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Home My WebLink AboutCertificate of Compliance - 45 FOREST STREET 7/28/2009 tAORTH w. O �,�LEG 164 'YO O h+ ORA coc.i�Hewrc�`y�' SSAC HU5v' PUBLIC HEALTH DEPARTMENT Community Development Division f 12TIFIC.A�I2 O F C0-1401'.GIAX As of: lufy 28, 2009 This is to certify that the individual subsurface disposal system received a SA`ITS EACTORT INS(EC7IOLV of the: ftairl&p&cement of the complete Septic 'osalSwstem James 7Ce ett 45 Forest Street 911ap — 106.A; Farrel-71 North Andover, M,4 01845 The Issuance of this certificate shall not 6e construed as a guarantee that the system will function satisfactorily. S 'an �Y. Sawyer Public Wealth Director 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com TOWN OF FORTH ANDOVER , ,ORTI, Office of COMMUNITY DEVELOPMENT AND SERVICES orb`>r".o-'`°+° HEALTH DEPARTMENT 400 OSGOOD STREETS .-mss-• * NORTH ANDOVER, MASSACHUSETTS 01845 �,s CR St sACHt154 978.688.9540-Phone Susan Y.Sawyer,REHS/RS 978.688.8476-FAX Public Health Director E-MAIL; healthdept atownofnorthandover.com WEBSITE:hgp://www.townofnorthandover.com TOWN OF NORTH ANDOVER SEPTIC DISPOSAL SYSTEM - INSTALLATION CERTIFICATION The undersigned hereby certify that the Sewage Disposal System O constructed; ( repaired; by (Print Name) located at F0'en cJ 77'eG� /i/D (Installation Address) was installed 71no�formance with the North Andover Board of Health approved plan, originally d ted � � and last Revised on /�/z— with a design flow of a g &2�9 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: 7(2 Engineer Repr ssentative(Signature) �eM kydt- And-Print Name Final inspection date: -7 .®, (f C:),2 _ Eng' eer Representative(Signature) And-frint Name Installer: (Signature) Date: And-Print Name Engineer: (Signature) Date: '�-;z 00D JR ' clvl And-Print Na 8-�.}ter„v ✓Y~�� rt AS-BUILT CBECKLIST t 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 G .." LOCATIONS OF DEEP HOLES &PERC TESTS ELEVATIONS OF DISPOSAL SYSTEM TOP OF FDN ELEVATION LOCATIONS OF WELLS, DRAINS, WATERCOURSES WITHIN 1 S0' OF SYSTEM 4' LOCATION OF WATER, GAS, ELECTRIC LINES, CABLE DISTANCES FROM CORNERS OF HOUSE TO CENTER OF TANK & D-BOX ORIGINAL STAMP & SIGNATTURE IMPERVIOUS AREAS -DRIVEWAYS, ETC. NORTH ARROW ti "'" LOCATION & ELEVATIONS OF BENCHMARK USED '"FOWN OF NORTIi ANDOVER wZ rrN-'-° Office of COMMUNITY DEVELOPMENT AND SERVICES 0 HEALTH DEPARTMENT 1600 OSGOOD STREET; BUILDING 20; SUITE 2-36 NORTH ANDOVER, MASSACHUSETTS 01845 4 C.H Susan Y. Sawyer, REI-IS/RS 978.688.9540—Phone Public Health Director 978.688.8476—FAX QNSITE WASTEWATER SYSTEM CONSTRUCTION NOTES LOCATION INFORMATION ADDRESS: MAP- LOT: INSTALLER: DESIGNER: PLAN DATE: BOH APPROVAL DATE ON PLAN: INSPECTIONS TANK INSPECTION: DATE OF BED BOTTOM INSPECTION: DATE OF FINAL CONSTRUCTION INSPECTION: DATE OF FINAL GRADE INSPECTION: SITE CONDITIONS ❑Existing septic tank properly abandoned ❑Internal plumbing all to one building sewer ❑Topography not appreciably altered Comments: SEPTIC TANK ❑ Bottom of tank hole has 6" stone base ❑ Weep hole plugged ❑ 1500 gallon tank has been installed H-10 loading Monolithic construction F-1 Watertightness of tank has been achieved (Visual or Vacuum Test or Water held for 24hrs) F-1 Inlet tee installed, centered under access port ❑ Outlet tee (gas baffle or effluent filter) installed, centered under access port ❑ 24" inch cover to within 6" of final grade installed over one access