HomeMy WebLinkAboutCertificate of Compliance - 385 RALEIGH TAVERN LANE 12/18/2001 Town of North Andover , NORTH
Office of the Health Department
Community Development and Services Division
27 Charles Street
North Andover,Massachusetts 01845 "SSgcHUS``�
Sandra Starr Telephone(978)688-9540
Public Health Director Fax(978)688-9542
TOWN OF NORTH ANDOVER
BOARD OF HEALTH
CERTIFICATE OF COMPLIANCE
DATE OF COMPLIANCE
1211W01
This is to certify that
the individual subsurface disposal system
constructed O or repaired (X)
by
y
John Soucy
at
385 Raleigh Tavern Lane
has been installed in accordance with the provisions of Title V of the State Sanitary Code and with the
North Andover Board of Health regulations.
The Issuance of this certificate shall not be construed as a guarantee that the system will function
satisfactorily.
pan J. LaGrasse
Board of Health Inspector
BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535
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' TOW NN' OF ;rORrfH ANBOVER SMVAGE,,'� DISPOSAL S) q�ci��z
I\,STAS.X.A-no,\! CERTIFICATION
1-he undersW_,ed here.,v certify that the Sewage Disposal SYste.:n 2' ! co�str..2ct d;
(X) re^aired; y
located at A A;E'
was installed in cbnfermance with the Iiiiii �`t Ando,,i Board of Health a`provec plan,
Svstern Desi17n Pe;:rit dated. wit an approved design
Flow of gallons per day The mate a:s use,,-; were in conformance `-viih those
specisied oh the appro%•ed plan; the system was installed in accordar.ce ,,,iih thz provisions
of 3 10 Cam. 15.000, Title 5 and local regulations, and the anal E?radinry agrees
substantially with the approved plan. ,-U work is accurately reoresented ,)r. the As-built
M6ch has been submitted to the Board c:H'ifalth
Bee inspection date:
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EnQineer .
Re,;mr siit!::.ative
Final inspect-'on date ►�. , l �__ - �. Cw t
T � L-nCir.eer Rzpresz:-:cat:.e
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Cesi<_rri Engin er: �. Date
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INSPECTION CHECKLIST FOR SEPTIC SYSTEMS
Yes NO Init' is
A. Bottom of Bed Q�
1. Excavation to proper depth
2. With trenches,sides of excavation are beneath B horizon `
3. Edge of excavation specified distance 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 "
1. 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
10. 10'minimum offset to water line
Comments:
D. Septic Tank
1. 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/4"crushed stone under tank w
14. Tank is watertight a.
Comments:
Yes NO
' E. Pump Chamber
1. If separate from tank,compact base with 6"of/<"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
11. Manual operating switch 1
. F
12. Pump delivers liquid to d-box
Fl,
Comments:
t.
F. Distribution Box
1. D-box level
2. Minimum 0.1 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
8. Schedule 40 pipe
Comments:
G. Soil Absorption system
1. All stone double-washed-3/4"-1 %"
-pea stone
Bucket test done? 'c
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
1.. 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<S0 feet or specified \
5. Distance between trenches minimum 4' and maximum of 6'
6. Minimum distance betweeu`trenches 10'
7. Pipe slopes minimum 0.005 or 6.'per 100'
8. Depth of trer}ches below outlet invert minimum of 6".
t
Yes NO
9. Pipes set on stable base.
Comments:
I. 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
I Leaching Pits
1. Minimum inlet pipe 4"
2. Pits of concrete
j 3. Sidewall between 12"and 48"wide
4. Access manholes on each pit
5. Pipes cemented with hydraulic cement
Comments:
E
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
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AS-BUILT CHECKLIST
� Y
LOT NUMBER, STREET NAME
ASSESSORS MAP & PARCEL
,- NUMBER
LOT LINES & LOCATION OF DWELLINGS
LOCATIONS &DIMENSIONS OF SYSTEM,
INCLUDING RESERVE
TIES TO LOT LINES & DWELLING, WELLS
a. FROM SEPTIC TANK
b. FROM LEACH AREA
LOCATIONS OF DEEP HOLES & PERC
TESTS
ELEVATIONS OF DISPOSAL SYSTEM
TOP OF FDN ELEVATION
LOCATIONS OF WELLS, DRAINS, WATERCOURSES
WITHIN 150' OF SYSTEM
LOCATION OF WATER, GAS, ELECTRIC LINES, CABLE
DISTANCES FROM CORNERS OF HOUSE TO CENTER OF
TANK& D-BOX
ORIGINAL STAMP & SIGNATURE
IMPERVIOUS AREAS - DRIVEWAYS, ETC.
NORTH ARROW
,� J LOCATION &ELEVATIONS OF BENCHMARK USED