cc: Owner File i I JAMES M. KAVANAUGK P.E. 14 Shady Hill Drive North Reading, MA 01864 Tel./Fax(978)664-2925 December 20, 2004 Board of Health Town of N. Andover 27 Charles Street N. Andover, MA 01845 Att: Susan Sawyer Re: Septic System Design 80 Patton Lane Ms. Sawyer: Environmental Consultant • Engineering Consultant • Septic System Designs • Construction Services • Custom Home Builder Please find enclosed 3 revised copies of a proposed plan for the upgrade of an existing septic system located at 80 Patton Lane, N. Andover. The revisions on the plan address items within your December 6, 2004 letter. Please contact me if you cannot locate or require further explanation any of the revisions to the plan. If you have any question please do not hesitate to contact me at (978)664-2925. Sincerely, James M. Kavanaugh, P.E. BOARD OF HEALTH 120 MAIN STREET NORTH ANDOVER, MASS. 01845 TEL. 682-6400 60lid I vq (o -j 6��Y, r� lvr PCrrv0 Lt:� &0viT h(A� � �ro 06(6e"G T �v v1 TO rt�� v� 5 c, a CA 5�t�^ I� V7 T�� 6 tM r v�G � l r t 1ti w r- 1 y Town of North .Andover, Massachusetts Form No. 3 NORTH BOARD OF HEALTH of�t�ao �'9S''•'•''ct' DISPOSAL WORKS CONSTRUCTION PERMIT SACHUSE Applicant G'"�- �l t_.t�'�_ /e�"' NAME ADDRESS TELEPHONE Site Location;/I� Permission is hereby granted to Construct ( ) or Repair(— A�an Individual Soil Absorption Sewage Disposal System as shown on the Design Approval S.S. No. CHAIRMAN, BOARD OF HEALT Cil Fee '..I��, D.W.C. No. INSTALLER PROJECT MANAGEMENT OBLIGATIONS As the North Andover licensed installer for the construction of the septic system for the property at relative to the application of V,9nV,,PLMted for plans by S U FduAh4ug 1-I and dated / p -a } -o,( with revisions dated f 6- - t ® o q I understand the following obligations for management of this project: 1. As the installer I am obligated to obtain all permits and Board of Health approved plans prior to performing any work on a site. I must have the approved plans and the permit on site when any work is being done. 2. As the installer I must call for any and all inspections. If homeowner, contractor, project manger, or any other person not associated with my company schedules an inspection and the system is not ready then item three shall be applicable. 3. As the installer I am required to have the necessary work completed prior to the applicable inspections as indicated below. I understand that requesting an inspection, without completion of the items in accordance with Tile 5 and the Board of Health Regulations may 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 not have to be present. b) Final inspection - Engineer must first do their inspection for elevations, ties, etc. As -built or verbal OK from engineer must be submitted to Board of Health, after which installer calls for inspection time. Installer must be present for this inspection. With pump system all electrical work must be ready and able to cause pump to work and alarm to function. c) Final Grade - Installer must request inspection when all grading is complete. Does not have to be on site. 4. As the installer I understand that only I may perform the work (other than simple excavation) required to complete the installation of the system identified in the attached application for installation. I further understand that work by others unlicensed to install septic systems in North Andover can constitute reasons for denial of the system, and/or revocation or 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. d) Installation of tank, D -box, pipes, stone, vent, pump chamber, retaining wall and other components. 