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Home My WebLink AboutCertificate of Compliance - 491 SALEM STREET 4/24/2012 • PUBLIC HEALTH DEPARTMENT Town of North Andover (ommunity Development Division Certifi,cate ' nce AS of Apdf24 1201 This is to certify that a SATISF.AC`I0RT IM1PEC`IIO5V Was completed for the: Tuff ' On-Site r DjTqgfS Oy: Toddoateson at: 491 Safem Street Parcel ID :210/038-0010-0000.0 er, °5 The Issuance of this cent cate shaffnot be construed as a guarantee that the On Site Sewage isposaCSystem wifffunction satisfactorily. ,d usa Z4TYSauye-�, R E AS/ z PubfcifeaCth Director 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com w"'"pgCFP"P"&gip"� rt . M A W PUBLIC VMt'ALT11 0EPAR"1' f11i i:nnendsnity Oevelot iffie w Division TOWN OF NORTH ANDOVER SEPTIC DISPOSAL SYSTEM—INSTALLATION CERTIFICATION The undersigned hereby certify that the Sewage Disposal System constructed; repaired; ' By: Tor2(2 (Print Name) Located at: ` Lx H VN'Wi (Installation Address) Was installed in conformance with the North Andover Board of Health approved plan,originally dated u- 10- 11 and last revised on I Z` , —I I ,with a design flow of -44-o 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; '0 , r � , Engineer Representative(Signature) And—Print Name Installer: igftature) Date: " And—Print Name Enginer: 1/ gnature) Date: And—Print Name 1600 Osgood Street, North Andover, Massuchusetts 01845 Phone 978.688.9540 Fox 978.688„8476 Web ttp://www.townainurthondove;r.com o - � k F North Andover Health Department ent y Development Division ONSITE WASTEWATER SYSTEM CON TRUCTION NOTES TIO CATION INFORM ADDRESS: MAP: ° INSTALLER: . .. -.. PDATE —— DESIGNER:,/LAN BOH APPROVAL DATE ON PLAN: � /v/,"--I INSPECTIONS TANK a INSPECTION: DATE OF BED BOTTOM"!NSP ECTION: DATE OF FINAL CONSTRUCTION INSPECTION: 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: 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 ., gallon tank has been installed loading Monolithic tank construction ❑ Watertightness of tank has been achieved by testing E] 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: PUMP CHAMBER Bottom of tank hole has 6" stone base Weep hole plugged F-1 gallon Pump Chamber installed ❑ loading [1' Monolithic tank construction [2"' Inlet tee installed, centered under access port El Pump(s) installed on stable base 6A(A, ❑ Alarm float working F-1 Pump On/Off floats working F-1 Separate on/off floats ❑ Drain hole in pressure line ❑ cover at final grade installed over pump access port ❑ Water tightness of tank has been achieved by ❑ 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 Comments: 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 (General) F, 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 ❑ 40 Mil HDPE barrier installed F-1 Laterals installed and ends connected to header (and vented if impervious material above) ❑ Elevations of laterals and chambers installed as on approved plan F-1 Retaining wall (boulder/ concrete /timber/ block) F-1 Final cover as per plan Comments: SOIL ABSORPTION SYSTEM (Gravel-less Chambers) ❑ Brand and Model of Chamber: Standard Quick 4 Infiltrator Chambers F-1 Number of chambers per row: ❑ Number of rows (trenches): Comments: Total Chambers BM = HR = HI = SYSTEM ELEVATIONS ROD AS-BLT INVERT DESIGN INVERT ELEVATION ELEV 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 INVERT Lateral 5 TOP Lateral 5 INVERT Lateral 6 TOP Lateral 6 INVERT Top of Chamber Bottom of Bed/Chamber SKETCH PLAN 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 3 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 AS-BUILT All changes to the design plan have been reflected on the as-built �J� Is of suitable scale; (one inch=40 feet or fewer for plot plans and one inch=20 or fewer for details of system components) r'? Lot number, Street Name,Assessors Map and Parcel.Numberr�� P Lot Lines and Location of Dwellings served by the system Locations&Dimensions of system, mcludiii j f serve,(if a pplicable) 1""OWN Qi'�! ANDOV F° �. .. Ties to dwelling or Permanent Structure&Wells �fEA �ti� Ft�t4ST'MC�tJT a. From Septic Tank b.From Leach Area Ties to Lot Lines from leach area Locations of Deep Holes&Peres Elevations of Disposal System ' Top of Foundation Elevation Locations of Wells,Drains,Watercourses within 1.50 feet of system �"" Location of water,gas,electric lines,cable Distances from Corners of House to Center of Tank&D-Box f Location of Structures within 6 Inches of Finished Grade rr' Original Stamp&Signature r Location and holder of any easements which could impact the system Impervious Areas;Driveways, etc North Arrow Location&Elevations of Benchmark used STATEMENT ON PLAN(NA 5.3) "I certify the locations, elevations, ties, cover material; exposed component covers etc, shown on this cis-built substantially agree with the approved plan and have determined that the break out elevations, if applicable, have been rnet." Signature of Designer Date or, if a STUCTURAL WALL IS PRESENT(NA 4.9)Letter or statement on the as-built indicating the wall was, or was not, constructed in accordance with the intended design and any manufacturer's specifications Signature of Designer Date As of:Wednesday,April 27,2011