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Home My WebLink AboutCertificate of Compliance - 300 GRANVILLE LANE 5/16/2016 e • ,r PUBLIC HEALTH DEPARTMENT Town of Forth Andover Community Development Division C'E'RTIFICATE ()IF Cu"MPLIANCE As of: 5/16/16 This is to certify that the individual subsurface disposal system received a SATISFACTORY INSPECTION of the: Repair By: Joseph Watson Ate 300 Granville Lane Map 106.A Lot 0035 North Andover, MA 01845 The Issuance of this certificate shall not be construed as a guarantee that the system will function satisfactorily. r Wian 4. aGrasse Public Health .Director 1600 Osgood Street,North Andover,Mossochusetts 01845 Phone 978.688.9540 Fox 978.688.8476 Web www.townofnorthondover.com North Andover Health Department Community and Economic Development Division QNSITE WASTEWATER SYSTEM T CTI N NOTES LOCATION INFORMATION ADDRESS: 300 Granville Lane MAP: 106.A LOT: 0035 INSTALLER: Joseph Watson DESIGNER: PLAN DATE: BOH APPROVAL DATE ON PLAN: INSPECTIONS .' TANK INSPECTION: 1 1511 DATE OF BED BOTTOM INSPECTION: DATE OF FINAL CONSTRUCTION INSPECTION: DATE OF FINAL GRADE INSPECTION: SITE CONDITIONS Contractor reports any changes to design plan Existing septic tank properly abandoned eternal plumbing all to one building sewer Topography not appreciably altered Comments: SEPTIC TAN{ Building sewer in continuous grade, on compacted firm base Cleanouts per plan Bottom of tank hole has 6" stone base Weep hole plugged 1500 gallon tank has been installed H-10 loading [" MI olithic tank construction Water tightness of tank has been achieved by visual testing Inlet tee installed, centered under access port t5 4.J f �( Outlet tee installed, cente d under access (gas baffle/effluent filter) �l( ye�,� �t S inch cover to withi installed over one access port Hydraulic cement around inlet & outlet Comments: PUMP CHAMBER ❑ Bottom of tank hole has 6" stone base ❑ Weep hole plugged ❑ 1500 gallon Pump Chamber installed ❑ H-10 loading ❑ Monolithic tank construction ❑ Inlet tee installed, centered under access port ❑ Pump(s) installed on stable base ❑ Alarm float working ❑ Pump On/Off floats working ❑ Separate on/off floats ❑ Drain hole in pressure line ❑ cover at final grade installed over pump access port ❑ Water tightness of tank has been achieved by testing ❑ Hydraulic cement around inlet & outlet Comments: CONTROL PANEL ❑ Alarm & Pump are on separate circuits ❑ Alarm sounds when float is tripped ❑ Location of control panel: basement ❑ Alarm signal located inside: basement Comments: DISTRIBUTION-BOX ❑ Installed on stable stone base ❑ H-20 D-Box ❑ Inlet tee (if pumped or >0.08'/foot) ❑ Hydraulic cement around inlet & outlets ❑ Observed even distribution ❑ Speed levelers provided (not required) ❑ Schedule 40 PVC Pipe Comments: ° w m NOW i ......_ .. �� m %�� `�/ '� �� „� � i �i�¢vr�v „� H� ��% i � � � lra��r�'t � �� ,� � �u� �� - � � it �� r '" �1� i,,. 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Commonwealth of Massachusetts Map-Block-Lot ® 106.A0035 BOARD OF HEALTH ----------------------- Permit No North Andover BHP-2016-0140 FEE $175.00 DISPOSAL WORKS CONSTRUCTION I'T Permission is hereby granted JOSEPH WATSON to(Repair)an Individual Sewage Disposal System. at No 300 GRANVILLE LANE as shown on the application for Disposal Works Construction Permit No. BHP-2016-014__ Dated May 09,2016 ---- - ----- Issued On:May-09-2016 - --------- ------------------------- BOARD OF HEALTH SIC ti®n for AY' DATE Construction Permit — T TO NORTH -ANDOVER, MA 01845 $250.00®Full Repair $125.00-Component Important: Application is hereby made for a permit to: When filling out ❑Construct a new on-site sewage disposal system* forms on the computer,use ❑ Re air or replace an existing on-site sewage disposal system* ( only the tab key ❑ ep to move your air or replace an existing system component—What? ( ...- l cursor-do not use the return A. Facility Information key. Address or Lot# City/Town _ MAY �� .� �(j 16 2.-*TYPE OF SEPTIC SYSTEM*: ➢ ❑ Pump ❑Gravity(choose one) TOWN ***If pump system, attach copy of electrical permit to application*** WUH k,M-_i[ME N r Y ❑Conventional System (pipe and stone system) ➢ ❑Infiltrator or Biodiffuser(Gravel-Less)(Attach a copy of your certification to install this type of system.) ➢ ❑ Pressure Distribution S.A.S.(No D-Box) ➢ ❑ Pressure Dosed(D-Box Present)S.A.S. > ❑Does the system require an effluent filter? Yes °' No If yes, does plan specify make and model of filter? YES=(no further info.needed) O= installer must specify brand of filter before DWC issuance) Whatis the Make? ' ti. Whatis the Model? 