6. As the installer I understand that I am solely responsible for the installation of the system as per the approved plans. No instructions by the homeowner, general contractor, or any other persons shall absolve me of this obligation. Undersigned Licensed Date: I/-(- N°RTM Application for Septic Disposal System AYtT..eo io9ti -Construction Permit -TOWN OF y9'oy "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. rub mmm Application is hereby made for a permit to: ❑ Construct a new on-site sewage disposal system* F�� epair or replace an existing on-site sewage disposal system* ❑ Repair or replace an existing system component/ A. Facility Info ' oCD Address or Lot # tdr\-� Lr Ivy City/Town /\(_ X) N"b © U R_\/�_ TODAY'S DAT 250.00 — ull Repair 125.00 - Component 2.- *TYPE OF SEPTIC SYSTEM*: ❑ Pump Mtiriavity (choose one) ***If pump system, attach copy of electrical permit to application*** (i f El Conventional System (pipe and stone system) je/e/ 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. 4. Owner Information Q, V \�A Lvkx, a Address (if different from above) City/Town State Zip Code Telephone Number Installer Information 1'o A 9_AArLC-('z/� !c Name Name of Company City/Town Name Address City/Town SAN, 01ST State Zip Code (�h?s-(. q 9-2a -;? T--4) Telephone Number (Cell Phone # if possible please) Name of Company State Zip Code Telephone Number (Best # to Reach) Application for Disposal System Construction Permit • Page 1 of 2 Z 10 Z 96ed .;iwaad uoipni;suoo walsAS jesodsia ao; uoileoyddy ON —off —off r :(Ajuo uoijona;suoo mou) zsunjd.coojg 'S (uvjd pa2ocddn sn ajpas autres) :(A'juor uo►;ona;suoo mou) pyng-sy uoz;npunol -{, —saA puuag jgau;aaj,7o oa yan;xb' `osfI zuia;s s ucng •f sad zpagan;V uuol uoz;nSi1RO cagvuvNli (ocg -z S 9 zpagmiV -lad 'I duo ash aoigo ao=i :suoseaJ 6uinnoIIOI ayj JOI panaddesia uoi}eoilddy aaea a01 rN (an►;e;uesardaa y;Ie-I Zopz, rs�. AS panoad uoi}eoilddy ale(] aweN Mul -�3 C?j y;jeeH jo paeog py; Aq panssi uaoq sey eoueydwo:) jo a;eo►ji;jao a 1!;un uoi;eaado ut we;sAs ay; eoeld o;;ou pue `aanopud yPoN jo umol ay; aoi suopeinBey /esodsia ooelinsgnS /e36-7 ay; se l;am se `apo le;uawuoaInu3 ay;,;o g el;►1 }o suois►noid ay; y;!m aouepr000e ut we;se's jesodsjip oBemes 9;!s-uo paq!aosep-aaoje ay; jo aoueua;u►ew pue uoi;onj;suoo ay; arnsue o; saar6e pou6►sropun eyl juawaGAV •8 jeiojaww000 ao 6uillaand 1equapisab uiplin8 jo GdAJL 'S ••••panuguo3 u014BWJOIUI 4!1!oej •d ZJOZ3Jbd yStiH�YSS ;uouodwoo - 00'9Z6$ }�oaraa b5 aiedoM lln_A - 00'09Z $ MIO VW ?I AO(I X HIIIO r��/� T !wJGd m ana suo^� 31tfa S,,lb'a 01 3O 1 �LLA1O �L, — � • a � � `� WGIS S Ieso sia J1. as iol uoi.leo' v O"� k1aOHy'O TOWN OF NORTH ANDOVER Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT F-1 27 CHARLES STREET NORTH ANDOVER, MASSACHUSETTS 01845 I SE Susan Y. Sawyer, REHS, RS Public Health Director 978.688.9540 — Pone 978.688.9542 — F H ALLTH DEPARTMENT N OF NORTH ER www.townofnorthandover.com APPLICATION FOR SOIL TESTS DATE: I Ll MAP & PARCEL: LOCATION OF SOIL TESTS: �/JU j/7,�/t/✓�" /Cid OWNER: fV �e !� tContact # (q -7o req - I-)f-I- APPLICANT:w/-1�e- Contact#: ADDRESS: �� D t I1 �� L �►^ ENGINEER: es I �� v R,,, a rT �+ Contact #: CERTIFIED SOIL EVALUATOR: 7--7 f 4,v' o V 9 Intended Use of Land: Residential Subdivision Single Family Ho Commercial Is This: Repair Testing: Undeveloped Lot Testing: Upgrade for Addition: In the Lake Cochichewick Watershed? Yes THE FOLLOWING MUST BE INCLUDED WITH THIS FORM No ➢ Proof of land ownership (Tax bill, or letter from owner permitting test) ➢ 8.5"x Il " Plot plan & Location of Testing (please indicate test nit sites on the Plan) ➢ Fee of $425.00 per lot for new construction. This covers t um two deep holes and two percolation tests required for each disposal area. Feef 360.00 er lot for repairs or upgrades. GENERAL INFOR ➢ Only Certified Soil Evaluators may perform deep hole inspections. ➢ Only Mass. Registered Sanitarians and Professional Engineers can design septic plans. ➢ At least two deep holes and two percolation tests are required for each septic system disposal area. ➢ Repairs require at least two deep holes and at least one percolation test, at the discretion of the BOH representative. ➢ Full payment will be required for all additional tests within two weeks of