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Home My WebLink AboutCertificate of Compliance - 545 JOHNSON STREET 10/29/2010 0 ° �6V,6' i�,,ei V N^ PUBLIC HEALTH DEPARTMENT Town of North Andover Community Development Division ., p Lrf m As 0 ® October 29, 2010 This is to certify that the individuaCsu6surface drsposalsystent receiveda SMIS FACT01RT INNEC7IOX of the. ft&cement of an individuaf On-Site Sewage "osafSystem : Dan Bn*scoe At2,,W 4�jofinson Street : 210/098.A-0013-0000.0 or t6 Xndover, 9WX 01845 The Issuance of this certificate shaff not 6e construed as a guarantee that the system wifffunction satisfactorify. S in Sauyer,- . (Pu6lu afecaCth Director 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnortliandover.com AS-BUILT CRECKILIST LOT NUMBER, STREET NAME ASSESSORS MAP & PARCEL NUMBER 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 ri 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 , Ll LOCATION & ELEVATIONS OF BENCHMARK USED Commonwealth of Massachusetts -- it /Town of North Andover Certificate Compliance -n, 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 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. Frank Peluso Facility Owner 545 Johnson Street Street Address or Lot# North Andover MA 01845 CikylTown � State Zip Code Designer Information: an, P.E. .� Scanlan Engineering LLC -___ — - James Scanl H w�i� � '� M Narr+e Name of Company - A �- 10/14/10 _ nature Date b 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^06/03 Certificate of Compliance•Page 1 of 1 „ AS-BLFILT CHECKLIST LOT NUMBER, ST E-T'NAME ASSESSORS MAP & PARCEL NUMBER LOT LINES &LOCATION OF DWELLINGS f� LOCATIONS & DIMENSIONS OF SYSTEM, 'EB” ,a....: w....�� ....SERVE . ..�UD�1VG RE.....��. TIES TO LOT LINES & DWELLING, WELLS A". -_.FR( .M...SEPTI"CTANK 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 a sIe,ou $6 SS -p9�. C4YK ri14 lq� t PUBLIC HEALTH DEPARTMENT Community Development Division QNSITE WASTEWATER SYSTEM CONSTRUCTION T LOCATION INFORMATION ADDRESS: 545 Johnson Street MAP: 93A LOT: 13 INSTALLER: Dan Briscoe DESIGNER: James S and n PLAN DATE: 7/30/10 1 BOH APPROVAL DATE ON PLAN: 9/14/10 INSPECTIONS TANK INSPECTION: �'r �i DATE OF BED BOTTOM INSPECTION: DATE OF FINAL CONSTRUCTION INSPECTION: 10/4/10 DATE OF FINAL GRADE INSPECTION: 10 1 l ll 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 ® 1500 gallon tank has been installed H-20 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 a rww.townofnorthondovor.com, Inspection Form June 2008 qt)F W '�SA MIU PUBLIC HEALTH DEPARTMENT Community Development Division Visual testing ® Inlet tee installed, centered under access port ® Outlet tee installed, centered under access port (gas baffle/effluent filter) ® 20" 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: C N1° OL 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 wwwr_._towiiofiiortlrandove.r.coni Inspection Form June 2008 o 2 PUBLIC HEALTH E TM Community Development Division DISTRIBUTION-BOX ® Installed on stable stone base ® H-20 D-Sox ® Inlet tee (if pumped or >0.08'/foot) ® Hydraulic cement around inlet & outlets ® Observed even distribution ® Speed levelers provided (not required) Comments: Speed levelers do not prohibit the effluent from draining into laterals during dose. SOIL A PTIO SYSTEM (General) fK 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 ® 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: 1600 Os0ood Street,North Andover,Mossachusens 01845 Phone 978.688,9540 Fax 978.688.8476 Web %wwwr.,townofriortliaiidov_ercoiii Inspection Form June 2008 Ot f « SS t ffi � PUBLIC EALTH DEPARTMENT Community Development Division Bill ® 100.00 HR = 3.84 HI ® 103.84 SYSTEM ELEVATIONS ROD ELEVATION AS-ELT INVERT ELEV DESIGN INVERT ELEV Benchmark 100.00 Building Sewer OUT 6.21 97.28 97.4+/- Se tic Tank IN 6.58 96.91 97.20 Septic Tank OUT 6.85 96.64 96.95 Pump Chamber IN 6.88 96.61 96.93 2" Pump Chamber OUT 6.50 97.17 97.18 2" Distribution Box IN 2.86 100.81 100.74 Distribution Box OUT 2.85 100.64 100.57 Lateral 1 TOP 292/307 Lateral 1 INVERT 100.57/100.42 100.54/100.40 Lateral 2 TOP 291/305 Lateral 2 INVERT 100.58/100.44 100.54/100.40 Lateral 3 TOP 292/306 Lateral 3 INVERT 100.57/100.43 100.54/100.40 Lateral 4 TOP 293/306 Lateral 4 INVERT 100.56/100.43 100.54/100.40 Bottom of Bed 99.9 99.9 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web a www.townoNorthandover.cam, Inspection Form June 2008 %40RTH 06 0 0 to 0 U PUBLIC HEALTH DEPARTMENT (ominunity Development Division CRITICAL SETBACK DISTANCES Mark those distances checked in the field against the design plan and regulatory setback Tank SAS Sewer Z 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 Z Interim Wellhead Prot. Area E Reservoirs 400 400 Z Drains (wat. supply/trib.) 50 100 Drains (intercept g.w.) 25 50 Drains (Other)Foundation 10(5) 20(10) Z 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 1600 Osgood Street,North Andover,Mossuchusens 01845 Phone 978.688.9540 Fax 978.688,8476 Web www.townofnorthandover.com Inspection Form June 2000 FINAL, GRADE INSPECTION ' Date: Address: f t i • LOAMED? • SEEDED? COVER PER PLAN? { Other: i