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Home My WebLink AboutCertificate of Compliance - 143 LACY STREET 2/24/2015 o ° PUBLIC LAIC H AID H DEPARTMENT Town of North Andover Community Development Division CERTIF IC A C""MPLIANCE 2/24/2015 This is to certify that the individual subsurface disposal system received a SATISFACTORY INSPECTION of the: Complete Repair of an On-Site Sewage Disposal System By: Robert Daigle At: 143 La eet Map 105D Lot 167 . .� , Andover, � ftl ' hall�riot be ec�.nstrged as a guarantee that the system will function satisfactorily. The Is�u` nce o, this certi�cate� Mich le"Grant Public Health Agent 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 fax 978.688.8476 Web www.townofnorthondover.corn { F V J Town f North Andover -- Septic System - AS-BUILT CHECKLIST 1) " All changes to the design plan have been reflected on the as-built 2) Is of suitable scale; (one inch = 40 feet or fewer for plot plans and one inch = 20 or fewer for details of system components) ._ s ,..... 3) Lot number,Street Name, s„ essoL rs Map,)an Parcel Number 4) Lot Lines and Location of Dwellings served by the system k 5) Locations,Elevations and Dimensions of system,including reserve (if applicable) 6) Ties to dwelling or Permanent Structure &Wells " a. From Septic Tank&Distribution (D) Box b. From Leach Area 7) Ties to Lot Lines from leach area &) Locations of Deep Holes &Peres 9) op of Foundation Elevation 10) Locations of Wells,Drains,Watercourses within 150 feet of system 11) Location of water,gas,electric lines,cable 12) Location of Structures within 6 Inches of Finished Grade 13) Original Stamp&Signature 14') _ Location and holder of any easements which could impact the system 15) Impervious Areas;Driveways,etc 16) North Arrow 1' V Location &Elevations of Benchmark used 18) STATEMENT ON PLAN (NA 5.3) a. "I certify the locations, elevations, ties, cover xnatexlal;exposed component covers etc.,shown oil this as-built substantially agree with the approved plan and have detertnined that the hivak out elevations,if applicable,have been met. Signature of Designer Date b. "If a STUCTURAL 147ALL IS PRESENT WA 4.9)a Letter or statement on the as-built indicating the J-vall- was,or was not; constructed in accordance with the intended design and any manufacturer's specifications." Signature of Designer Date As of,Tuesday,July 30,2D13 .11"WIT,.......... Town of North over - Se Air S stem - AS-BUILT CHECKLIST 1) _44LAtl changes to the design plan have been reflected on the as-built el/ 2) Is of suitable scale; (one inch=40 feet or fewer for plot plans and one inch =20 or fewer for details of system components) 3) Lot number,Street Name,Assessors Map and Parcel Number 4) 7 Lot Lines and Location of Dwellings served by the system 5) Locations,Elevations and Dimensions of system,including reserve(if applicable) Ties to dwelling or Permanent Structure&Wells a. From Septic Tank&Distribution (D) Box b. From Leach Area 7) Ties to Lot Lines from leach area -74 Locations of Deep Holes&Peres Top of Foundation Elevation 10) Locations of Wells,Drains,Watercourses within 150 feet of system 11.) Location of water,gas,electric lines,cable 12) TLocation of Structures within 6 Iriches of Finished Grade 1.3) Original Stamp&Signature 14) 1/1 ,Location and holder of any easements which could impact the system 15) _±_,,Jmveivious Areas,Driveways,etc 16) North Arrow 17) Location&Elevations of Benchmark used 18) STATEMENT ON PLAN (NA 5.3) a. dl "I certifij the locations,elevations, ties, cover material;exposed component covers etc., shown on this as-built substantially agree With the approved plan and have determined that the break out elevations, if applicable,have peen met." Signature of Designer Date b. _.