HomeMy WebLinkAboutCertificate of Compliance - 93 WINTERGREEN DRIVE 6/2/2003 Town of North Andover °, tO oTH
Office of the Health Department 0? "`tit' ;.,, o°p
Community Development and Services Division
VL
27 Charles Street " °+ .�wra:•• '>� '
North Andover, Massachusetts 01845 SSACHUS'
Susan Y. Sawyer, REHS/RS 978.688.9540-Phone
Public Health Director 978.688.9542-Fax
� O F COJI<1' A�CE C�RTI FICA2
As of:
,dune 2, 2003
q'his is to certify that
the individual subsurface disposal system
repaired•(X) — Full System
by
,john Soucy
at
93 Wintergreen Drive
North Andover, 911,4 01845
has been installed in accordance with the provisions of 7itfe v of the State Sanitary Code and
with the.worth Andover 0oard of Ifealth regulations.
The issuance of this certificate shall not 6e construed as a guarantee that the system will
function satisfactorily.
°Susa �Y. Sawyer,
Pu6licWealth Director
BOARD OF APPEALS 688-9541 BUILDING 688-954$ CONSERVATION 688-9530 HEALTI1 688-9540 PLANNING 688-9535
.t
RECEIVED
TOWN OF NORTH ANDOVER
HEALTH DEPARTMENT
TO '®F NORTH ANDOVER SEWAGE DISPOSAL SYSTIE
INSTALLATION CERTIFICATION
The undersigned hereby certify that the Sewage Disposal System( )constructed;
repaired;
by 0 M M
located at (zk VT-
was installed in conformance with the North Andover Board of Health approved plan,
System Design Permit# , plan dated , with a design flow
of 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: t 7 /6 3 C
12- Engineer Representative
Final inspection date: & o
6( c 2
Engineer Representative
Installer: Lic.#: Date:
Engine : HARD �'� Date: O
TANGARD
�s021 C/
O,r ST��'`Fd'k
INSPECTION CHECKLIST FOR SEPTIC SYSTEMS
Yes NO Initials
A. Bottom of Bed
1. Excavation to proper depth
2. With trenches,sides of excavation are beneath B horizon
3. Edge Ege of excavation specified stance from foundation,etc.
Comments:
B. Retaining Wall
1. Wall height and width as specified
2. Waterproofed
3. Wall minimum 10' to leaching facility
4. Wall meets specifications of plan
Comments;
C. Building Sewer
I. Pipe diameter minimum 4"
2. Schedule 40 pipe
3. Watertight joints
4. Inlet to tank cemented
5. Slope minimum 0.01 or 1/8"per foot minimum
6. Pipe properly set on compact firm base -
7. Pipe laid on continuous grade in straight line
8. Cleanouts precede all change in alignment and grade
9. Manholes at any 90°change
Comments: minimum offset o m Set to water ,.
D. Septic Tank
I. Level
2. 1,500 gal minimum
3. Gas baffle present on outlet
4. Manhole to grade
5. Manholes over center and each tee
6. 3-20"manholes
7. Inlet tee minimum 12"under invert
8. Outlet tee minimum 14"under invert
9. Outlet line cemented
10. Air space 3"above tees
11. 2"—3"drop from inlet to outlet
12. Pipe set
13. Compact base with 6"of 3/4"crushed stone under tank
14. Tank is watertight
Comments;
�.. .. .. I ... m_
Yes NO
E. Pump Chamber
1. If separate from tank,compact base with 6"of'/4"stone underneath
2. Minimum 2"pipe to d-box if gravity system
3. 20"access manhole
4. Tank level
5. Watertight
6. Tank size agrees with plan specification
7. Manhole to grade
8. Check valve and bleeder hole present
9. Alarm in building on separate circuit
10. Alarm functions
It. Manual operating switch
12. Pump delivers liquid to d-box
Comments:
F. Distribution Box
1. D-box level ,
2. Minimum 0.I T'(2")drop from inlet to outlet
3. Minimum 6"sump
4. Outlet pipes show equal distribution
5. Compact base with 6"of stone beneath box
6. Box is watertight -
7. All lines cemented with hydraulic cement �0
8. Schedule 40 pipe
Comments:
