HomeMy WebLinkAboutCertificate of Compliance - 212 HAY MEADOW ROAD 10/18/2001 Town of North Andover VtORrta
Office of h eat Department
Community Development a1 Services ivis'
27 Charles Street
North Andover,Massachusetts 01845 � MU
Sandra Starr Telephone(978)688-9540
Public Health Director Fax (978)688-959:2
TOWN OF NORTH ANDOVER
BOARD OF HEALTH
CERTIFICATE CIE COMPLIANCE
DATE OF COMPLIANCE
10/18/01
This is to certify that
the individual subsurface disposal system
constructed () or repaired (X)
by
John Soucy
at
212 Hay Meadow Road
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.
B ran J. LaGrasse
Board of Health Inspector
Q vvv � )
BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 68 9-9530 IIEAL'I'II 588-9540 PLANNING 688-9535
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TO)NV 'N Or �voR.'rr Ai` BOVZIZ SEA V Gr,, 7DISPOSAT. S),.Tr-' Im
I` -,STALLA"fI0N CLRTII=T(;,4TIOiii f
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The uncersi •ned here;,v cerifv that the Sewa2c Disposal System ( ! co2st:,.ic(::d,
( ) recaired:
by
r
located at l %
was installed in cbnrcrmartce with the ;V,):-t,`t Ando%er Board of Hea.ith a-proved plan;
Svstem Design Pe;-,Tait = dated _, wit: an aecroved desip
flow OI gallons per day The materials use, were in conxormar.ce .ti i:'a those
specinea on the app'roN•ea plan; the system ".as installed in accordance V'Vith the provisions'
of w 10 C R 15.000, Title 5 and local rc��latiors and the anal �?radir,� agrees
substantially with the approved plan. .-ail work is accurateiv represented ;)r, the As-built
which has been submitted to the Board c:Health
Bed inspection datti:
Engineer R ;�re.se::.ative
Final inspect.-on c C C.)
Engineer Represe t i:%e
tnstai:er: L;c m. Date: �
CesWr, EnQi tee : _ Date
1 HARD
C.
TANG ARD
PA
AS-BUILT CHECKLIST
LOT NUMBER, STREET NAME
ASSESSORS MAP & PARCEL NUMBER
LOT LINES &LOCATION OF DWELLINGS
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
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
Project Request Record
Town of North Andover
Date: Y 7z
Client Id: ToNA Card Id:ToNA Client/Company Nam Board of Health
Card,Type-Clientr
j Contact"Name: Ms,SandpavStarr- Phone: 978,-688-9540r
Titler;Director Fax:. 97:8-688,L9542'
Address:. 27Charles,Street_ Email:,sstarr:@townofnorthandover.co;ml� �, a
(F
Notes:_
k Tawn:. North Andover
;`State: NIA. Zipf,Code: 04'845
Other,cantacts, applicable ie Engineer/iastaller
'Name:, ; " Phone:
Title: Fax.:
Address:' Email:
�r
Notes:
1"Towns
State:: ZitxCode: r ��
Project:
Project Id: 1770 Project Title: Town of North Andover Board of Health
(JOB NO) (PROJECT NAME&STREET ADDRESS)
�.._.� .
Manager:NOW Billing Group: Billing Cod :Fixed Fee
Contractlnfa�PraJ ect Deecrt p tianf or w ea.ch blng group
BG/ Applicant
! Assessors,Map, ,�04 Lot .._W Street 7 ,_ ._ /Y;
�rType,ofservice� 72,:7,;r,e,
r,
Office/forms/jbrqutana
N&M Job number 1770/ Q �T
TOWN OF NORTH ANDOVER
INSPECTION CHECKLIST FOR SEPTIC SYSTEMS
Site: eV Final Date:
Installer: Q �-j A)
Tel: ;
Date Yes No Initials
A. Bottom of Bed
1. Excavation to proper depth
2. With trenches,sides of excavation are beneath B horizon
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 90°change
9. 10'minimum offset to water line
Comments:
D. Septic Tank
1. Level
2. 1,500 gal minimum
3. Gas baffle present on outlet
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 from inlet to outlet
9. Pipe set
10. Compact base with 6"of 3/a"crushed stone under tank
11. Tank is watertight
12. Tees 12"off side of tank
N&M Job number 1770/
Comments: Date Yes No Initials
E. Pump Chamber
1. If separate from tank,compact base with 6"of/"stone underneath
2. Minimum 2"pipe to d-box if gravity system
3. 20"access manhole
4. Tank level
5. Watertight
6. Tank size agrees with plan specification
7. Manhole to grade
8. Check valve and bleeder hole present y.
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
3. Minimum 6"sump
4. Outlet pipes show equal distribution
5. Compact base with 6"of stone benea#h box
6. Box is watertight
7. All lines cemented with hydraulic cement
8. Schedule 40 pipe
9. First 2'from box laid level
Comments:
G. Soil Absorption system
1. All stone double-washed—3/a"—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;
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'
2. Pipe slope minimum 0.005 or 6"per 100'
3. Separation between pipes 6'maximum �G f
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
s
Comments: Na g p�;
`Pi. .�d F 1 i±'.� i,A a"`' ?' ' 'v,d( ...+e � ' r:� s i,;! 4..^r.,✓ r y r.''�-� o.,l py�
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
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