port, must be over outlet of tank if effluent filter is present ❑ Hydraulic cement around inlet & outlet Wastewater System Documentation—Feb 2006 Page 1 of 6 TOWN OF NORTH ANDOVER Office of COMMUNITV DEVELMMENTAND SERVICES to HEALTH DEPARTMENT 1600 OSGOOD STREET; 13UILDING 20; SUITE 2-36 NORTH ANDOVER, MASSACHUSETTS 01845 Acim SUSall Y. Sawyer, REHS/RS 978.688.9540—Phone Public Health Director 978.688,8476—FAX D-BOX ❑ Installed on stable stone base F-1 Inlet tee (if pumped or >0.08'/foot) F-1 Hydraulic cement around inlet & outlets F-1 Observed even distribution [:1 Speed levelers provided (not required) Comments: SOIL ABSORPTION SYSTEW/ Bottom of SAS excavated down to (',,soil layer, as provided on plan Size of SAS excavated as per plan Title 5 sand installed, if specified on plan F-1 3/4-1 1/2" double washed stone installed ❑ 1/8-1/2" (peastone) double washed stone installed ❑ Laterals installed and ends connected to header F-1 Laterals vented if impervious material above ❑ Orifices @ 5 & 7 o'clock positions ❑ Gravel-less disposal systems: type, number and location as per plan F-1 Elevations of laterals installed as on approved plan F-1 40 Mil HDPE barrier installed ❑ Retaining wall (boulder/' concrete /timber/ block) ❑ Final cover as per plan Comments: Wastewater System Documentation—Feb 2006 Page 3 of 6 TOWN OF NORTH ANDOVER Office of COMMUNITY DEVELOPMENT AND SERVICES Z. HEALTH DEPARTMENT ' 1600 OSGOOD STREET; BUILDING 20; SUITE 2-36 64� . .°'14 NORTH ANDOVER, MASSACHUSETTS 01845 AC.H Susan Y. Sawyer, REHS/RS 978.688,9540— Phone Public Health Director 978.688.8476— FAX PRESSURE DISTRIBUTION F-1 -- inch manifold ❑ laterals installed with end sweeps size: material: ❑ Squirt test ft in height ❑ Equal distribution to all laterals F-1 orifice size inch as per plan Comments: CONTROL PANEL ❑ Alarm & Pump are on separate circuits ❑ Alarm sounds when float is tripped F-1 Location of control panel: F-1 Rated for exterior if placed outside Comments: Wastewater System Documentation-Feb 2006 Page 4 of 6 TOWN OF NORTH ANDOVER F NORTH Office of COMMUNITY DEVELOPMENT AND SERVICES 0 2 "ao etio HEALTH DEPARTMENT p 1600 OSGOOD STREET; BUILDING 20; SUITE 2-36 NORTH ANDOVER, 1VlASSACHUSETTS 01845 Susan Y. Sawyer, REHS/RS 978.688.9540—Phone Public Health Director 978.688.8476— FAX 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 Bank 75 100 ❑ 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 1 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 Wastewater System Documentation—Feb 2006 Page 5 of 6 TOWN OF NORTH ANDOVER a �toRrN Office ®f COIVINIUNITV DEVELOPMENT AND SERVICES HEALTH DEPARTMENT A 1600 OSGOOD STREET; BUILDING 20• SUITE 2-36 NORTH ANDOVER MASSACHUSETTS 01845 CHUS �y SACHUg Susan Y. Sawyer, REHS/RS 978.688.9540—Phone Public Health Director 978.688.8476—FAX SYSTEM ELEVATIONS INVERT ON DESIGN PLAN FIELD INVERT ELEV. Building Sewer OUT Septic Tank IN Septic Tank OUT Pump Chamber IN Pump Chamber OUT Distribution Box IN Distribution Box OUT Lateral 1 HIGH Lateral 1 LOW Lateral 2 HIGH Lateral 2 LOW Lateral 3 HIGH Lateral 3 LOW Lateral 4 HIGH Lateral 4 LOW Lateral 5 HIGH Lateral 5 LOW Wastewater System Documentation—Feb 2006 Page 6 of 6 ENE 11 r •! , $ ✓�r�i r�'..^` ��;` `� �sr'Rr f�'''�rulr'" ''s - r r !r ,�rF,r,�✓t�r�� , ✓ x � r r� ''r r�£�rrr ✓'✓/�stN��'f,��r,� � k�^y5��sr� 2r� r r , � (r'�%rr��f��r141 r3f/✓ f��fi� rrs� �`� '✓`�I!��r!' 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