G. Soil Absorption system ,
1. All stone double-washed-'/4"- 1 %"
-pea stone
Bucket test done? _
2. Minimum 2"of pea stone above distribution lines
3. Minimum 6"stone beneath pipe
4. Distribution lines capped or connected together
5. Grading meets 3:1 slope
6. Minimum of 9"of fill graded over system
7. Toe of slope stops minimum 5' from edge of property; if not,then swale.
Comments:
H. Leach Trenches
I. Minimum 2 trenches
2. Length of trenches agree with plan. (Max. length 100')
3. Width of trenches agree with plan-Minimum 2';maximum-4'.
4. Vent present if<50 feet or specified
5. Distance between trenches minimum 4' and maximum of 6'
6. Minimum distance between trenches 10'
7. Pipe slope minimum 0.005 or 6"per 100'
8. Depth of trenches below outlet invert minimum of 6".
Yes NO
9. Pipes set on stable base.
Comments:
1. Leach Field
1. Maximum length of field 100'
2. Pipe slope minimum 0.005 or 6"per 100'
3. Separation between pipe 6'maximum
4. Pipes connected at end
5. Separation between adjacent fields 10'minimum
6. Pipes set on stable base
7. Maximum 4'separation from edge of field to first line
8. Minimum two distribution lines
9. Maximum perc rate 20 mpi
Comments:
I Leaching Pits
1. Minimum inlet pipe 4"
2. Pits of concrete
3. Sidewall between 12"and 48"wide
4. Access manholes on each pit
5. Pipes cemented with hydraulic cement
Comments:
K. Final Grade
1. Slope over soil absorption system minimum 0.02
2. All system components covered by at least 9"soil
3. Cover soil free of stones larger than 6"
4. Grading slopes away from dwelling
5. No areas over system that may pond
CHECKLIST FOR NORTH ANDOVER
SEPTIC SYSTEM PLANS
Job
The following is a checklist that incorporates all Title 5 and local regulations for septic plans.
Name of Applicant: Name of Designer: Z5-1
Plan Date: 'Revision Date: Date of Review:
Property Address: l�� /V°/���' � Map: Lot:
BOH Reviewer: Type of Plan(new or upgrade):
Number of Bedrooms: gpd) Garbage Disposal Allowed:
General Information: N.A.=North Andover Septic Regulations Other numbers refer to Title 5
OK f Problem N/A
Street number and map/lot-220(4)(u)
Maximum scale of 1 "=40'for plot plan-220(4)
Maximum scale of 1 "=20'for profile and component details-220(4)
Legal boundaries of the facility being served-220(4)(a)
Names of abutters from recent tax map- NA 8.02j
L l Number of bedrooms,design talcs.,-NA 8.021
Name&address of record owner&applicant- NA 8,02k
Name&address of designer-NA 8.021
Holder and location of all easements-220(4)(b)
Date plan drawn&any revision date- NA 8.02m
All dwellings and buildings,existing and proposed-220(4)(c)
V j Location of all existing or proposed impervious areas-220(4)(d)
�- All distances on site plan—NA 8.03 a-c
Elevation of proposed driveway-NA 8.02t
Location and elevation of foundation drain-NA 8.02y
,., Location and dimensions of the system Incl.reserve(new const.)-220(4)(e)
Limits of excavation of leach area on site plan-NA 8.02z
Locus plan-220(4)(t) (Not to scale)
North arrow-220(4)(g)
Existing and proposed contours-220(4)(g)
Locations and logs of deep holes-220(4)(h)
Locations and logs of percolation tests-220(4)(i)
Date(s)of soil testing-220(4)(h)&(i)