__._"If a STUCTURAL WILL IS PRESENT(NA 4,9)a better or statement on the as-built indicatilz h the wall-was,or 7yas not, constructed in accordance With the intended design and any inannfacturer's �eci icatio�ns- As of:Wednesday,February 18,2015 f5 roµ p PUBLIC HEALTH DEPARTMENT Wiiniunity Develoj)iiieat Division TOWN OF NORTH ANDOVER SEPTIC DISPOSAL SYSTEM—INSTALLATION CERTIFICATION The undersigned hereby certify that the Sewage Disposal System( )constructed;( }repaired; By: 0 16 (Print Name) ,w �.... Located at:� (Installation Address) Was installed in conformance with the North Andover Board of Health approved plan,originally dated and last revised on -i i -- i ,I- ,with a 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. Bottom of Bed Inspection Date: Engineer Representative(Signature) r And—Print Name 1.0 15 Final Construction Inspection Date; Engineer Representative(Signatu>e) And—Print Name Installer, �i. o s�+� �'t � (Signature) Daterr ,7 And—Print Name E+nginer:V (Signature) Date: p- s"'�" And—Print Name 1 600 Osgood Street, North Andover, Massachusetts 01845 Phone 978.688.9540 Fox 978.688.8476 eh littp://www.towitofiiorthuitdover.com North Andover Health Department Community Development Division QNSITE WASTEWATER SY T M CONSTRUCTION NOTES LOCATION INFORMATION ADDRESS: 143 Lacy St MAP: 105D LOT: 167 INSTALLER: Rob Daigle DESIGNER: Vladimir Nemchenok PLAN DATE: 6/20/14 BOH APPROVAL DATE ON PLAN: 10/27/14 INSPECTIONS TANK INSPECTION: DATE OF BED BOTTOM INSPECTION:12/16/14 and 12/19/14 DATE OF FINAL CONSTRUCTION INSPECTION: 12/30/14 DATE OF FINAL GRADE INSPECTION: SITE CONDITIONS ® Contractor reports any changes to design plan N/A Existing septic tank properly abandoned ® Internal plumbing all to one building sewer ® Topography not appreciably altered Comments: SEPTIC TANK ® Water tightness of tank has been achieved by visual testing ® Inlet tee installed, centered under access port ® Outlet tee installed, centered under access port (gas baffle/eff luent filter) ® inch cover to finish grade installed over inlet and outlet ® Hydraulic cement around inlet & outlet Comments: Existing septic tank reused DISTRIBUTION-BOX ® Installed on stable stone base ® H-20 D-Box N/A 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 (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 N/A 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 N/A Retaining wall (boulder/ concrete /timber/ block) ❑ Final cover as per plan Comments: Old sand fill was removed and excavated down to original soil on 12/19/14 t 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 = FINAL GRADE Loamed Seeded ❑ �,..... .. " .. ❑ Cover per plan �1' ', .. Comments: DOCUMENTS NEEDED []]/Certification of Installation Form submitted By engineer and signed and dated by Engineer and installer As-Built Plan BM = 107.50 HR = 0.64 HI = 108.14 SYSTEM ELEVATIONS ROD AS-BLT INVERT DESIGN INVERT ELEVATION ELEV ELEV Benchmark Building Sewer OUT ---- ---- ---- Septic Tank IN ---- ---- ---- Septic Tank OUT 3.58 104.21 104.05 Distribution Box IN 3.94 103.85 103.82 Distribution Box OUT 4.14 103.65 103.65 Lateral 1 TOP 4.16 /4.40 Lateral 1 INVERT 103.63 / 103.39 103.61 / 103.36 Lateral 2 TOP 4.17 /4.40 Lateral 2 INVERT 103.62 / 103.39 103.61 / 103.36 Lateral 3 TOP 4.17 /4.40 Lateral 3 INVERT 103.62 / 103.39 103.61 / 103.36 CRITICAL SETBACK DISTANCES Mark those distances checked in the field against the design plan and regulatory setback Tank SAS Sewer ® 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 Bank3 75 89+1- ® Wetlands bordering surface water supply or trib. (in Watershed) 150 150 ® Trib.to surface water supply 325 325 ® Public well 400 400 ® Interim Wellhead Prot. Area ® Reservoirs 400 400 ® Drains (wat. supply/trib.) 