HomeMy WebLinkAboutCertificate of Compliance - 99 MARIAN DRIVE 12/8/2008 NORTH
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PUBLIC HEALTH DEPARTMENT
Community Development Division
CE RTI FICA 2�E ®F ®�Vl�'G AA�C E
As of:
December 8, 2008
This is to certify that the individuaCsu6surface disposafsystem received a
SA` ,TSEACT0RT1'NSITECZ70Nof the:
Tuff System Repair of the
Subsurface Sewage 1DisposaCSystem
By:
James Keffett
At:
99 Warian (Drive
9Vap 107.C; Parcef47
North Andover, WX 01845
The issuance of this certificate shaCC not 6e construed as a guarantee that the system wiCC
function satisfactoriCy.
Susan&Sawyer
1t 6Cic Wealth Director
1600 Osgood Street,North Andover,Massachusetts 01845
Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com
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Commonwealth �� Massachusetts
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Certificate of Compliance
Form 3
DEP has provided this form for use by local Boards of H althV]6 the'ffo s 8i b sed, but the
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information must be substantially the same as that providbn&'� Before using f is form, check with
the local Board of Health to determine the form they use.
This is to Certify that the following work on an {}n'Siba Sewage Disposal System
Important:
When filling out F1 Construction ofa new system
forms unthe Z Repair or replacement ofon existing system
computer,use Fl Repair or replacement ofonexinUng system component
only the�bkey
��
0o move your
�
oumor-donn( Has been done in accordance with Title 5 and the Disposal System Construction Permit(DSCP): �
use the return
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DSCP'_ DSCP Date �
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Facilit Owner
Street
Nq�
City/Town State Zip Code
Designer Information:
B New England E i i Services, |
N W7� Name of Conpany
SIT�H Date
Installer Information:
Na�e Name of Company
"90nature Date
� Use of this system is conditioned on compliance with the provisions set forth below: �
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The issuance of this certificate shall not be construed as a guarantee that the system will function as
designed.
Approving Authority
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S'y""°'" Outu �
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AS-BUILT CHECKLIST
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.... LOT NUMBER, STREET NAME
ASSESSORS MAP & PARCEL NUMBER
LOT LINES & LOCATION OF DWELLINGS
N .r 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
t 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
f ORIGINAL STAMP & SIGNATURE
IMPERVIOUS AREAS e DRIVEWAYS, ETC.
...,., NORTH ARROW
LOCATION & ELEVATIONS OF BE CH1IAARK USED
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TOWN OF NORTH ANDOVERraortrr
Office of C,OM UNITY DEVELOPMENT AND SERVICES �,�ayq,Uea
HEALTH DEPARTMENT
1600 OSGOOD STREET;Building 2-36
NORTH ANDOVER,MASSACHUSETTS 01845'
Susan Y. Sawyer,REHS/RS 978.688.9540—Phone
Public Health Director 978.688.8476—FAX
ON SITE A T T SYSTEM T UCTI NOTES
OR
LOCATION INFORMATION
ADDRESS: W ✓' 41 °d=MAP: LOT;
INSTALLER:R ) ,
DESIGNER �•....
PLAN DATE; i '° H
BOH APPROVAL DATE ON PLAN:
INSPECTIONS
TANK INSPECTION:
DATE OF BED BOTTOM INSPECTION: . � ,w
DATE OF FINAL CONSTRUCTION INS P TI N:
DATE OF FINAL GRADE INSPECTION:
SITE CONDITIONS
❑Existing septic tank properly abandoned
❑Internal plumbing all to one building sewer
❑Topography not appreciably altered
Comments:
SEPTIC TANK
Bottom of tank hole has 6" stone base
❑ , Weep hole plugged
1500 gallon tank has been installed
H-10 loading N�dnolithic construction
❑ Water tightness of tank has been achieved
(Visual or Vacuum Test or Water held for 24hrs)
❑ Inlet tee installed, centered under access port
❑ Outlet tee (gas baffle or effluent filter) installed,
centered under access port
❑ 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
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TOWN OF NORTH ANDOVER RTF{A
Office of COMMUNITY DEVF,LOPMENT AND SERVICES 32°`'` °°.
HEALTH DEPARTMENT
1600 OSGOOD STREET; Building 2-36
NORTH ANDOVER,MASSACHUSETTS 01845 'ASSpCH�s����
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
❑ Speed levelers provided (not required)
Comments:
SOIL ABSORPTION SYSTEM
❑ Bottom of SAS excavated down to soil layer, as
provided on plan
❑ Size of SAS excavated as per plan
❑ Title 5 sand installed, if specified on plan
❑ 3/4-1 Y2" double washed stone installed
❑ 1/8-1/2" (peastone) double washed stone installed
❑ Laterals installed and ends connected to header
❑ 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
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