Existing grade elevation of each deep hole-220(4)(h)
Elevation of percolation tests—N.A. 8.02n
Name of approving authority representative-220(4)(h)&(i)
G Name of soil evaluator-220(4)0)
Z= Soil logs and pert test logs match BOH records
Locations of waterlines,drains,and subsurface utilities-220(4)(m)
Observed and adjusted g.w.elevation in the vicinity of the system-220(4)(n)
Complete profile of the system to scale-220(4)(o),NA 8.02c
Cross section of leaching facility-NA 8.02w (Not to scale)
-� Location of benchmark(s)within 50-75 feet of facility-220(4)(q)
t Note listing all variance requests with proper citations-220(4)(p)
...`" Local upgrade approval request form submitted-403(1)
2
i/r,% Original R.S./P.E. stamp,signature&date-220(1)&(2)
P.E., discipline specified within stamp. MGL C. 112 s. 81M
sfe. supplies(w/in 400'),pub. wells(w/in 250'),pvt.wells(w/in 150')-220(4)(
Location of watercourses,wetlands,wells,etc.w/in 150'of system—NA 8.02r
Wetland disclaimer—NA 8.02s
0( J RLS plan reference&certification required(prop line setbacks)-220(3)
Plan contains designer's certification statement
L Use approvals/standards checked for VA system-DEP docs.,
Perc rate>30 MPI-not allowed for new,LUA for upgrade-245(1)&('3)
r/ Perc rate> 60 MPI-must use modified tight tank or I/A technology-245(4)
u Proposed system qualifies as"shared"system-002(definitions)
Flow is over 2,000 gpd-No R.S. allowed-220(1)
J- Design flow was set in accordance with code-203
Existing system location and note on proper abandonment-354
Leaching facility at least 1' above Base Flood elevation—NA 9.05
All piping Sch 40 minimum—NA 10.01
7 ' Basement floor minimum 1' above groundwater elevation—NA 5.04
c,r Foundation drain present with elevation—NA 8.02y
On-site Soil and Groundwater Review
OKJ Problem N/A
Proper deep observation hole logs on plan-220(4)(h)
All deep holes and peres shown,including aborted tests—NA 8.02n
Soil evaluation forms submitted within 60 days of field work-018(2)
✓,i Proper percolation test log-220(4)(i)
Ample deep observation holes in primary disposal area(minimum 2)- 102(2)
Ample deep observation holes in secondary disposal.area(minimum 2)- 102(2)
Ample perc testing(one in each disposal area,3 in prim.>2,000 gpd)- 104(4)
Deep hole testing conducted within two years—NA 7.05
Hole Identification Numbers:
ground elevation el.
acceptable soil el.
Leach facilitv invert el. /-�•� C�
ground water el.
refusal el.
bottom of leach facility el. (�� l'J
thickness of acceptable soil
before&after soil R&R
separation to groundwater
1 �iseparation to refusal S,: f f.
soil class
2
3
perc rate
J
loading rate I 7�
septic tank below g.w.table lam, (yes or no)
pump tank below g.w. table / ! (yes or no)
1.f in fill r -255(l)
Setback Distances(Given in feet) 15.21 1
YES NO Is the lot in the Lake Cochiewick Watershed? NA 6.00&5.02
OK Problem N/A
Septic Tank Leach Facility
V1 Property line 10 10
✓ Cellar wall 10 20
Inground pool 10 20
Slab foundation 10 10
J Deck,on footings,etc. 5 10
Waterline 10 10
✓' I
' Private drinking well 75 100
Irrigation well 75 100
Wetlands 75 100
Public well 400 400
Wetlands bordering surface 150 150
water Supply or trib.
