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Home My WebLink AboutCertificate of Compliance - 209 BRIDGES LANE 9/10/2009 %AORTM �9 6 a,zwE I' ,d� R PUBLIC HEALTH DEPARTMENT fommunity Development Division r TI('C I qCM OE CogYPLIT M JrVCE As Of: b 0, 009 This is to certify that the individuarsu6surface disposaf system received a SAVSTACT01RT INST EC IO?V of tfiie: ir On-Site e Disposa[System By: John T Shaw, III 209 Ofidges Lane G. . rc . 7lie Issuance of this certijicate shaff not 6e construed as a guarantee that the system wiff function satisfacto65. S an 2'. Sa S/ 1t 6fic Yfeal'tfii Director 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.towoofnorthandover.com Commonwealth f Massachusetts City/Town of North Andover Certificate of Compliance Form 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. This is to Certify that the following work on an On-Site Sewage Disposal System Important: When filling out ❑ Construction of a new system forms on the ® Repair or replacement of an existing system computer,use El Repair or replacement of an existing system component only the tab key to move your cursor-do not Has been done in accordance with Title 5 and the Disposal System Construction Permit(DSCP): use the return key. DSCP Number DSCP Date Facility Owner 209 Bridges Lane Street Address or Lot# North And MA 01845 Cityfrown State Zip Code Designer Information: BENJAMIN C OSGOOD JR. N / Name of Company gnature Date Installer Information: ' Z�_- Name Name of Company l'�(", „�" ter.,✓ r�J 1 � - --------- Si rt`ature date Use of this system is conditioned on compliance with the provisions set forth below: The issuance of this certificate shall not be construed as a guarantee that the system will function as designed L Approving A utho y Sg- Si natures°° Date t5form3.doc•06/03 Certificate of Compliance•Page 1 of 1 0R,rP �' b�d�4CFCKil was�KSl 0 �%• "®" RFgqe��g T'yD gp��0111 PUBLIC HEALTH DEPARTMENT Community Development Division QNSITE WASTEWATER SYSTEM T U TI NOTES LOCATION INFORMATION ADDRESS: 209 Bridges Lane MAP: Not on plan LOT: Not on plan INSTALLER: John Shaw DESIGNER: Ben Osgood PLAN DATE: 5/3/07 BOH APPROVAL DATE ON PLAN: 1/28/09 INSPECTIONS TANK INSPECTION: DATE OF BED BOTTOM INSPECTION: DATE OF FINAL CONSTRUCTION INSPECTION: 7/29/09 DATE OF FINAL GRADE INSPECTION: SITE CONDITIONS ® Contractor reports any changes to design plan ® Existing septic tank properly abandoned ® Internal plumbing all to one building sewer ® Topography not appreciably altered Comments: Installer received approval from BOH for relocation of septic tank. SEPTIC TANK ® Building sewer in continuous grade, on compacted firm base N/A Cleanouts per plan ❑ Bottom of tank hole has 6" stone base ❑ Weep hole plugged ® 1500 gallon tank has been installed H-10 loading mono construction ® Water tightness of tank has been achieved by Visual testing 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townolnorthandover.com Inspection Form June 2008 J TOWN OF NORTH ANDOVER OORTH Office of COMMUNITY DEVELOPMENT AND SERVICES Ill.- " +0-0 Ro HEALT14 DEPARTMENT 1600 OSGOOD STREET;Building 2-36 NORTH ANDOVER, MASSACHUSETTS 01845 's Susan Y. Sawyer,REIISiRS Public Health Director 978.688.9540—Plione 978.688,8476—FAX QNSITE WASTEWATER SYSTEM CONSTRUCTION NOTES LOCATION INFQRM"ATICO�, ADDRESS: c MAF�:'' LOT: INSTALLER: DESIGNER' PLAN DATE: BOH APPROVAL DATE ON PLAN: INSPECTIONS TANK INSPECTION: DATE OF BED BOTTOM INSPECTION: DATE OF FINAL CONSTRUCTION INSPECTION: c-, DATE OF FINAL GRADE INSPECTION: SITE CONDITIONS Sr ' ,,,,jExisting septic tank properly ndod--]Internal plumbing all to one buding sewer Comments: ❑Topography not appreciably altered SEPTIC TANK Bottom of tank hole has 6" stone base F-1 Weep hole plugged 1"') c, 1500 gallon tank'has.