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Home My WebLink AboutCertificate of Compliance - 351 REA STREET 2/8/2001 TOWN OF NORTH ANDOVER BOARD OF HEALTH CERTIFICATE OF COMPLIANCE DATE OF COMPLIANCE 02/08/01 This is to certify that the individual subsurface disposal system constructed (X ) or repaired ( ) by Tom Sawyer at 351 Rea Street 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. n Board of Health Inspector I OT YY AREA=142,804 i Yr e� e'e ✓' 25 1p .� 200 FT RIPARIAN -- ` TP--3 ELEVA p/ f 6` DESIGN AS—BUILT 3J<� INV_OF PIPE OUT OF HOUSE 70.28 70.45 M � INV. OF PIPE AT SEPTIC TANK INLET 70.06 70.11 `� es•00 INV. OF PIPE AT SEPTIC TANK OUTLET 69.81 69.86 ` INV. OF PIPE AT D—BOX INLET 69,51 69.46 140 INV. OF PIPE AT D—BOX OUTLET 69.34 69.28 IBM 7 INV. AT REG, OF DISTRIBUTION PIPE 1 69.26 69.19 C\S 12' BIRCH INV. AT BEG. OF DISTRIBUTION PIPE 2 69.26 69.21 EL,=67.49 USGS INV. AT BEG OF DISTRIBUTION PIPE_ 3 69.26— 69,28 100 FT WETLANDS BUFFER 7ONk INV. AT BEG, OF DISTRIBUTION PIPE 4 69.26 69.21 INV. AT BEG. OF DISTRIBUTION PIPE 5 69.26 69.21 PLAN S � INV. AT END OF DISTRIBUTION PIPE 1 69.08 69.10 SCALE. 1"=20' INV. AT END OF DISTRIBUTION PIPE 2 69,08 69.09 INV. AT END OF DISTRIBUTION PIPE' 3 69:08 69.08 INV, AT END OF DISTRIBUTION PIPE 4 69.08 69.07 INV. AT END OF DISTRIBUTION PIPE .5 69.08 69.08 TOWN OF NORTH ANDOVER SEWAGE DISPOSAL SYSTEM INSTALLATION CERTIFICATION The undersigned hereby certify that the Sewage Disposal System ) constructed; ( ) repaired; by located at 3�+/ RPM 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: Engineer Representative Final inspection date: iEngineeT Representative Installer: „s_ 2, Lic.#: Date: Design Engineer ' - Date: 9—, ® pw U u C aC', u a w w z Q ;> o m Z W °° w 411-a: M r. °n w G w w c w U) PQ U) co cd • = S iW O o ` O CD c Pk o no Q CO) AL CD cm CO Q ;3 t u Q rp.. O. l CO) r:14 CO2 m ni LU O O cl H 3 Er N3 O � O W m N O ui .v � � o //� v O W cc 0 4-J CL LLJ N O O fry ® •� W E m = Fil ( 1 � -v a° � m v ca � r m ; Lil "C. O co lzi co ® m o m O O. OV N O L � y : —yZ o U O p _ °Q r ® !6 CL N Po Cl)LLJ Lu r _ O 0 - CA CA~ E v O = Z W p v •N O • V m m� c Cl) d m'O o 2 A 0 N•� F- �° ai O m a � 'i INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having.jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable or requirements. 'APPLICANT FILLS OUT THIS APPLICANT _ 6��etl C t 61C L PHONE LOCATION: rssessor's Map Number PARCEL SUBDIVISION LOT (S) STREET PElq S% ST. NUMBER lzj7— �2- * � OFFICIAL USE OyLY RECOMMENDATIONS O F TOWN A G E N TS C NSERVATION ADMINISTRATOR DATE APPROVED DATE REJECTED COMMENTS �% I. �,'�'� , ��'1 (A— TOWN ANNER DATE APPROVE;�"-"5 _.. I DATE REJECTED L) COMMENTS ate, FOOD INSPECTOR-HEALTH DATE APPROVED DATE REJECTED SEPTIC INSPECTOR-HEALTH DATE APPROVED �- DATE REJECTED COMMENTS ✓�J PUBLIC WORKS - SEWERIWATER CONNECTIONS DRIVEWAY PERMIT �� r i. / -''/%/�' — 2:—Z —00 G FIRE DEPART MEJT RECEIVED EY EUILCING !NSPECTOR DATE Revised 919 jm Expiration Date iEnature Tele hone 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 E ORIGINAL STAMP & SIGNATURE l` IMPERVIOUS AREAS - DRIVEWAYS, ETC. NORTH ARROW 1- LOCATION &ELEVATIONS OF BENCHMARK USED " INSPECTION CHECKLIST FOR SEPTIC SYSTEMS Yes NO Initi s 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. L_-�' Comments: , 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. Watertight joints 4. Inlet to tank cemented 5. Slope minimum 0.01 or 1/8"per foot minimum 6. Pipe properly set on compact firm base 7. Pipe laid on continuous grade in straight line 8. Cleanouts precede all change in alignment and grade 9. Manholes at any 90°change 10. 