HomeMy WebLinkAboutCERTIFICATE OF COMPLIANCE PUBLIC HEALTH DEPARTMENT
Town of North Andover
Community Development Division
kiw-TICAV
As of.-
Jy6L15 2011
This is to certzjy- that the individuaf subsurface drsposafsystem received a
S.A7zsEACT0RTzjArSTEC' 100 of the:
Complete System Wspair of an
On-Site
Bye
W96ertAmor
.fit°
470 LaOL,�trgt
911ap-1 05..A~Tarcel-001 0
0
9 9VA 01845
T he Issuance of is cert cate shaCCnot be construedas aguarantee that the system willfunction satisfactori(y.
anly. . auy !A�
PU6 9fearth Dir8cV�
1600 Osgood Street,North Andover,Massachusetts 01845
Phone 978.688.9540 Fox 978.688.8476 Web www.townofnorthandover.com
AS-BUILT CHECKLIST
All changes to the design plan have been reflected on the as-built
Is of suitable scale;(one inch=40 feet or fewer far plat plans and one inch—2 ✓//
•�� " — or fewer or details of systefn
components)
Lot number, Street Name,Assessors Map and Parcel Number RECEIVED
Lot Lines and Location of Dwellings served by the system l �
Locations&Dimensions of system,including reserve(if applicable) Fitm'ml F M1
EXPARTNEja
Ties to dwelling or Permanent Structure&Wells
a.From Septic Tank
b.From Leach Area
Ties to Lot Lines from leach area
Locations of Deep Holes&Peres
Elevations of Disposal System
r` Top of Foundation Elevation
Locations of Wells,Drains,Watercourses within 150 feet of system
V Location of water,gas,electric lines,cable
,r Distances from Corners of House to Center of Tank&D-Box
Location of Structures within 6 Inches of Finished Grade
Original Stamp&Signature
Location and holder of any easements which could impact the system
Impervious Areas;Driveways,etc
f North Arrow
V' Location&Elevations of Benchmark used
STATEMENT ON PLAN(NA 5.3)
`7 certify the locations, elevations, ties, cover material; exposed component covers etc. shown an this as-built
substantially agree with the approved plan and have determined that the break out elevations, if applicable, have
been met."
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
PUBLIC HEALTH DEPARTMENT
(ommunity Development Division
TOWN OF NORTH ANDOVER
SEPTIC DISPOSAL SYSTEM—INSTALLATION CERTIFICATION
g y certify he Sewage Disposal System( constructed;( )repaired;
By: T4 vv%O-q, N.:)
The undersigned hereb certi that t
(Print Name) ; v
Located at: — 0 I
� Z TOWN OF NORTH DOVER
I�tATi~N � A �° BJT
(Installation Address)
Was installed in conformance with the North Andover Board of Health approved plan,originally dated
4-28—W and last revised on - ,with a design flow of
_ 5 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 ?P
Final Construction Inspection Date: ........°
Engineer Representat a(Signature)
And—Print Name
Installer: , , ,,•,„ (Signature) Date:
And—Print Name
Engnrer: m gu Date:
REM ur
CIVIL, T,
r o.27'14 c1ar
(r/S7 44` And—Print Name
VV
1600 Osgood Street, North Andover, Massachusetts 01845
Phone 978688.9540 Fax 978.688.8476 Web http://www.townofnorthandover.com
06/08/2011 13:48 781-438-6216 UTS PAGE 01
particle Size Distribution Report
� qo
.6 Oarcrn, eiNRONMeNT c nvis�5S?1•
100 --
--
90 - —
70 —
Z
IL
Z s° '
W — -
w a° 1
CL
30 L —
20 \ t
10 { �`
1
' 0.1 0.01 0.a01
0 D 1Q0; 1D GRAIN SIZE-mm SILT �CLAY
%GRAVEL y.5AND 2.3
%Coal! 97.7
0.0 0.0
SIEVE PERCENT SPEC* PASS?
Material DgSCri 1100
SIZE FINER PERCENT W--NO) SEPTIC SAND
#4 100.0 100- )00
#10 96.5
420 84.5 AtterbefiLumits
0
050 39 5 10-100 PL- LL= Pl=
#100 10.4 0-20
#200 2.3 0-5 CoefficIOfft
-D85= 0.870 Dsp= 0A20 D50= 0.356
D30= 0.253 D15= 0.176 01p= 0.147
Cu- 2.85 CC- 1.03
Classification
USCS= AASHTO=
Remarke
2.9%BY wwolIT OF THE SAMPLE RETAINED ON'T IE
NO.4 SIEVE,STATE ENVIRONMENTAL COVE TITLE V
SAMPLE MEETS GRADATION.
STATE ENVIRONMENTAL CODE 717 .F.V 15.255(3)
Sample No.: I Sourca of Sample: ROWLEY,MA PIT 2 Date: 6/08/2011
Location: Elev./Depth:
UTS OF MASSACHUSETTS, INC. Client: R.T.AMOR&SON EXCAVATING
5 Richardson Lane Project:
Stoneham, MA 02180 Pro ect No: Figure >i
06/30/2011 09:19 781-438-6216 UT5 PAGE 01
Particle Size Distribution Report
100 --__
0
• °cmcvu°n:Sena C -sena
70 - — --
1
w 60 — _
U.
Z5D - -- _-
U ` 1
LL) 40
,1
30 - 1
20
10 -
0 - L
500 100 10 1 DA 0.01 0.001
GRAIN SIZE-mm
%COBBLES %GRAVEL %SAND %SILT I %CLAY
0.0 0.4 97.8 1 f.8
SIEVE PERCENT SPEC." PASS? Material Aescriation
SIZE FINER PERCENT (X-NO) F-M-C SAND,TRACE SILT,TRACE GRAVEL
3/8 in. 100.0 100- 100
94 99.6 95- 100
48 86.9 80- 100
416 66.6 50-85 A_tterberg Limits _
030 42.5 25-60 PL= LL= PI=
950 18.7 10-30
#200 1.8 2 2-10
Coefficients
D85= 2.18 D60= 0.974 D50= 0.736
D30= 0.426 D1 g= 0.260 D10= 0.206
Cu= 4.74 Cc= 0.91
Classlflcation
USCS= SP AASHTO=
Rem-arks
ASTM C 33-Sand
Sample No.: 2 Source of Sample: BENTLEY WARREN,C33 SAND Date: 613012011
Location: Elev./Depth:
UTS OF MASSACHUSETTS, INC. Client: R-T-AMOR&SON EXCAVATING
5 Richardson Lane Project: 7
Stoneham, MA 02180 Project No: Fi ure 2
SOIL ABSORPTION SYSTEM (General)
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
❑ Retaining wall (boulder/ concrete /timber/ block)
❑ Final cover as per plan
Comments:
SOIL ABSORPTION SYSTEM (Gravel-less Chambers)
❑ Brand and Model of Chamber: Standard Quick
4 Infiltrator Chambers
❑ Number of chambers per row:
❑ Number of rows (trenches):
Comments: Total Chambers =
v 7- ,s
AIA
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