HomeMy WebLinkAboutCertificate of Compliance - 360 FOREST STREET 4/12/2002 Town of e
North Office of the Health I)epartnu!nt
Community' 'Development and Services Division,
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Charles° tr°e t
North Andover, Massachusetts 0184 5
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Sn;nd a Starr telephone(978)688-19540
Public Health Diiector Fax(978)688-954
TOWN OF NORTH ANDOVER
BOARD OF HEALTH
CERTIFICATE OF COMPLIANCE
DATE OF COMPLIANCE
04/12/02
This is to certify that
the distribution box and connection pipe
constructed () or repaired (X)
by
Todd Bateson
at
360 Forest 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.
Brian J. LaGrasse --
Board of Health Inspector
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TOWN OF NORTH ANDOVER SEWAGE DISPOSAL SYSTEM
INSTALLATION CERTIFICATION
The undersigned hereby certify that the Sewage Disposal System ( ) constructed;
( ► repaired:
by_ '7?
located at ;r ,,w1li
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: ;:a"'�
Engineer Representative
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Final inspection date:
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Engineer e
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Installer: �,, f d. Lic.#: Date.
Design En ineer: � - Date: . .— O
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N &M Job number 1770/
TOWN OF NORTH ANDOVER
INSPECTION CHECKLIST FOR SEPTIC SYSTEMS
Site.• Final Date:
4
Installer
Tel:
Date Yes T40 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. Wadi 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 based
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 teems
(1 0
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 3/4"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
L If separate from tank, compact base with 6"of/4"stone underneath
2. Minimum 2"pipe to d-box if gravity system y.
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 4P
11. Manual operating switch
12. Pump delivers liquid to d-box
Comments:
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4
F. Distribution Box
1. D-box level
2. Minimum 0.17"(2")drop from inlet to outlet s s.
3. Minimum 6"sump J
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
9. First 2'from box laid level
Comments:
G. Soil Absorption system
1. All stone double-washed—3/a"—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. 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
4. Pipes connected at end&vent end raised
5. Separation between adjacent fields 1.0'minimum.
6. Pipes set on stable base
7. Maximum 4' separation from edge of field to first line
8. Minimum two distribution lines
Comments:
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 ld(0(-,
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 P
AS LT, 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, DRAIN , WATERCOUR
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
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AS-BUILT CHECKLIST
LOT
_ NUMBER, STREET NAME
✓ ASSESSORS MAP& PARCEL NUMBER
✓ LOT LINES & LOCATION OF DWELLINGS
LOCATIONS & DIMENSIONS OF SYSTEM,
INCLUDING R . F N A ,
TIES TO LOT LINES & DWELLING, WELLS
d. FROM SEPTIC TANK
b. FROM LEACH AREA -.> I
✓ 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, ,(ELECTRIC LINES, CABLE)
CIA, 69\15" 4sok p
DISTANCES FROM CORNERS OF HOUSE TO CENTER OF
TANK&D-BOX
ORIGINAL STAMP & SIGNATURE
/ IMPERVIOUS AREAS a DRIVEWAYS, ETC.
✓ NORTH ARROW
✓� LOCATION& ELEVATIONS OF BENCHMARK USED