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Home My WebLink AboutCertificate of Compliance - 300 RALEIGH TAVERN LANE 2/14/2011 • • PUBLIC HEALTH DEPARTMENT Town of North Andover fommunity Development Division rwRTI('IC rr(F OT CoMPL-T.ANCE As of: February 14, 2011 This is to certify that the indtWual su6surface d&posa(system received a SM7STACTORTINS(E077ONof the: Instaffation of an Individuat iN Site Sewage tD►isposafSystem By, games Kpllitt At: 300 ' h tavern Lane 9Yap-107.,9 Parcel-0128 210/107.A-0128-0000.0 Xorth,gndover, 9l�A 01845 27ie Issriance of tftis certiate shaflnot be construed as a guarantee that the system willfunction satisfactorily. S an T. (Wrsc 9feartFi Directar 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 Fox 978.688.8476 Web www.townofnorthandover.com 1 A. ( r_ 151,4 PUBLIC HEALTH DEPARTMENT � Community Development Division TOWN OF NORTH ANDON ER ��.. SEPTIC DISPOSAL SYSTEM—INSTALLATION CERTIFICATION The undersigned hereby certify that the Sewage Disposal System(instructed;( )repaired; By: J I l LL' I --- - — (Print Name) Located at: _oQ - �. _ �� ' -- - O�'— (Installation.Address) Was installed in conformance with the North Andover Board of Health approved plan,originally dated -?z- ' 10 and last revised on 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. Bottom of Bed Inspection Date: Engineer Representative(Signature) And-Print Name Final Construction Inspection Date:-- --L�w Engineer Representati a(Signature) !!_!u- lu And-Print Name Instal ler: m'"" ;ro�� (Signature) Date: � r'd' And-Pri tit Name Enginer: Vc'QIA J 4C"Na,114 el4-"- (Signature) Date: And-Print Name 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web http://www.townofnortliandover.com lrrvti l/ i / liA✓ of LY I¢f fNia lm � �(,/','f�a.r:+l' f'. 'W'i.... `-..("' C � " p 7 (,___/v7 AS-BUILT, C TONI OF LOT NUMBER, STREET NP1w � ASSESSORS MAP & PARCEL NUMBER LOT LINES & LOCATION OF DWELLINGS k LOCATIONS &DIMENSIONS OF SYSTEM, INCLUDING RESERVE -A 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. g:. NORTH ARROW , LOCATION &ELEVATIONS OF BENCHMARK USED %AORTiN 6 co"I.I.I WICM y1� OA go -I CHU5� PUBLIC HEALTH DEPARTMENT Community Development Division QNSITE WASTEWATER SYSTEM T TI NOTES PATIO .p w. LOCATION IN MAP: LOT: ADDRESS d�� ..; u_A" � �;� INSTALLER �w DESIGNER: PLAN DATE: �, a SOH APPROVAL DATE ON PLAN: � �� INSPECTIONS TANK INSPECTION: i � " 11(1 )(( ( DATE OF BED BOTTOM INSPECTION: DATE OF FINAL CONSTRUCTION INSPECTION: DATE OF FINAL GRADE INSPECTION: SITE CONDITIONS ® Contractor reports any changes to design plan ® Existing septic tank properly abandoned Ej Internal plumbing all to one building sewer ® Topography not appreciably altered Comments: SEPTIC TANK ® Building sewer in continuous grade, on compacted firm base i�(�� "®. Cleanouts per plan Bottom of tank hole has 6 stone base M1 `�"❑ Weep hole plugged .� gallon tank has been installed loading Monolithic tank construction ® Water tightness of tank has been achieved by 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688,9540 Fax 978.688.8476 Web wv✓w.tov✓notnorthandov_er.com Inspection Form June 2008 Y %AORTA O�RtLeo e-1+ O M a _ A C ®" O COCpIC ptWKp 1' SSAC!-0U5��y PUBLIC HEALTH DEPARTMENT (ommunity Development Division testing ❑ Inlet tee installed, centered under access port ❑ Outlet tee installed, centered under access port (gas baffle/effluent filter) ❑ inch cover to within 6" of final grade installed over one access port ❑ Hydraulic cement around inlet & outlet Comments C C�C� 6iJYI (; PUMP CHAMBER ❑ Bottom of tank hole has 6" stone base ❑ Weep hole plugged ❑ gallon Pump Chamber installed ❑ loading ❑ Monolithic tank 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 ❑ cover at final grade installed over pump access poi ❑ Watertightness of tank has been achieved by testing ❑ Hydraulic cement around inlet & outlet Comments: CONTROLPANEL ❑ 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.lownofnorthandover.com Inspection Form June 2008 V%OR Tj 4 6 Y� �„,d 44L NI41 IwKN y7' do F�p'Do? a4CHU51, PUBLIC HEALTH DEPARTMENT Community Development Division DISTRIBUTION-BOX ❑ Installed on stable stone base ❑ H-20 D-Box ❑ Inlet tee (if pumped or >0.08'/foot) ❑ Hydraulic cement around inlet & outlets ❑ Observed even distribution ❑ Speed levelers provided (not required) Comments: SOIL. ABSORPTION SYSTEM',(Generatl) 0 Bottom of SAS excavated down to C `oil layer, as provided I Size of SAS excavated as per plan E Title 5 sand installed, if specified on plan PF40 Mil HDPE barrier installed L, Laterals installed and ends connected to header (and vented if impervious material above) ❑ Elevations of laterals and chambers installed as on approved plan ❑ Retaining wall (boulder/ concrete /timber/ block) ❑ Final cover as per plan .�. omments: SOIL ABSORPTION SYSTEM (Gravel-less Chambers) ❑ Brand and Model of Chamber: Standard Quick 4 Infiltrator Chambers ❑ Number of chambers per row: ❑ Number of rows (trenches): Comments: Total Chambers 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688,9540 Fax 978.688.8476 Web www.town0northandover.com Inspection Form June 2008 ry. tAORTa, ®C�" 0 . ® f� O COCHKMlWKN V^' �A0RtiT¢o �SSACHUS�� PUBLIC HEALTH DEPARTMENT Community Development Division BM = HR = HI = SYSTEM ELEVATIONS ROD ELEVATION AS-BLT INVERT ELEV DESIGN INVERT ELEV Benchmark Building Sewer OUT Septic Tank IN Septic Tank OUT Pump Chamber IN Pump Chamber OUT Distribution Box IN Distribution Box OUT Lateral 1 TOP Lateral 1 INVERT Lateral 2 TOP Lateral 2 INVERT Lateral 3 TOP Lateral 3 INVERT Lateral 4 TOP Lateral 4 INVERT Lateral 5 TOP Lateral 5 INVERT Lateral 6 TOP Lateral 6 INVERT Top of Chamber Bottom of Bed/Chamber 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www,townofnorthandover.com Inspection Form June 2008 %AORTH ® �,c`,E.D IB4 "YO Lp R yP cocNcHIWKw ��SSACHUS�� PUBLIC HEALTH DEPARTMENT fommunity Development Division SKETCH PLAN 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com Inspection Form June 2008 %A®RTI4 ®FRt%-ED ie0 - o Co' COC NBC N[WKN y1' � 'i TED SSAC HUS��,�S 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 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 I 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.lownofnorihandover.com Inspection Form June 2008 FINAL GRADE INSPEC`T'ION Date: , Address: LOAMED? SEEDED? ❑ COVER PER PLAN? Other: t "Z/