(in Watershed)
L' Trib. To Surface Water supply 325 325
Lr' Reservoirs 400 400
l' Tributaries to reservoirs 200 200
Drains(wat. supply/trib.) 50 100
Drains(intercept g.w.) 25 50
Foundation drains 10 20
Drains(Other) 5 10
Drywells 20 25
15'to 3:1 slope
Downhill slope P
3
4
w/o barrier
Building Sewer
OK Problem N/A
Grease trap required for certain uses(check 230 for details)
_Pipe diameter listed(4"minimum)-222(1)
Pipe.schedule listed-222(3)
Pipe cast-iron or Sch 40 PVC—NA 11.02
Watertight'joints specified-222(3)&(4)
Pipe laid on compact,fin base-222(5)
Pipe laid on continuous grade in straight line-222(7)@
Cleanouts precede all changes in alignment and grade-222(8)
Cleanout provided every 100-feet-222(8)
Manhole at any 90 degree alignment change-222(8)
Invert elevation at building: f
Invert elevation at septic tank:
Length of run:
Slope: (minimum of 0.01 -0.02'desirrd)-222(6)
10'offset to private well or suction line-222(2)
i
Septic Tank
OK, Problem N/A
Tank is accessible-228(3)
No structures above tank—(228(3)
Tank can accommodate both primary&reserve—NA 9.04
200%of flow(required&provided given. 1500 min.)-220(4)(f)&-223)(1)(a)
2-3"drop from inlet to outlet-227(5)
Minimum of 4'liquid depth-223(2)
`3 air space above tees/baffles(minimum)-227(4)
flair space above flow line(minimum)-227(4)
Tees"arp not to be replaced by baffles-227(1)
Tees extend 6"above flow line-227(1)
Inlet tee extends 10"below flow line(minimum)-227(6)
Outlet tee extends,14"below flow line(more for deeper tanks)-227(6)
Gas baffle installed bn.outlet-227(4)
T Access manhole cover above center of tank&each tee(except 2 compart)
228(2)
3-20"manholes-228(2)
1 childproof,24"riser/manhole'w/in 6"of final grade if<1000gpd-228(2)
Inlet and outlet tees on center line'?2270)
Soil compaction below tank specified(if soil is non-native)-221(2)
6" of<=3/4"stone beneath tank specified-221(2)&22 8(1)
If> 1,000 gpd AND not a single fain.dw ell.must be 2 tks or 2 comp.-223(1)(b)
If plan specifies disposal must be 2 tanks`in series or 2 compart.tank-223(1)(c)
Buoyancy talcs.required if tank at or below1water table-221(8)
Tank is watertight-221 (1)
9"of cover over tank(minimum.)-228(1)
H 10 loading(min.)-H-20 if traffic-226(3)
Top of tank<=36"below grade-221(7)
All pumping to tank(if applies)in accordance with-229
Tank is set to keep old system in service during install if po sible
4
5
Tight Tank(Check here if not present: )
OK Problem N/A
500%of design flow or 2000 gallons provided—260(2)(a)
3-20"manholes—22 8(2)
Soil compaction below tank specified(if soil non-native)—221(2)
6"of<=3/4"stone beneath tank specified—221(2)&228(1)
Buoyancy calcs.Required if tank at or below water table—221(8)
Tank is watertight—221(1)
9"of cover over tank specified(minimum)—228(1)
H 10 loading(min.)—H-20 if traffic—226(3)
Top of tank<=36"below grade—221(7)
All pumping to tank(if applies)in accordance with—229
AN alarm set at 3/5 tank capacity—260(2)(c)
Min. 1-24"frame w/cover at finished grade—228(2)(f)
Year round access for pumping—228(2)(g)
i
Distribution Bog(Check here if not present:^ �
OK Problem N/A
Inlet elevation: `7
Outlet elevation: l7 ��`
0.17'drop from inlet to outlet(minimum)-232(3)(b)
6"sump(minimum)-232(3)(e)
All outlets at same elevation-232(3)(b)
VZ Outlet pipes laid level for first 2 ft. -232(3)(c)
u, Pipe Sch 40-NA 10.01 , 1 '
i Number of outlets: �0) Number of laterals:
Size of outlets: f
Inlet baffle/tee min. 1" over outlet invert for all d-boxes-232(3)(a),
Soil compaction below distribution box specified(if soil is non-native)-221(2)
�- 6"of stone beneath distribution box specified-221(2)
Box is watertight-221 (1)
Top of box<=36"below grade-221(7)
., Buoyancy calculations required if box is at or below water table-221(8)
Pump Chamber(Check here if not present: �` )
OK Problem N/A
Volume specified: 220(4)(r)
Pump on elevation- 220(4)(r)
Pump off elevation: 220(4)(r)
Alarm on elevation: 220(4)(r)
Number of cycles per day-220(4)(r)(also 254(1)(d)if gravity from d-box)
Minimum 2" delivery line to d-box if gravity-254(1)(c)
Pressure dosed 1.£ if flow>=2,000 gpd-254(1)(a)&254(2)(a)
Cycles per day is consistent with chamber volume-23 1
Volume calculations include flowback volume-2') 1(2)
5
e .