testing. ➢ Within 45 days of testing, a scaled plan (no smaller than 1"-100') shall be submitted to the Board of Health showing the location of all tests (including aborted tests). ➢ Within 60 days of testing soil evaluation forms shall be submitted.. Please Do Not Write Below This Line N.A. Conservation Commission Approval Date: Signature of Conservation Agent: Date back to Health Department: (stamp in): CL f Lu Or a. T tON GALLON TANK- 'is ANK- T cV /�! �R � V" i 2 V IV SECTION 1-InNLQ.T 4-OUTLET5 -DISTRIBUTION -NOT i0 SCA LF-- —til—III— EXISTING WEYLANt)S —+{Kx—Kxx— NUOM5ED EDOE Of AE7LAND5 __ STAYS_b "Av k3AL.rc5 COME DoT#6-E /37,70,8 � t' Y� (9 rM�S� NG rir+ nrrvirrn-A" v f :,Fxu K1220xi Last Transaction Date Time Twe Identification Log for NORTH ANDOVER 9786889542 Sep 28 2004 3:45pm Duration Pages Rouh Sep 28 3:40pm Fax Sent 819782820012 4:16 5 OK W m a z m_, m O 0 0 a � U) 0 r° CD CL Q cn � @ obi � C C x Z d 3 D 1 cr 5 m S � m m CA cn O O O O � K m m O O a g g OL o M a � m P. it 0 0 a X cD C O m m h ego m ti n d o�DofDm o a O O o m 3 Mi 0 cn ❑ ❑ w 0' z 0 11 K CD O m C c Q F a c v o O g 9 v C z d 3 N N C 0 cr g N n pr o O v 0) C z m m� n a� o a o J 2 0 O Vmi ❑ El Z C o ❑m a m N N C m a m ❑ a C g ori 0 g 711 cr C) CD CA C cr nm N �G O. (ND rt 01 ? N mo m N •o O a.rr o CD CD CD -0 00 m T. cc m ? U1 vi m o a m W 0 CA � O O� C 3: �i ? 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Commonwealth of Massachusetts " City/Town of Percolation Test Form 12 Percolation test results must be submitted with the Soil Suitability Assessment for On-site Sewage Disposal. DEP has provided this form for use by local Boards of Health. Other forms may be used, but the information must be substantially the same as that provided here. Before using this form, check with the local Board of Health to determine the form they use. A. Site Information Maark Palmer Owner Name 80 Patton Lane Street Address or Lot # N. Andover Cityrrown Contact Person (if different from Owner) B. Test Results Observation Hole # Depth of Perc Start Pre -Soak End Pre -Soak Time at 12" Time at 9" Time at 6" Time (9"-61 Rate (Min./Inch) James Kavanaugh Test Performed By: Mill River Consultants Witnessed By: Comments: MA 01845 State Zip Code (978)689-9782 Telephone Number 10/27/04 10 am Date Time Date Time P-1 63" �F1nT 9:50 AM 9:50 AM 9:52 AM < 2 MIN./IN. Test Passed: ❑ Test Passed: ❑ Test Failed: ❑ Test Failed: ❑ t5form12.doc• 06/03 Perc Test " Page 1 of 1 a r rN C N m P+ M N s m m. 0 Q LL pt tC d 3 p , o 03 a C 0 a C N N N N N tD O 0 CA v 0 N mn o 03 � O 0,ONION o Cl) CN WWI 0 Cr C N H N N N N N CD O O 1 O 1� V+ CO) CDd v N 'L3 O N Commonwealth of Massachusetts City/Town of RECEIVED System Pumping. Record 7 2016 Form 4 TOWN OF NORTH ANDOVER EALTH DEPARTMENT DEP has provided this form for use- by local Boards of Health. Other form may be used, but the information must be substantially the same as that provided here. Before using Ahis form, check with your local Board of Health to determine the form they use. The System Pumping Record must be submitted to the local Board of Health or other approving authority. A. Facility. Information 1. System Locatio : e. Rig ontf house Left / Right rear of house, Left / right side of house, Left / Right side of building, Left / Rig roll o uildirig, Left / Right rear of building, Under deck Address Cityfrown State Zip Code 2. System Owner. Name Address (f different from location) Cityfrown B. Pumping 1. Date of Pumping 3. Type -of system: ❑ 4. A 9 State Zip—Code Telephone Number f. Date 2. Quantity Pumped: Gallons —? Cesspool(s) eptic Tank ❑Tight Tank ❑ Other (describe): Effluent Tee Filter present?6.,)re�,so No 5. Condition of System: 6.. System Pumped By: Neil. Bateson Name Bateson Enterprises Inc- Company ncCompany 7. Location where contents -were disposed: Waste Water If yes, was it cleaned? es ❑ No; F5821 Vehicle License Number Date t5form4.doc- 06103 System Pumping Renard • Page 1 of 1