50 100 ® Drains (intercept g.w.) 25 50 ® Drains (Other)Foundation 10(5) 20(10) ® Drywells 20 25 ' 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 Grant, Michele From: Stephanie O'Mahony <somahony @o ma honyelectric.com> Sent: Thursday,January 22, 2015 8:20 AM To: Grant, Michele Subject: Septic Hi Michele, Thank you for taking the time to come out yesterday to review the grading. We will be taking the responsibility of seeding and putting mulch hay down on the exposed area of the leach field. This will occur immediately and if you need to come back by and review it I will call you once it's been completed. Please let me know when you receive the asbuilts from Bill Dufresne, I want to make sure that we can get signed off on our Certificate of Compliance. If there is anything further that I need to do to get this completed, please let me know. As you know, this has gone on long enough. Thanks you again for all your help and assistance in this matter. Regards, Stephanie L. O"Mahony T978-762-4600 Ext. 102 F 978-762-6600 C 617-593-7917 i Grant, Michele From: Stephanie O'Mahony {somahony @omahonyelectric.com> Sent: Thursday, January 22, 2015 8:20 AM To: Grant, Michele Subject: Septic Hi Michele, Thank you for taking the time to come out yesterday to review the grading. We will be taking the responsibility of seeding and putting mulch hay down on the exposed area of the leach field. This will occur immediately and if you need to come back by and review it I will call you once it's been completed. Please let me know when you receive the asbuilts from Bill Dufresne, I want to make sure that we can get signed off on our Certificate of Compliance. If there is anything further that I need to do to get this completed, please let me know. As you know, this has gone on long enough. Thanks you again for all your help and assistance in this matter. Regards, tide L O"Mahony T 978-762-4600 Ext 102 F978-762-6600 C: 617-593-7917 i Blackburn, Lisa From: Isaac Rowe <irowe @millriverconsulting.com> Sent: Wednesday, December 31, 2014 2:48 PM To: Sawyer, Susan; Blackburn, Lisa Cc: Pam Lally; Isaac Rowe Subject: 143 Lacy St - final inspection Attachments: 143 Lacy St - Construction Inspection Form.doc; Sand Fill Sieve Analysis.PDF Susan/Lisa, Attached are the construction inspection form and sand fill sieve analysis for the above referenced property. We also have copies of the sales recipes of the sand fill if needed. Everything looked good. Please let me know if you have any questions. Thanks, Isaac M. Rowe, R.S. Project Manager Mill River Consulting 6 Sargent Street Gloucester, MA 01930-2719 Phone: 978-282-0014 ext.804 Fax: 978-282-1318 irowe@millriverconsulting.com www.miliriv rcon ulting.c„o n i ............ . ...... 0 Dayton Sand& Gravel Co, Inc. 920 Goodwirts Milli Road,nsgNa:a,Maine 0400S,7352 1-000,339.2 700®r 1-207A99-2306 Kml•207-499,7102 f I Project: Hentley Warren pate: Wednesday,December 17,2014 Customer: bentley Warman Tested t3y: M.Stolle&1),McKenzie Material Source: Dayton Sand&Gravel Co.,laic. Material tlescriptiorr: Warhead Sand Material Locution: Stockpile Specification; C33(EA 1)Finn,Aggregate(Modified) 100 go 80 _ _ LA i � { f _. i + + 4 Q) 50 try 1 { - 1 40 a Qt I R l 20 + i # i a pp ti t. 100 10 1 0 1 0.01 Sieve Size Gradation Analysis ;love:Size Note(s) passing Specification Inch nana _-_ ....... _ _....... , ..-_ ... ._....__.__ .__.__. US 100.0 7/16' 11.2 100.0 _ 1/11" 95 MOM 100 I pr 63 100.0 t#4 4.75 99.7 95 100 d#8 2161 89.0 80 - 100 It 1.6 1.18 71,8 5() � 05_..,.... ...._.. — —_._____ . _ . ,. __ ----- 820 0,85 613 I 1130 0,lr VIA 2', - 4i0 _...,.._.. .... - -,-..,. _ __...._,._..... ., ._ ----------.. _. 1150 0.3 223 S - 30 t#106) 0 1."i 5J3 0 - 1 0 It 2raaa 0 0Y/5 1"2 t i