-b, en.-instaflod - onothic constructi,on H-10 loading 6 /> -tank-h-a&been-a6hie'ved Watertightness of (Visual or Vacuum Test or Water held for 24hrs) ❑ 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 F-1 Hydraulic cement around inlet & outlet Wastewater System Documentation—Feb 2006 Page I of 6 't` j q ,6V � '`.. SbC.w1E WC WeCw��' CHIUS PUBLIC HEALTH DEPARTMENT (ommunity Development Division ® Inlet tee installed, centered under access port ® Outlet tee installed, centered under access port (effluent filter) ® 20" inch cover to final grade installed over all three access ports ® Hydraulic cement around inlet & outlet Comments: Effluent filter was not proposed on design plan, only a gas baffle. DISTRIBUTION-BOX ® Installed on stable stone base ® Hydraulic cement around inlet & outlets ® Observed even distribution ® Speed levelers provided (not required) Comments: SOIL ABSORPTION SYSTEM (General) ® Size of SAS excavated as per plan ® Title 5 sand installed, if specified on plan N/A 40 Mil HDPE barrier installed ® Laterals installed and ends connected to header (and vented if impervious material above) ® Elevations of laterals and chambers installed as on approved plan N/A Retaining wall (boulder/ concrete /timber/ block) ❑ Final cover as per plan Comments: Inspection ports are provided for each row of chambers SOIL ABSORPTION SYSTEM (Gravel-less Chambers) ® Brand and Model of Chamber: Infiltrator Chamber Standard (wick 4 ® Number of chambers per row: 7 1600 Osgood Street,North Andover,Mosso(husens 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthondover.rom Inspection Form June 2008 1(,t°aD 116 'W^+ G..D CP}G KIC IM0WV4.X ' R TE G --A PUBLIC HEALTH DEPARTMENT (ommunity Development Division ® Number of rows (trenches): 6 Comments: 42 chambers total BM = 101.63 HR = 0.54 HI = 102.17 SYSTEM ELEVATIONS ROD ELEVATION AS-BLT INVERT ELEV DESIGN INVERT ELEV Benchmark 101.63 Building Sewer OUT 2.84 98.98 98.10 Septic Tank IN 4.17 97.70 97.60 Septic Tank OUT 4.44 97.38 97.35 Distribution Box IN 4.56 97.26 97.19 Distribution Box OUT 4.74 97.08 97.02 Lateral 1 TOP 4.89 Lateral 1 INVERT 96.93 96.92 Lateral 2 TOP 4.90 Lateral 2 INVERT 96.92 96.92 Lateral 3 TOP 4.89 Lateral 3 INVERT 96.93 96.92 Lateral 4 TOP 4.88 Lateral 4 INVERT 96.94 96.92 Lateral 5 TOP 4.88 Lateral 5 INVERT 96.94 96.92 Lateral 6 TOP 4.88 Lateral 6 INVERT 96.94 96.92 To of Chamber 4.88 97.29 97.25 �-BED�BOTTOM ELEV. 96.29 96.25 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.tow✓nonortlrcrndov_er.con7 Inspection Form June 2008 ORT " 1 6 rep u PUBLIC HEALTH DEPARTMENT Community Development Division CRITICAL SETBACK DISTANCES Mark those distances checked in the field against the design plan and regulatory setback Tank SAS Sewer ® Property line 10 10 ® Cellar wall 10 20 ® Inground pool 10 20 -- ® Slab foundation 10 10 -- ® Deck, on footings, etc 5 10 -° ® Waterline 10 10 101 ® Private drinking well 75 1002 50 ® Irrigation well 75 100 ® Surface Water 25 50 ® Bordering Vegetated Wetland , Salt Marsh,Inland/Coastal Bank3 75 100 ® Wetlands bordering surface water supply or trio. (in Watershed) 150 150 ® Trib.to surface water supply 325 325 ® Public well 400 400 ® Interim Wellhead Prot. Area ® Reservoirs 400 400 • Drains (wat. supply/trib.) 50 100 • Drains (intercept g.w.) 25 50 • Drains (Other)Foundation 10 (5) 20(10) • Drywells 20 25 ' Suction line 222(2) 2 100 feet is a minimum acceptable distance and no variance is allowed for a lesser distance(NA 5.02). 3 As defined in 310 CMR 10.55, 10.32, 10.54,and 10.30,respectively,pursuant to 15.211(3),also by NA wetland bylaws 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 Fox 978.688.8476 Web www.towngtraogh—ui dpver.Lorn Inspection Form June 2008