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Home My WebLink AboutCertificate of Compliance - 194 OLYMPIC LANE 2/23/2010 NORTW O t p �RA0RATED �SSAC HUS�� PUBLIC HEALTH DEPARTMENT Community Development Division CERTIFICArIE OF C01"1'.GI.,gXCE As of: February 23, 2010 This is to certify that the individual subsurface disposal system received a SA7IS WTORTINSIPECTIONof the: ftairlWsp&cement of an On Site Sewage �1�isposaCSystem By ,john Soucy At: 194 Of Cane 911ap-106.B; Parcel-128 90rtfi,gndover, JKA 01845 The Issuance of this certificate shall not 6e construed as a guarantee that the system will function satisfactorily. S n 7 Sazvy , 1� S19U Pu6lic Yfealth Director 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com Commonwealth of Massachusetts City/Town of NORTH ANDOVER u hCertificate of Compliance Form 3 At�C�C�WIR TMIMT 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 forms ❑ Construction of a new system on the computer, ® Repair or replacement of an existing system use only the tab Repair or replacement of an existing system component key to move your cursor-do not use the return Has been done in accordance with Title 5 and the Disposal System Construction Permit(DSCP): key. rQ DSCP Number DSCP Date Sarah Keogh Facility Owner 194 Olympic Lane Street Address or Lot# North Andover MA 01845 City/Town State Zip Code Designer Information: BENJAMIN C. OSGOOD, JR PENNONI ASSOC Narxie Name of Company gnat y— Date Installer Information: John Sous Name Name o Comp y ;, Sig use V Date U se,fof this syste is condition on compliance with the provisions set forth below: n s tale) C- t,t�l �` i k lMiUt/ �t art �,;� The issuance of this certificate shall not be construed as a guarantee that the system will function as designed Approving Apt,'on y / Signatdre Date t5form3.doc•06/03 Certificate of Compliance•Page 1 of 1 oopr I ORT��j ,6 ,* qp tae 11 PUBLIC HEALTH DEPARTMENT Community Development Division QNSITE WASTEWATER SYSTEM TI NOTES LOCATION INFORMATION ADDRESS: 194 Olympic Lane MAP: 106B LOT: 126 INSTALLER: John Soucy DESIGNER: Ben Osgood PLAN DATE: 7/22/09 BON APPROVAL DATE ON PLAN: 10/16/09 INSPECTIONS TANK INSPECTION: DATE OF BED BOTTOM INSPECTION: DATE OF FINAL CONSTRUCTION INSPECTION: 11/25/09 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: Design plan proposed to keep existing septic tank but it was not watertight, installed new 1500 gallon septic tank SEPTIC TANK ® Building sewer in continuous grade, on compacted firm base ® 1500 gallon tank has been installed H-10 loading mono construction ® Water tightness of tank has been achieved by Visual testing ® Inlet tee installed, centered under access port 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townohorthondoverarn Inspection Form June 2008 ORT�4 r�-e 0 a7 cac«isa 4A 13AC H PUBLIC HEALTH DEPARTMENT (ommunity Development Division ® Outlet tee installed, centered under access port (effluent filter) ® 24" inch cover to within 6" of final grade installed over one access port ® Hydraulic cement around inlet & outlet Comments: 24" C.I. manhole covers to grade above inlet and outlet. PUMP CHAMBER ® 1000 gallon Pump Chamber installed ® H-10 loading monolithic construction) ® Inlet tee installed, centered under access port ® Pump(s) installed on stable base ® Alarm float working ® Pump On/Off floats working ® Separate on/off floats ® Drain hole in pressure line ® 24" cover at final grade installed over pump access