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 grade 5. Manholes over center and each tee 6. 3-20"manholes 1� 7. Inlet tee minimum 12"under invert 8. Outlet tee minimum 14"under invert 9. Outlet line cemented 10. Air space 3"above tees 11. 2"-3"drop from inlet to outlet 12. Pipe set 13. Compact base with 6"of'/4"crushed stone under tank 14. Tank is watertight Comments: � � ] < Yes NO ` E. Pump Chamber L If separate from tank,compact base with 6"of3/4"stone underneath 2. Minimum 2"pipe Wd-6ox iy gravity system I 2U"access manhole 4. Ionklove| ------ ----- 5. Watertight 6. Tank size agrees with plan specification 7. Manhole tograde 8. Check valve and bleeder hole present 9. A|uon in building on separate circuit 10. Alarm functions ll. Manual operating switch 12. Pump delivers liquid tod'buz Cmnmaoro: F. Distribution Box l. C-box levc I Minimum Ci IT'[2 )drop from inlet to outlet ]. Minimum f/'sump 4. Outlet pipes show equal distribution 5. Compact base with 6"oC stone beneath box 6. Box is watertight 7. All lines cemented with hydraulic cement 0. Schedule 4Opipe ----- Comments: G. ~.'^-~~~^'.~^^,~._^. l. All stone double-washed—1/4"- 1 V2" i -poustone -' k Bucket test done? ------- ------- /� - 2. Minimum 2"of pea stone above distribution lines ^/ _/ 3. Minimum t7`stone beneath pipe 4. Distribution lines capped or connected together 5. Grading meets 3:| slope 6. Minimum of9"of fill graded over system 7. Toe of slope stops minimum 5` fi-nm edge of property; if not,d6coaxmie. Comments: H. Leach Trenches l. Minimum 2trenches 2. Length of trenches agree with plan. (Max. length lOU") ]. Width nf trenches agree with plan—Minimum 2`;maximum—4`. 4. Vent present if<5O feet nrspecified 5. Distance between trenches minimum 4` and maximum of6` 0. Minimum distance between trenches 10` ------- ----- 7. Pipe slope minimum 0.005 ur6"per 100` 8. Depth of trenches below outlet invert minimum of 6". ' | Yes NO 9. Pipes set ou stable base. Comments: 1. Leach Field }. Maximum length ot field 100` 2. Pipe slope minimum 0.O05 or6''per 100' 3. Separation between pipc6`moxiooum 4. Pipes connected atend 5. Separation between adjacent fields 10` minimum 6. Pipes set nostable buan 7. Maximum 4` separation fi-om edge of field to first line 8. Minimum two distribution lines 9. Maximum pero rate 2Ompi Comments: J. Leaching Pits l. Minimum inlet pipe 4" 2. Pits of concrete 3. Sidevvo8botxcum 12"and 4D"wide 4. Access manholes ou each pit 5. Pipes cemented with hydraulic cement Comments: ' K. ^--' —'--- l. Skmeover soil ohaorphoouyu�mmio��um 0.02 2. /�U^myatcm components covered hyut least 9`'mnii '� 3. Cover soil free of stones larger than 6" 4. Grading slopes away from dwelling 5. Nh areas over system that may pond / � �