e
6 e
24 hour storage capacity above pump on elevation-231(2)
Number of pumps: 2 if system serves>2 dwelling units-231(6)
''Capacity ofpump(s)- gpm @ 'TDH-220(4)(r)
Pump.can pass 1 1/4"solids(minimum)-231(7)
Pump controls specified-220(4)(r)
Alarm equipment specified-231(2)
Alarm is in building and powered on separate circuit from pump-2') 1(9)
Pump sequence correct(off-lead on-lag on-alan-n on)-231(8)
Pump performance curves included-220(4)(r)
Manual operating switch-NA 12.01
Check valve,bleeder hofe-NA 12.01
1 childproof,24"riser/manhole to final grade-2'31(5),
Soil compaction beneath pump.chamber specified(if soil is non-native)-221(2)
6"of<=3/4"stone beneath chmbrspecified-221(2)&228(1),
Buoyancy calculations if chamber is,,aror below water table-221(8)@
9" of cover over chamber(minimum)';228(1)
H- 10 loading(min.)-H-20 if traffic-226(')),
Chamber is watertight-221 (1) .
Top of chamber<=36"below grade-221(7)
Leaching Facility(general-complete for all designs)
I
OK Problem N/A
50%larger if garbage disposal-240(4)
Trenches to be used whenever possible-240(6)
_ No vehicle or imperv. area above 11 unless unavoidable-240(7);NA 13.02
Vented'ifunder impervious cover,-241 (1)
Vented through same pipes as distribution system-241 (1)(a)
/i Vent protected from precipitation/animal entry-241 (1)(b)
Vent is placed beyond traffic or impervious area-24 1 (1)(c)
All lines connected to vent if bed or trenches-241(1)(d)
�-� 9" cover over peastone-240(9)
i.' Reserve area provided(new construction)-248(1)
Reserve 4' from primary leach area-NA 9.04
4'(5'if pert rate<=2 MPl)separation to g.w. -212(a)&(b)
4'(down to 2'with variance or I/A-upgrades only)of natural soil under l.f.
t..�^ GW separation is adjusted to highest existing grade if facility cuts into a hillside
�✓/ : Pipe slope minimum of 0.005-251(9)
1%rte` Require 5'removal and replacement if in fill-255(5)
Top of leach facility<=36"below grade-221(7)
Final grade over 11 minimum 0.02 ft/ft-240(10)
Surface&subsurface drainage away from 11-240(1 1)&245(5).
