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Home My WebLink AboutCertificate of Compliance - 114 STONECLEAVE ROAD 6/30/2010 I %AORTH W 1 OA 4p�cac.+iinewKa`��* A "C) ACW5 � PUBLIC HEALTH DEPARTMENT Community Development Division June 3 09 2010 This is to certify that the individual su6surface disposal system received a SA71STWTO 7IArSPECTIOWofthe: Tuff&pairl&pfiacement of an On-Site Sewage 04osa[System By: ToddBateson At: 114 Stonecfeave-&ad The Issuance of this certiftate shall not 6e construed as a guarantee that the system will function satisfactorily. ,f r' {{ /Susan T Sawyer, kE3fS19U Pu6ficYfealth Director 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com TOWN OF NORTH zkNDOVER � N01VT11 Q Y4aM Ib Office of COMMUNITY REVEL OP;VIENT AlND SERVICES HEALTH DEPARTMENT a a � � fr W OSGOOD STREET ,p pQhhT�D ',NORTH ANDOVER, MASS,ACHUSETTS 01845 8 C USA` 978.688.9540—Phone Susan Y. Sawyer, REHS/RS 978.688.8476—FAX Public Health Director E-MAIL: healthdept ttownofnorthandover.com W EBSITE: http:, www.townofnorthandover.com TOWN OF NORTH ANDOVER SEPTIC DISPOSAL SYSTEM d INSTALLATION CERTIFICATION The undersigned hereby certify that the Sewage Disposal System ( ) constructed- repaired; by :, (Print Name) located at CA V"- e (Installation Address) was installed in conformance with the Noah Andover Board of Health approved plan, originally dated and last Revised on j f , with a design flow of (11w) 7 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: Engineer Representative(Signature) And- Print Name Final inspection date: Engineer Representative(Signature) �. And- Print Name -,%�M¢Wk vN)d W mytlP W. JbWMZ "'21E4?, auuM1 N'r- dWD9m+.e r t :`WMIAWAIWMWW.AA, M Installer: M — --- Signature) Date: / t And- Print Name Engineer:— _ (Signature) Date: _ _ And-Print Name ----- — i-- i Commonwealth Of Massachusetts ��a�� K City/Town Of NORTH ANDOVER TtbPt4d)l Pat Yr,ifrEtdfl�:htfR 4 Certificate Ii 1 �EI , ,� � Form 3 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 Sewaqe Disposal System Important: When filling out ❑ Construction of a new system forms on the ® Repair or replacement of an existing system computer,use F1 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 Q Facility Owner ---------------- ---------- 114 STONECLEAVE ROAD Street Address or Lot# NORTH ANDOVER MA 01845 _ CitvTrown State Zip Code Designer Information: BENJAMIN C OSGOOD JR. ---------- -----------Name of of Company ... " " 7-14-10 -------------- ---- ------ natur ' Date Installer 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•06103 Certificate of Compliance•Page 1 of 1 elleChiaie, Pamela From: Isaac Rowe [irowe @millriverconsulting.com] Sent: Monday, June 28, 2010 10:50 AM To: 'Daniel Ottenheimer'; Grant, Michele; irowe @millriverconsulting.com; 'Marianne Peters'; DelleChiaie, Pamela; 'Randy Burley'; Sawyer, Susan Subject: 114 Stonecleave Road Attachments: 114 Stonecleave Road - Final Inspection 6-23-10.doc; Construction Inspection Form 6-10.doc Susan, Please find attached the final inspection report for the above referenced property. The outlet invert of the pump chamber will be a lot lower than on the proposed plan in order for the force main to drain back to pump chamber. Ben should indicate what the elevation is but it will be approximately 12" above bottom of tank. You may need them to request a post LUA for the invert being less than 12" above ESHWT depending on what elevation Ben indicates on his as-built plan. On the approved plan there was a belly in the force main and this should have been addressed prior to approval. We did make a note on our plan review. So Todd Bateson did the correct thing by lowering the outlet of the pump chamber to ensure complete drain of the force main to prevent any freezing issues. Pam—I also attached a blank construction inspection form. Not too many changes compared to the previous form. Please let me know if you have any questions. Thank you, Isaac Isaac M. Rowe,R.S. Project Manager Mill River ::`o nsantt nn 6 Sargent Street 1 FORTH 4 6 o 0 ° rar � PUBLIC HEALTH DEPARTMENT Community Development Division QNSITE WASTEWATER SYSTEM T UJ TI LOCATION INFORMATION ADDRESS: 114 Stonecleave Rd MAP: 104B LOT: 138 INSTALLER: