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TOWN OF NORTH ANDOVER
BOARD OF HEALTH
CERTIFICATE OF COMPLIANCE
DATE OF COMPLIANCE
9/26/03
This is to certify that
the individual subsurface disposal system
constructed ( ) or repaired (X)
by
Todd Bateson
at
45 Hollow Tree Lane
has been installed in accordance with the provisions of Title V of the State Sanitary Code and with the
North Andover Board of Health regulations.
The Issuance of this certificate shall not be construed as a guarantee that the system will function
satisfactorily.
jonatha Markey
Chairman,North Andover Board of Health
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TOWN OF NORTH ANDOVER SEWAGE DISPOSAL, SYSTEM
INSTALLATION CERTIFICATION
The,�indersigned hereby certify that the Sewage Disposal System ( ) constructed;
(�repaired:
located at Z� -I� �
was installed in conformance with the North Andover Board of Health approved plan,
System Design Permit# dated with an approved design
flow of 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: _�� I��?�
Engineer Representative
Final inspection date:
Engineer Repres ntative
Installer: Lic.#: Date:
Design Engineer: (A Date: . '"
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AS-BUILT CHECKLIST
LOT NUMBER, STREET NAME
ASSESSORS MAP& PARCEL NUMBER
LOT LINES & LOCATION OF DWELLINGS
LOCATIONS & DIMENSIONS OF SYSTEM
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
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
N&M Job number 1770/
TOWN OF NORTH ANDOVER
INSPECTION CHECKLIST FOR SEPTIC SYSTEMS
Site: `�� �,a��' � r�. ° � P `r: Final bate:
Installer: Tel:
Date Yes No Initials
A. Bottom of Bed
1. Excavation to proper depth /
2. With trenches,sides of excavation are beneath B horizon t --
3. Edge of excavation specified distance from foundation,etc. �...
Comments: (Use back of sheet for diagrams.)
B. Retaining Wall
1. Wall height and width as specified
2. Waterproofed
3. Wall minimum 10'to leaching facility
4. Wall meets specifications of plan
Comments:
C. Building Sewer
1. Pipe diameter minimum 4" ,..
2. Schedule 40 pipe
3. Inlet to tank cemented
4. Slope minimum 0.01 or 1/8"per foot minimum
5. Pipe properly set on compact firm base
6. Pipe laid on continuous grade in straight line
7. Cleanouts precede all change in alignment and grade
8. Manholes at any 900 change ...
9. 1.0'minimum offset to water line ,,.
Comments:
D. Septic Tank
I. Level -
2. 1,500 gal minimum
3. Gas baffle present on outlet l ,
4. Manhole to w/in 6"of grade
5. Manholes over center and each tee ,
6. 3-20"manholes -°
7. Outlet line cemented
8. 2"—3"drop fi•om inlet to outlet
9. Pipe set
10. Compact base with 6"of 1/a"crushed stone under tank i w
11. Tank is watertight
12. Tees 12"off side of tank
N&M Job number 1770/
Date Yes No Initials
Comments:
E. Pump Chamber
1. If separate from tank,compact base with 6"of V stone underneath
2. Minimum 2"pipe to d-box if gravity system
3. 20"access manhole J
4. Tank level /
5. Watertight
6. Tank size agrees with plan specification
7. Manhole to grade
8. Check valve and bleeder hole present
9. Alarm in building on separate circuit
10. Alarm functions
11. Manual operating switch
12. Pump delivers liquid to d-box
Comments:
F. Distribution Box
1. D-box level
2. Minimum 0.17"(2")drop from inlet to outlet t/
3. Minimum 6"sump - v -
4. Outlet pipes show equal distribution ✓
5. Compact base with 6"of stone beneath box t/
6. Box is watertight
7. All lines cemented with hydraulic cement
8. Schedule 40 pipe 1/
9. First 2' from box laid level
Comments:
G. Soil Absorption system
1. All stone double-washed—V—1 %"
-pea stone /
Bucket test done?
2. Minimum 2"of pea stone above distribution lines
3. Minimum 6"stone beneath pipe
4. Distribution lines capped or connected together
5. Toe of slope stops minimum 5' from edge of property; v
5a, if not,then Swale.
Comments:
N&M Job number 1770/
Date Yes No Initials
H. Leach Trenches
1. Minimum 2 trenches
2. Length of trenches agrees with plan. (Max. length 100')
3. Width of trenches agrees with plan-Minimum 2';maximum-4'.
4. Vent present if>50 feet or specified
5. Minimum distance between trenches 10'
6. Pipe slope minimum 0.005 or 6"per 100'
7. Depth of trenches below outlet invert minimum of 6".
8. Pipes set on stable base.
Comments:
I. Leach Field
1. Maximum length of field 100' U
2. Pipe slope minimum 0.005 or 6"per 100' Lr
3. Separation between pipes 6'maximum (/
4. Pipes connected at end&vent end raised
5. Separation between adjacent fields 10'minimum
6. Pipes set on stable base
7. Maximum 4' separation from edge of field to first line
8. Minimum two distribution lines
Comments:
J. Leaching Pits
1. Minimum inlet pipe 4"
2. Pits of concrete
3. Sidewall between 12"and 48"wide
4. Access manholes on each pit
5. Pipes cemented with hydraulic cement
6.
Comments:
K. Final Grade
1. Slope over soil absorption system minimum 0.02
2. All system components covered by at least 9"soil T
3. Cover soil free of stones larger than 6"
4. Grading slopes away from dwelling
5. No areas over system that may pond
6. Grading meets 3:1 slope
7. Minimum of 9"of fill graded over system