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Home My WebLink AboutCertificate of Compliance - 730 WINTER STREET 7/8/2014 e ° 0 y .�. COPY PUBLIC HEALTH DEPARTMENT Town of North Andover Community Development Division CERTIFICATE OF COMPLIANCE As ® 7/8/2014 This is to certify that the individual subsurface disposal system received a SATISFACTORY INSPECTION of the: Complete Repair and Constructl*on of an On-Sifte Sewage Disposal System By: Chad Jablonski Ate 730 Winter Street Map 104.A Lot 0089 North Andover, MA 01845 The Issuance of this certificate shall not be construed as a guarantee that the system will function satisfactorily. Curt Bellavance Director, Community Development 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com ��ll/I1�1�11111�/iii •„ M 1, North Andover Health Department Community Development Division QNSITE WASTEWATER Y T M CONSTRUCTION NOTES LOCATION INFORMATION ADDRESS: 730 Winter St. MAP: 104A LOT: 89 INSTALLER: Chad Jablonski DESIGNER: Atlantic Engineering & Survey Consultants PLAN DATE: 3/6/12 BOH APPROVAL DATE ON PLAN: 4/2/12 INSPECTIONS TANK INSPECTION: 4/24/14 DATE OF BED BOTTOM INSPECTION:4/24/14 DATE OF FINAL CONSTRUCTION INSPECTION: 4/24/14 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: Contractor will check with designer about not having inspection port go down to the water table. SEPTIC TANK ® Building sewer in continuous grade, on compacted firm base ® Cleanouts per plan ® Bottom of tank hole has 6" stone base ® Weep hole plugged ® 1500 gallon tank has been installed H-20 loading ® Monolithic tank construction ® Water tightness of tank has been achieved by visual testing Z Inlet tee installed, centered under access port ® Outlet tee installed, centered under access port (gas baffle) ® 24" inch cover to within 6" of finish grade installed over one access port ® Neoprene boots Comments: DISTRIBUTION-BOX ® Installed on stable stone base ® H-20 D-Box N/A Inlet tee (if pumped or >0.08'/foot) ® Hydraulic cement around inlet & outlets N/A Observed even distribution N/A Speed levelers provided (not required) ® Schedule 40 PVC Pipe Comments: Only one outlet from D-box because Presby system. SOIL ABSORPTION SYSTEM (General) ® Bottom of SAS excavated down to C soil layer, as provided on plan ® 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: SOIL ABSORPTION SYSTEM (Presby) ® Presby Enviro-Septic ® 40 Linear Feet/row ® Number of rows (trenches): 5 FINAL GRADE Loamed Seeded Cover per plan Comments: DOCUMENTS NEEDED Certification of Installation Form submitted By engineer and signed and dated by Engineer and installer As-Built Plan BM = 140.97 HR = 2.01 HI = 142.98 SYSTEM ELEVATIONS ROD AS-BLT INVERT DESIGN INVERT ELEVATION ELEV ELEV Benchmark Building Sewer OUT 3.64 138.99 138.77 Septic Tank IN 4.14 138.49 138.39 Septic Tank OUT 4.32 138.31 138.14 Distribution Box IN 4.48 138.15 138.04 Distribution Box OUT 4.69 137.94 137.87 Presby Pipe 1 TOP 4.77 138.21 138.12 Lateral 1 INVERT 137.79 137.70 Presby Pipe 2 TOP 4.77 138.21 Lateral 2 INVERT 137.79 137.70 Presby Pipe 3 TOP 4.77 138.21 Lateral 3 INVERT 137.79 137.70 Presby Pipe 4 TOP 4.77 138.21 Lateral 4 INVERT 137.79 137.70 Presby Pipe 5 TOP 4.77 138.21 Lateral 5 INVERT 137.79 137.70 Top of Presby 138.21 138.12 Bottom of Bed/Presby 137.21 137.12 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 Bank 50 56 ® 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 Commonwealth of Massachusetts t City/Town of - Certificate of Compliance 0 N I' Form 3 PtiV1116 rliUiJ�J Ir d 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 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 AMY BRENNAN _ Facility Owner 730 WINTER STREET Street Address or Lot# NORTH ANDOVER MA 01845 _ Cityrrown State Zip Code Designer Information: GEORGE Z BOURAS ATLANTIC ENGINEERING INC. Name Name of Company _ ®� 6/10/2014 Signatyr a Date InstM er Informat' Chad Ja n I _ J Name Name of Company - 6/10/2014 Signature Date Use of this /steisonditioned 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. Approving Authority Signature Date t5form3.doc^06/03 Certificate of Compliance•Page 1 of 1 Commonwealth of Massachusetts I,'ity/Town Of i i li "JUN oa ��1°, Form 3 �°��W4 OF N0R,T1l/311)()VER V iG:.AL"I`I Ii.DEPI� R P ME1',,J 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 ❑ 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 VQ AMY BRENNAN Facility Owner 730 WINTER STREET Street Address or Lot# NORTH ANDOVER MA 01845 City/Town State Zip Code Designer Information: 6 GEORGE Z BOURAS ATLANTIC ENGINEERING INC. Name Name of Company 6/10/2014 Signat re Date Inst `Iler Information: Name Name of Company Signature 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. Approving Authority Signature Date t5form3.doc-06/03 Certificate of Compliance•Page 1 of 1 Town of over® Septic System CHECKLIST 1) .,`All changes to the design plan have been reflected on the as-built 2) _zLIs of suitable scale; (one inch =40 feet or fewer for plot plans and one inch = 20 or fewer for details of system components) 3) -Lot number,Street Name,Assessors Map and Parcel Number 4) Lot Lines and Location of Dwellings served by the system 5) °''Locations,Elevations and Dimensions of system,including,,re�Cive (if applicable) 6) Ties to dwelling or Permanent Structure &Wells a. From Septic Tank&Distribution (D) Box b. From Leach Area 7) " Ties to Lot Lines from leach area 8) Locations of Deep Holes &Peres 9) of Foundation Elevation 10) Locations of Wells,Drains,Watercourses within 150 feet of system 11) Z"'Location of water,gas,electric lines,cable 12) Location of Structures within 6 Inches of Finished Grade 13) 'Original Stamp&Signature 14) �`Lation and holder of any easements which could impact the system 15) o Impervious Areas;Driveways,etc 16) North Arrow 17) Location &Elevations of Benchmark used 18) STATEMENT ON PLAN (NA 5.3) a. ) "I certify the locations,elevations, ties, coverrnaterial;etposed component covets etc.,shown on this as-huilt s1ihs tat tially agree ji7ith the approved plan and have detertrlined that the break out elevations,ifapplicable,have been rrlef Sig ture of Designer Date f1" .. b / `Ifa STUCTURAL WAIL IS PRESENT W 4.9)a Letter or statement on the as-built indieatin�the wall- was,or was not constructed in accordance with the intended design and anvmanzrfactarer's specifications." Signature of Designer Date As of:Friday,April 29,2011 EC?EIV>>'n D Commonwealth of Massachusetts City/Town of Certificate of d C � r,al,i 1 t/v["li��x�rl�J:"" Ht.At V U P f tl yew h i s iV l,t t" Farm3 �� wyNyriNrow , , au 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 ❑ 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 r� AMY BRENNAN _ Facility Owner -------------------- ---------- 730 WINTER STREET en�n Street Address or Lot# NORTH ANDOVER MA 01845 ------------------ -------- ------- City/Town State Zip Code Designer Information: GEORGE Z BOURAS ATLANTIC ENGINEERING INC. Name "7 Name of Company 6/10/2014 -------- -- --------- ----- -------- ------- Sigr,) ture Date In§tller Information: ----------------------- ---- --- -- Name Name of Company --- --------- ----- -------- ------- Signature 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. Approving Authority Signature Date t5form3.doc•06/03 Certificate of Compliance•Page 1 of 1 TO: NORTH ANDOVER, MASS .5 19 7r BOARD OF HEALTH FROM: DESIGN ENGINEER Re: Soil Absorption Sewage System Inspection This is to certify that I have inspected the construction of the said disposal system at 7` 1V'7—,5x? .S T North Andover, Mass. SITE LOCATION The grades and construction are as specified in my plans and specifications dated e f9f. ngl-`gNr/Reg✓Sanitarian r r