HomeMy WebLinkAboutCertificate of Compliance - 20 ROCKY BROOK ROAD 5/12/2000 i
i
TOWN OF NORTH ANDOVER
BOARD OF HEALTH
CERTIFICATE OF COMPLIANCE
DATE OF COMPLIANCE:
5/12/00
This is to certify that
the individual subsurface disposal system
constructed (X) or repaired ()
by
Peter Breen
at
Lot 24B (20)Rocky Brook 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.
Board of Health Inspector
® E to O Q '
�I d O ` W -Z
,� _ ®° ® ey
Im ® H m a
-M Z " W'
ffin
W � � W =
�! W —1 ® Wy
CD
® c -I
_ : C7
Lv Q
to °
0 y 7®
CD co)
0 -03F
CD CD ao
• ® 'o
t a r c9' C!) CD W H :
to 0 CD
d W 3 CO) n�• m W CA
O ° W CO) cr
_ C EL
70 0 CD r-L
< 0
CD fo �q
a CO)
TI
'
m �. _ co o n W :
TO
-S O o o .8� a�
CD C) CD O • ® ^' _ boo
CD
® CD
Q co n> f%
it i
CD
W �m T
col
CD
® 1s
CD
CD
a
CD
r
cn to ?� 7� '�? x n• 7� o o
G o 0 0
ou w w w r� w w ^ R ID
ro z .-, J �\ P Ca�1 �
rD
o Ci7 o O CD
d
Z
z
AS® UIL,T A CKLIST
LOT NUMBER, STREET NAME
ASSESSORS MAP &PARCEL NUMBER
LOT LINES &LOCATION OF DWELLINGS
LOCATIONS & DIME ESION,S OF SYSTEM,
INCLUDING
TTES-T(4-L--C3T.LINES�&-b WELLING, E °��
a. FROM SEPTIC TANK
b. FROM LEACH AREA
LOCATIONS OF DEEP HOLES &PERC
TESTS
V 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
w
TOWN OF NORTH ANDOVER SEWAGE DISPOSAL SYSTEM.[
INSTALLATION CERTIFICATION
The undersigned hereby certi-f that the Sewage Disposal System (x) constructed;
( ) repaired;
by
located at
was installed in conformance with the North Andover Board of Health approved plan.;
System Desian.Pe nit dated with an approved design
flow. of _ gallons per day. The materials used were in ccnfor-nance with these
speciEed on the appxaved plan; the system was installed in accordance with the provisions
of 510 CIMR 15.000, Title 5 and local regulations, and the final grading agrees
substantially with the anproyed plan. Alf work is accurately represented on the As-built
which has been submitted to the Board of Health.
Bed inspection date: `/I 4/0C
Engineer Representative
Final inspection date:
Ens&er Representative
a
i
� u
Installer: ��� .i "f' ` � t" .� � Lic.m: Date: v "
Design.Engineer (-.•. ,' "M ��v"t c.°�°r"��, Date: 5514 (9 0
Q
ti
t
INSPECTION CHECKLIST FOR SEPTIC SYSTEMS
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. t,%
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: 47-21
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
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/<"crushed stone under tank
14. Tank is watertight
Comments:
Yes NO
E. Pump Chamber
1. If separate from tank,compact base with 6"of 3/4"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
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 0.1T'(2")drop from inlet to outlet
3. Minimum 6"sump
4. Outlet pipes show equal distribution
5. Compact base with 6"of stone beneath box
6. Box is watertight
7. All lines cemented with hydraulic cement
8. Schedule 40 pipe
Comments:
G. Soil Absorption system
1. All stone double-washed-'/4"-- 1 ''/z"
-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. Grading meets 3:1 slope
6. Minimum of 9"of fill graded over system
7. Toe of slope stops minimum 5' from edge of property; if not,then swale.
Comments:
H. Leach Trenches
1. Minimum 2 trenches
2. Length of trenches agree with plan. (Max. length 100')
3. Width of trenches agree with plan-Minimum 2%maximum-4'.
4. Vent present if<50 feet or specified
5. Distance between trenches minimum 4' and maximum of 6'
6. Minimum distance between trenches 10'
7. Pipe slope minimum 0.005 or 6"per 100'
8. Depth of trenches below outlet invert minimum of 6".
Yes NO
9. Pipes set on stable base.
Comments:
1. Leach Field
1. Maximum length of field 100'
2. Pipe slope minimum 0.005 or 6"per 100'
3. Separation between pipe 6'maximum
4. Pipes connected at end
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
9. Maximum perc rate 20 mpi
Comments:
I 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
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