Todd Bateson DESIGNER: Ben Osgood, Jr. PLAN DATE: 10/19/09 BOH APPROVAL DATE ON PLAN: 11/15/09 INSPECTIONS TANK INSPECTION: DATE OF BED BOTTOM INSPECTION: DATE OF FINAL CONSTRUCTION INSPECTION: 6/23/10 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: Laundry now connected to building sewer line and laundry system abandoned. SEPTIC TANK ® Building sewer in continuous grade, on compacted firm base NA Cleanouts per plan ❑ Bottom of tank hole has 6" stone base ® Weep hole plugged ® 1500 gallon tank has been installed H-10 loading ® Monolithic tank construction 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web Wgw.town0northundover.com Inspection Form June 2008 ORT y 4° RA V" a ��^yb teac rii<wS�xcra �� A 91 pPa4YCCi 0 SS 16 PUBLIC HEALTH DEPARTMENT Community Development Division ® Water tightness of tank has been achieved by Visual testing ® Inlet tee installed, centered under access port ® Outlet tee installed, centered under access port (effluent filter) ® 24" inch cover to final grade installed over outlet access port ® Hydraulic cement around inlet & outlet Comments: PUMP CHAMBER Bottom of tank hole has 6" stone base ® Weep hole plugged ® 1000 gallon Pump Chamber installed ® H-10 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 ® 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 PANEL ® Alarm & Pump are on separate circuits ® Alarm sounds when float is tripped ® Location of control panel: basement ® Alarm signal located inside: basement 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorlhondover,com Inspection Form June 2008 0RT ,. � GpC alYf ali�lh( �• ' A M9lb 5 PUBLIC HEALTH DEPARTMENT (ommunity 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 NA Speed levelers provided (not required) Comments: 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 NA 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 NA Retaining wall (boulder/ concrete /timber/ block) ❑ Final cover as per plan Comments: SOIL ABSORPTION SYSTEM (Gravel-less Chambers) ® Brand and Model of Chamber: Standard Quick 4 Infiltrator Chambers ® Number of chambers per row: 8 ® Number of rows (trenches): 4 Comments: Total Chambers = 32 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townolnorthandaver.cam Inspection Form June 2008 2D;6140 S C t9 US PUBLIC HEALTH DEPARTMENT (ommunity Development Division BM = 96.45 HR = 3.74 HI = 100.19 SYSTEM ELEVATIONS ROD ELEVATION AS-ELT INVERT ELEV DESIGN INVERT ELEV Benchmark Building Sewer OUT 5.22 94.62 93.00 Septic Tank IN 5.42 94.42 92.80 Septic Tank OUT 5.68 94.16 92.55 Pump Chamber IN 5.76 94.08 92.20 Pump Chamber OUT(2") 91.08+/- refer to as- built plan Distribution.Box IN 2" 5.16 94.86 94.93 Distribution Box OUT 5.15 94.69 94.76 Lateral 1 TOP 5.18 Lateral 1 INVERT 94.66 94.66 Lateral 2 TOP 5.18 Lateral 2 INVERT 94.66 94.66 Lateral 3 TOP 5.18 Lateral 3 INVERT 94.66 94,66 Lateral 4 TOP 5.18 Lateral 4 INVERT 94.66 94.66 Top of Chamber 5.06 95.13 95.00 Bottom of Bed/Chamber 6.06 94.13 94.00 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978,688.9540 Fax 978.688.8476 Web www,towno60orthJNiiclov,er_c� Inspection Form June 2008 � o C0r- 4 0 re 40CW CY OwKw 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 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 t 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 wrvrw.townafnorthandover.com Inspection Form June 2008 TOWN OF NORTH ANDOVER µORTH q4, Office of CONI1V1UNI.TY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT 1600 OSGOOD STREET; Building 2-36 NORTH ANDOVER, MASSACHUSETTS 01845gs sacuse Susan Y. Sawyer,REHS/RS 978.688.9540—Phone Public Health Director , / / �f C 978.688.8476—FAX QNSITE WASTEWATER 9LS EM CONSTRUCTION NOTES LOCATION INFORMATI � ADDRESS: MAP: LOT: INSTALLER: .. DESIGNER: Bo APPROVAL DATE ON PLAN: /� r INSPECTIONS TANK INSPECTION: DATE OF BED BOTTOM INSPECTION: � e-x DATE OF FINAL CONSTRUCTION INSPECTION: DATE OF FINAL GRADE INSPECTION: SITE CONDITIONS �� ❑Existing septic tank properly abandoned ❑Internal plumbing all to one building sewer Comments: ❑Topography not appreciably altered SEPTIC TANK Bottom of tank hale has 6" stone base Weep hale plugged 1500 gallon-tankw 0 loading ono.iithic construco . 