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Home My WebLink AboutCertificate of Compliance - 60 PATTON LANE 11/22/2011 i PUBLIC HEALTH DEPARTMENT Town of North Andover Community Development Division e ' i As of This is to certify that a Was completed for the: in a i o . _ ` � d e 76 re ,an a ( a to L ne Map-4 06.,A~(ffirce - T The Issuance of this certificate shall not be construed as a guarantee that the On-Site ,Sewage DisposafSystem wiff wnction satisfactorify. r �Pu6Cic ifealth(Director 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.town0northandover.com - a � ,, Commonwealth of Massachusetts Map-Block-Lot • BOARD OF HEALTH Permit No North Andover BHP-2011-0822 P.1. FEE F.I. $125.00 DISPOSAL WORKS CONSTRUCTION PERMIT Permission is hereby granted Todd Bateson i f to(Repair-D-BOX ONLY)an Individual Sewage Disposal System. J at No 60 PATTON LANE I as shown on the application for Disposal Works Construction Permit No. BHP-2011-082_ Dated November 14,2011 Issued On: Nov-14-201 1 OAS F,HEAT TI Commonwealth of Massachusetts Map-Block-Lot • BOARD OF HEALTH 106.A0166 0 North Andover CERTIFICATE I i THIS IS TO CERTIFY,That the Individual Sewage Disposal System (Repair-D-BOX ONLY) by Todd Bateson - Installer at No 60 PATTON LANE has been installed in accordance with the provisions of TITLE 5 of the State Environmental Code as described in the application for Disposal Works Construction Permit No. BHP-2011-082 Dated November 14,2011 Printed On: Nov-14-201 1 BOARD OF HEALTH p1tlRTy I� i fir ti a1 ... ' . . TOWS DATE $250.00®Full Repair -- � ;,H®® $726.00-Component aeHU f� Important, Application is hereby made for a Rermit to: 44 When on the out ® Construct a new on-site sewage disposal system* d forms on the computer,use ® Repair or replace an existing on-site sewage disposal system* only the tab key , to move your Bfrepalr or replace an existing system component—What? cursor-do not ' use the return A. Facility Information key. 0 �°1. i s Address or Lot# City/Town 2- 4,v-er°' 61._ n 2.-"TYPE OF PT'IC S'" STEM*: ®Pump ravity(choose one) P" El i fi,(�Ep P,��dk, bvl *** pump system,attach copy of electrical permit to t t1d, ` c��r l��o i Conventional System(pipe and stone system) ❑infiltrator or Biodiffuser(Gravel-Less) (Attach a copy of your certification to install this type of system. ❑Pressure Distribution S.A.S.(No D-Sox)(Attach Draft Maintenance Agreement) ®Pressure Dosed(D-Box Present)S.A.S. 2. Owner Information Name , Address(if different from above) 1d, City/Town State Zip Code Telephone Number 3. Installer Information BAT sON ENTERPRISES,INC. 111 ARGILLA RoA Name Name of Company A 01810 Address City/Town State Zip Code Telephone Number(Cell Phone#if possible please) 4. Designer Information Name Name of Company Address Citytrown State . Zip Code Telephone Number(DW#to fach) . Application for Disposal System Construction Permit=Page t of 2 w:oregtib SIC tr r tIC i I y ��, .." d a; `4.`"� � X'.* °A Construction r it TODAY'S DATE o $250.00-Full Repair "sSACNUS< ' $125.00 -Component PAGE 2 OF 2 A. Fadility.Information continued.... 5. Type of Building; Residential Dwelling or®Commercial B. Agreement The undersigned agrees to ensure the construction and maintenance of the afore-described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code, as well as the Local Subsurface Disposal Regulations for the Town of North Andover, and not to place the system in operation until a Certificate of Compliance has been issued this Board of Health. Name Date Application Approved By: (Board of Health)R"epresentative) Name Date Application Disapproved for the following reasons: For Office Use only: 1. Fee Attached.? Yes l No 2. Project Manager Ohlrgation Farm Attached Yes No 3. Prun,p Svstem? if so;Attach copy ofElectrical Permit' Yes No 4. Foundation As-Built?(new construction ronly); Yes No (Same scale as approved plan) 5 Floor Plans?(new construction only). Yes No Application for Disposal System Construction Permit•Page 2 of 2 SEPTIC SYSTEM INSTALLER PROJECT MANAGEMENT OBLIGATIONS As the North Andover licensed installer for the construction for the septic system for the property at: (Address of septic system) For plans by (En ' e Relative to the application of Al A-I-� (Installer's name) And dated ri ate Dated �O - oclay's ate With revisions dated st revised date) I understand the following obligations for management of this project: 1. As the installer, I am.obligated to obtain all permits and Board of Health approved plans prior to performing any work on a site. I must have the approved plans and the permit on site when any work is being done. 2. As the installer,.I must call for any and all inspections. If homeowner,contractor,project manager, or any other person not associated with my company schedules an inspection and the system is not ready, then item three shall,be applicable. 3.` As the installer, I am-required to,have the necessary work completed prior to the applicable inspections as indicated below. I understand that requesting an inspection,without completion of the items in accordance with Title 5 and the Board of Health Regulations may result in a$50.00 fine being.levied against me and/or my company a. Bottom of Bed-Generally, this is the first (15�`inspection unless.there is a retaining wall,which should be done.first. The installer must request the inspection but does not have to be present. b. Final:Construction Inspection—Engineer must first do their.inspection for elevations,ties, etc. As-built of verbal OK (or e-mail to: healthdept townofnorthandover.com) from the engineer must be submitted to the Board of Health,after which installer calls for an inspection time. Installer must be present for this inspection. With a pump system,all electrical work:must be ready and able to cause pump to work and alarm to function. c. Final Grade—Installer must request inspection when all grading is complete. Installer does not have to be on-site. 4. As the installer,I understand that only I may perform the work (other than simple excavation)and I am required to complete the installation of the system identified in the attached application for installation. '.I further understand that work done by others unlicensed to install septic systems in North Andover can constitute reasons for denial of the system and/or revocation or suspension of my license to operate in the Town of North Andover, significant fines to all persons involved are also possible 5. As the installer, I understand that I must`be on-site during the performance of the following construction steps: a. Determination that the proper elevation of the excavation has been reached. b. Inspection of the sand and stone to be used c. Final inspection by Board ofHealth staff or consultant. d Installation,of tank,D-Box;pipes, stone, vent,pump chamber, retaining wall and other components. 6. As the installer I understand that I am solely res onsible for the installation of the system as per the anbroved rilans. No instructions by the homeowner, general contractor, or any other persons shall absolve me of this obligation. Undersigned Licensed Septic Installer: (Today's Date) ®fir ame—Print) ? 11e North Andover over Health D partnwnt Community Development Division QNSITE WASTEWATER SYSTEM T TI NOTES J LOCATION INFORMATION ADDRESS: ❑ _r /l .�❑. � ....... MAP: LOT; INSTALLER:" DESIGNER: PLAN DATE: BOH APPROVAL DATE ON PLAN: INSPECTIONS TANK INSPECTION: 2,: � �❑ DATE OF BED BOTTOM INSPECTION: 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 ❑ Inlet tee installed, centered under access pork ❑ 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 ❑ gallon Pump Chamber installed ❑ 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 ❑ cover at final grade installed over pump access port ❑ Watertightness of tank has been achieved by testing ❑ Hydraulic cement around inlet & outlet Comments: C NTROL 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: . 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