port ® Water tightness of tank has been achieved by Visual testing ® Hydraulic cement around inlet & outlet Comments: CONTROL PAN L ® Alarm & Pump are on separate circuits ® Alarm sounds when float is tripped ® Location of control panel: basement ® Alarm signal located inside: basement Comments: 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 Fax 978.688,8476 Web www.townofaortltandover.com Inspection Form June 2008 I D " r &SAC HU PUBLIC HEALTH DEPARTMENT Community Development Division DISTRIBUTION-BOX ® Installed on stable stone base ® Inlet tee (if pumped or >0.08'/foot) ® Hydraulic cement around inlet & outlets ® Observed even distribution N/A Speed levelers provided (not required) Comments: 2" x 4" coupling installed 5'+/- prior to D-box inlet to reduce velocity of effluent. SOIL ABSORPTION SYST M (General) M Size of SAS excavated as per plan ® Title 5 sand installed, if specified on plan ® 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: SOIL ABSORPTION Y TE (Gravel-less Chambers) ® Brand and Model of Chamber: Standard Quick 4 Infiltrator Chambers ® Number of chambers per row: 6 ® Number of rows (trenches): 6 Comments: Total number of Chambers = 36 1600 Osgood Street,North Andover,Massachusetts 01045 Phone 979.688.9540 Fax 978.688.8476 Web www tov_an0northandover.cant Inspection Form June 2008 t4ORTH ` . 6 L q SS CHU PUBLIC HEALTH DEPARTMENT fommunity Development Division BM = 98.74 HR = 2.88 HI = 101.62 SYSTEM ELEVATIONS ROD ELEVATION AS-ELT INVERT ELEV DESIGN INVERT ELEV Benchmark Building Sewer OUT 7.35 93.92 ___ Septic Tank IN 7.60 93.67 --- Se tic Tank OUT 7.88 93.39 93.50 Pump Chamber IN 7.95 93.32 93.40 Pump Chamber OUT 2" 8.40 93.05 93.15 Distribution Box IN 4" 4.70 96.57 96.53 Distribution Box OUT 4.84 96.43 96.36 Lateral 1 TOP 4.93 Lateral 1 INVERT 96.34 96.25 Lateral 2 TOP 4.93 Lateral 2 INVERT 96.34 96.25 Lateral 3 TOP 4.93 Lateral 3 INVERT 96.34 96.25 Lateral 4 TOP 4.93 Lateral 4 INVERT 96.34 96.25 Lateral 5 TOP 4.93 Lateral 5 INVERT 96.34 96.25 Lateral 6 TOP 4.93 Lateral 6 INVERT 96.34 96.25 Top of Chambers 4.88 96.74 96.59 Bottom of Bed/Chamber 5.88 95.74 95.59 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 918.688.9540 Fax 918.688.8416 Web www.townofnorthandover.com Inspedion Form June 2008 oF� wt .�%.PD ,6�ash 0 ., a tGCMdC 9�MCW k��' °weer" � SSA US " PUBLIC HEALTH DEPARTMENT (Ommunity 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 10' ® Private drinking well 75 1002 50 ® Irrigation well 75 100 ® Surface Water 25 50 ® Bordering Vegetated Wetland , Salt Marsh, Inland/Coastal Bank 75 100 ® Wetlands bordering surface water supply or trib. (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 Fax 978.688.8476 Web www.lown0northandover.com Inspection Form June 2008 FINAL GRADE INSPECTION Date: Address: ❑ LOAMED? ❑ SEEDED? ❑ COVER PER PLAN? Other: Date..... (....; : pyoR/h _ OWN OF NORTH ANDOVER +� PERMIT FOR WIRING NG This certifi that ............ ..............4 ................... .................... has pertnissi on to perform .... J/..rG......�y51.. .......................... wiring in th building of.............!.�,.�;. "�.� ...................;...................... .., � / � � • ! /f/ :..�`/Lr<•. ,North Andover,Mass. Fee.... .. .... Lic.No.. ELECTRICAL I CT6 Check n 9120 'flwtZ LOT NUMBER, STREET NAME all ASSESSORS MAP & PARCEL NUMBER s r 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 , LOCATION& ELEVATIONS OF BENCHMARK USED