1 s h Vacuum Tess n achieved tor-( ! t t or Water held for 2,4hrs) Inlet tee installed, cente�drdc ess port ❑ Outlet tee (gas baffle effluent fi installed, centered under access ObFff- P1 24" inch cover to within 6" of final grade installed over one access port, must be over outlet of tank if effluent filter is present Hydraulic cement around inlet & outlet Wastewater System Documentation—Feb 2006 Page i of 6 TOWN OF NORTH ANDOVER F ,,o"T„ Office of COMMUNITY DEVELOPMENT AND SERVICES �?°`` ..,°a" 0. HEALTH DEPARTMENT '0 A 1600 OSGOOD STREt-T;Building 2-36 NORTH ANDOVER, MAS SACHUSETTS 01845 SAC Ac HUSE Susan Y.Sawyer,REHS/RS 978.688.9540—Phone Public Health Director 978.688.8476—FAX Comments: PUMP CHAMBER [Bottom of tank hole has 6" stone base Weep hole plugged [❑ o Tank installed. Size: 000 gallon Pump Chamber installed onolithic c struction) In e tailed, 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" inch cover to within 6" of final grade installed over r pump access port ® Water tinhtnegc of flank has bean achieved Visual testing ® Comments: Hydraulic cement around inlet & outlet ADVANCED TREATMENT TECHNOLOGY ❑ Type of treatment device: ❑ Installed per manufacturers requirements ❑ All components working in accordance with manufacturer's requirements Comments: Wastewater System Documentation—Feb 2006 Page 2 of 6 TOWN OF NORTH ANDOVER F NoerH Office of COMMUNITY DEVELOPMENT AND SERVICES °``t eO °" 4,0 HEALTH DEPARTMENT p 1600 OSGOOD STREET; Building 2-36 M� NORTH ANDOVER,MASSACHUSETTS 01845 ��SSacHUSeK�y Susan Y. Sawyer,REHS/RS 978.688.9540—Phone Public Health Director 978:688.8476-FAX D-BOX ❑ Installed on stable stone base ❑ Inlet tee (if pumped or >0.08'/foot) ❑ Hydraulic cement around inlet & outlets ❑ Observed even distribution El levelers provided (not required) Comments: J + SOIL ABSORPTION SYSTE Bottom of SAS excavated down tool/soil layer, as provided on plan Size of SAS excavated as per plan Title 5 sand installed, if specified on plan 3/4-1 '/2" double washed stone installed ❑ 1/8-1/2" (peastone) double washed stone installed n Laterals installed and °nclls Connertort to header ec .❑ Laterals vented if impervious material above ❑ Orifices @ 5 & 7 o'clock positions ❑ Gravel-less disposal systems: type, number and location as per plan ❑ Elevations of laterals installed as on approved plan ❑ 40 Mil HDPE barrier installed ❑ Retaining wall (boulder/ concrete /timber/ block) ❑ Final cover as per plan Comments: Wastewater System Documentation-Feb 2006 Page 3 of 6 TOWN OF NORTH ANDOVER NORTH Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT p 1600 OSGOOD STREET; Building 2-36 NORTH ANDOVER,MASSACHUSETTS 01845 SacHUS� Susan Y. Sawyer,REHS/RS 978.688.9540—Phone Public Health Director 978.688.8476—FAX PRESSURE DISTRIBUTION ❑ -- inch manifold ❑ laterals installed with end sweeps size: material: ❑ Squirt test ft in height ❑ Equal distribution to all laterals ❑ Comments: orifice size inch as per plan CONTROLPANEL ❑ Alarm & Pump are on separate circuits ❑ Alarm sounds when float is tripped Location of control panel: ❑ Comments: Rated for exterior if placed outside Wastewater System Documentation—Feb 2006 Page 4 of 6 TOWN OF NORTH ANDOVER a NoerH Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT v 1600 OSGOOD STREET;Building 2-36 NORTH ANDOVER,MASSACHUSETTS 01845 �qs"""°"'��° SHCHUSE Susan Y. Sawyer,REHS/RS 978.688.9540—Phone Public Health Director 978.688.8476—FAX 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 1 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 Wastewater System Documentation—Feb 2006 Page 5 of 6 TOWN OF NORTH ANDOVER NORTH Office of COMMUNITY DEVELOPMENT AND SERVICES HE, DEPARTMENT � E � A 1600 OSGOOD STREET;Building 2-36 NORTH ANDOVER,MASSACHUSETTS 01845 pSSACHUSEK Susan Y. Sawyer,REHS/RS 978.688.9540—Phone Public Health Director 978.688.8476—FAX SYSTEM ELEVATIONS INVERT ON DESIGN PLAN FIELD INVERT ELEV. Building Sewer OUT Septic Tank IN Septic Tank OUT Pump Chamber IN Pump Chamber OUT Distribution Box IN Distribution Box OUT Lateral 1 HIGH Lateral 1 LOW Lateral 2 HIGH Lateral 2 LOW Lateral 3 HIGH Lateral 3 LOW Lateral 4 HIGH Lateral 4 LOW Lateral 5 HIGH Lateral 5 LOW Wastewater System Documentation—Feb 2006 Page 6 of 6