v' Minimum design flow 440 gpd without deed restriction-NA 13.01
U-1 3:1 slope where grading required-255(2)
Toe of fill slope stops 5'from property line or Swale installed-255(2)
(� Impermeable barrier if<3:1 slope or<15 feet to-3:lslope-255(2)
Impermeable barrier/retaining wall poured concrete-NA 9.02
car Retaining wall stamped by P.E.-255(2)(b)
�- Top of retaining wall>=top of peastone elevation-255(2)(f)
ti°.. 10'offset from edge of leach facility to edge of ret.wall-255(2)(g)
✓' Perc test(s)done in most restrictive layer- 104(2)
Perc test 4'below leaching elevation-NA 7.06
Design flow listed and required/provided leach area given-220(4)(f)
Leach pipes SCH40 PVC-NA 10.01
Leach pipes minimum 4"diameter except for dosed system-NA 14.04
6
7
✓' Leach lines capped,vented;or connected together-251(9)
-! Pressure dosing guidance followed if pressure distribution-254(2)(c),
�X Pressure dosing required over 2,000 gpd or with I/A remedial use-231(1)
Leaching Trenches(Check here if not present:
OK Problem N/A
Number of trenches:
Minimum of 2 trenches-NA 9.01(2)
Depth of trenches(max eff. 2'): -247(l)
Width of trenches(2'min.,4'max.): -251 (1)(b)
Length of trenches(100'max.): -25 1 (1)(a)
Trenches are vented(when>50')-251 (11)
Trenches follow contour lines-251(2)
Trench spacing 3 times effective width or.depth minimum-251 (1)(d) 1
In fill or reserve between trenches, 10'min. -NA 14.01& 14.03
Available leach area given(Min. 5.00 s.f.)-NA 9.01(2)
Bottom=L x W x# = s.f.
i
Sidewall=L x D x# x 2= s. f.
Effective leach area given
Loading factor:
Effective area=total area s.£x LTAR = g/day
Effective area is>=design flow of facility being served
2"of 1/8"- 1/2"2x washed peastone.-247(2)
Trench depth of 3/4"to 1 1/2"double washed stone-247(1)
Leaching Pits(Check here if not present:
OK Problem N/A
#of pits/pit systems: (dosing chamber if>1,231 (1))
Dimensions of each pit or system:L W D
Depth of pits(max eff.2'): -253(1)(a)
Available leach area given
Bottom=L x W x#of systems= s.f.
Sidewall=L+W x D x 2 x#of systems= s.f.
Total area=bottom - +Sidewall = s.f.
Effective leach area given
Loading factor:
Effective area=total area s.f.x LTAR =.____g day
Effective area is>=design flow of facility being served
Minimum of 2 pits at least 13'X16'—NA 9.01(3)
Distribution for galleries/chmbrs. in trench config. -pipe every 20'-253(6)
Distribution for galleries/chmbrs.in bed config.-ea.pipe serves<=40 s.f.-253(6)
Spacing-2 times the effective width or depth(the greater)-253(1)(c)
2"of 1/8"- 1 /2"2x washed peastone.-247(2)
3/4"to 1 1/2"double washed stone-247(1)
Each pit has at least one 20"access cover.24" Cl to grade over 2,000 gpd
-253(3)
Surrounding aggregate thickness between P (min.)and 4'(max.)-253(1)(b)
Vents,if necessary,extend under covers of pit(s)-241 (e)
Leach Fields(Check here if not present:
OK/. Problem N/A
Number of fields: ' (need dosing chamber if> 1)231 (1))
7
8
Length(100'm x.): (-'0 -252(2)(b)
(y/
-' Total area:L x W = ?f s. f.
k,e` Minimum 900 square feet-NA 9.01(1)
_77/7 Distribution lines connected with solid pipe-NA 15.01
Effective leach area given
Loading factor: ? 7 sy
( =
� Effective area=total area �- s.f x LTAR r
Lb7J g/dav
Effective area is>=design flow of facility being served
Minimum of two distribution lines-25.2(2)(a)
6'line separation(max.)-252(2)(d)
4'maximum separation from edge of field to line-'252(2)(e)
10'minimum separation between adjacent leach fields-252(2)(f)
f Between 6"and 12"of 3/4- 1 1/2"stone beneath field-252(2)(g)&247(2)
2"of 1/8"-1/2"2x washed peastone.-247(2)
Final Grading
OIL Problem N/A
Slope over leach area minimum of 0.02 feet/foot-240(10)
V Grading shall divert drainage away from leach area-240(l 1)
Grading slopes away from dwelling
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5/24/01
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