2. Owner Information . , Name Address(if dent from above) City/Town State Zip Code Email address Telephone Number 3. Installer Information 21, - ��,� Name of Cam a e el l ; Application for Sqpfip i I v 4em TODAY'S DATE Construction r i $250.00-Full Repair NORTH ANDOVER, A 01845 $125.00-Component PAGE 2 OF A. Facility Information continued.... 5. Type of Building: Eoesidential Dwelling or❑Commercial B. Agreement The undersigned agrees to ensure the construction and maintenance of the afore-described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code,as well as the Local Subsurface Disposal Regulations for the Town of No.h Andover; I understand that until a final Certificate of Compliance has been issued by thr oard of Health,the installed system is not approved Np6e Date Application'/ pprov Ry(: (43 and of Health Representative) � . Name Date Application Disapproved for the following reasons: For Office Use Only: 1. Fee Attached. Yes No 2. Pro%ectManager Obligation lam° a Attached? Yes No 3. Pump S ass tefn? Ifsa,Attacli cony ofE rical Permit Yes Na Applicant received copy of "Electrical Inspection Notes for Septic Sys te s" Yes No Handout. 4. Reviewed approvalletter, all papers orkreceived? Yes_ No Missing:' .5. Foundation As-Built?(new construction only): Yes No (Same scale as approved plan) 6. Floor Plans?(new Construction only): Yes No Application for Disposal System Construction Permit-Page 2 of 2 SEPTIC SYSTEM INSTALLER PROJECT MANAGEMENT OBLIGATIONS As the North.Andover licensed installer for the construction for the septic system for the property at: For plans by �� ./ .,.. �-r 6 st�xact�an.o•'j Relative to the application of r-� �ry (In taHcl's rt,GU lc) 7And dated ! a ,� et�uuar;a�r same') Dated *' ,+"'l aa N ;<..ka_c�) with revisions dated I understand the following obligations for management of this project: 1. As the installer, I am obligated to obtain all permits and Board of Health approved plans pdo r to performing any work on a site. I must have the approved plans and the hermit on site when any work is being done. 2. As the installer,I must call for any and all inspections. If homeowner, contractor,project manager, or any other person not associated with my company schedules an inspection and the system is not ready,then. item three shall be applicable. 3. As the installer, I am required to have the necessary work completed prior to the applicable inspections as indicated below. I understand that requesting an inspection without completion of the items in accordance with Title 5 and the Board of Health Regulations may result in a $50.00 fine being levied against me and/or my company. a. Bottom of Bed—Generally, this is the first (1") inspection unless there is a retaining wall, w1--Lich should be done first. The installer must request the inspection but does not have to be present. b. Final Construction Inspection—Engineer must first do their inspection for elevations, ties, etc. As-built of verbal OIL(or e-mail to: ,plc �V �rr,c:lotr?� : �ar�>,d�i.i��:tB�_gac�t> tD <..,.a:,it) from the engineer must be submitted to the Board of Health,after which installer calls for an inspection time. Installer must be present for this inspection. With a pump system,all electrical work must be ready and able to cause pump to work and alarm to function. c. Final Grade—Installer must request inspection when all grading is complete. Installer does not have to be on-site. 4. As the installer, I understand that only I may perform the work(other tl)(Ia simple cxcavalim)and I am required to complete the installation of the system identified in the attached application for installation. I further understand that work done by others unlicensed to install septic systems in North Andover can constitute reasons for denial of the system and/or revocation or suspension of my license to operate in the Town of North Andover, significant fines to all persons involved are also possible 5. As the installer, I understand that I must be on-site during the performance of the following construction steps: a. Determination that the proper elevation of the excavation has been reached. b. Inspection of the sand and stone to be used. c. Final inspection by Board of Health staff or consultant. d. Installation of tank, D-Box, pipes, stone, vent,pump chamber, retaining wall and other components. 6. As the installer,I understand that I am solely responsible for the installation of the system as per the approved plans. No instructions by tlne homeowner,general contractor, or any other persons shall absolve me of this obligation. Undersigned Licensed Septic Installer: ;. ('TodlaN D' '' :tcu) f � (N:ml .,. i t :at) (i" ,,ona s q,ried)