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Home My WebLink AboutCertificate of Compliance - 62 WINTERGREEN DRIVE 5/23/2016 ® S�TTLED��6` o PUBLIC HEALTH DEPARTMENT Town of North Andover Community Development Division As ®f: 5/23/16 This is to certify that the individual subsurface disposal system received a SATISFACTORY INSPECTION of the: Full Repair/Replacement On-Site Sewage Disposal System By: Robert Daigle Ate 62 Winte rive Map 104B Lot 194 The_Issuance of this certificate sl/all not be construed as a guarantee that the system will function satisfactorily. ; i 1 Michele Grant � Public Health Agent 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.tovnofnorthandover.com ECEIVED MIA 1 y I b 0W"�C Ol I A?400VE EAUl °l o. "i:, r (w PUBLIC HEALTH DEPARTMENT' (oinimfi ty Develoinneid Division TOWN OF NORTH ANDOVER SEPTIC DISPOSAL SYSTEM—INSTALLATION CERTIFICATION The undersigned hereby certify that the Sewage Disposal System(tj"constructed; ( )repaired; By: oe r (Print Na" �) Located at: Vvi lql l'z ej re r�.y� Or v(. _ a (Installation Add ess) Was installed in conformance with the North Andover Board of Health approved plan, originally dated an last revised on i°M. /y r� � with a design flow of if q gallons per day. The materials used were in conformance with those specified oil 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. c Bottom of Bed Inspection Date: f /l- E/veer Representative(Signature) And—Print Name , µ d Final Construction Inspection Date: /Engi�"per Representative(Signature) v._..� � g ure) And—Print Name Installer: /l (Signature) Date: w g a `1" < And—Print Name Engin ( ligature) Date: .- rv.. 4. And—Print Name 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 978.688.9540 Fox 978.688.8476 Web http://www.tiorthandovernin.gov North Andover Health ert nt Community and Economic Development Division QNSITE WASTEWATER Y T M CONSTRUCTION NO LOCATION INFORMATION ADDRESS: 62 Wintergreen Drive MAP: 1048 LOT: 194 INSTALLER: Rob Daigle DESIGNER: Philip Christiansen PLAN DATE: BOH APPROVAL DATE ON PLAN: INSPECTIONS TANK INSPECTION: T DATE OF BED BOTTOM INSPECTION DATE OF FINAL CONSTRUCTION INSPECTION: 4/28/16 DATE OF FINAL GRADE INSPECTION: y� li SITE CONDITIONS ® Contractor reports any changes to design plan ❑ Existing septic tank properly abandoned ® Internal plumbing all to one building sewer ® Topography not appreciably altered Comments: SEPTIC TANK ❑ 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 ❑ Monolithic tank construction ® Watertightness of tank has been achieved by visual testing ❑ Inlet tee installed, centered under access port Outlet tee installed, centered under access port (effluent filter) ❑ inch cover to within 6" of finish grade installed over one access port ❑ Neoprene boots around inlet & outlet Comments: 4/28/16 Existing tank was previously examined and reported by Installer to have been deemed watertight. Upon site visit today it was visually watertight as well. Existing building sewer used. Inlet baffle remained. Outlet baffle replaced with tee and effluent filter. Pipe penetration exiting the tank did not appear watertight. Requested Installer to expose the pipe penetration fully and re-cement it, and then leave exposed for a future re-inspection. Requested p g went filter if he is going to keep that optional component the tank.grade e, r DISTRIBUTION-BOX ® Installed on stable stone base ® H-20 D-Box ❑ Inlet tee (if pumped or >0.08'/foot) M Hydraulic cement around inlet & outlets ❑ Observed even distribution ❑ Speed levelers provided (not required) ® Schedule 40 PVC Pipe Comments: 4/28/16. At least one pipe did not have even distribution to it. Installer will return and provide leveling devices and leave open for re-inspection at a later date. SAIL ABSORPTION SYSTEM (General) Bottom of SAS excavated down to C soil layer, as provided on plan ® Size of SAS excavated as per plan ® Title 5 sand installed, if specified on plan ❑ 40 Mil HDPE barrier installed ❑ Laterals installed and ends connected to header (and vented if impervious material above) ® Elevations of laterals and chambers installed as on approved plan N/A Retaining wall (boulder/ concrete /timber/ block) ❑ Final cover as per plan Comments: SOIL ABSORPTION SYSTEM (Gravel-less Chambers) ® Brand and Model of Chamber: Low Profile Standard Quick 4 Plus Infiltrator Chambers ® Number of chambers per row: 11 ® Number of rows (trenches): 4 Comments: Total Chambers = 44 FINAL GRADE Loamed Seeded Cover per plan Comments: DOCUMENTS NEEDED Certification of Installation Form submitted By engineer and signed and dated by Engineer and installer As-Built Plan BM = 130.47 HR = 1.13 HI = 131.60 SYSTEM ELEVATIONS ROD AS-BLT INVERT DESIGN INVERT ELEVATION ELEV ELEV Septic Tank OUT 5.34 126.26 126.16 Distribution Box IN 5.52 125.75 125.60 Distribution Box OUT 5.67 125.60 125.43 Lateral Bottom 1 6.46 1 125.14 1 125.12 Lateral INVERTI 5.80 1 125.47 1 125.37 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 -- El 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 Bank3 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 Town of North Andover — Septic System - AS-BUILT CHECKLIST 1) All changes to the design plan have been reflected and noted on the as-built plan 2) `'// As-built plan has a suitable scale; (1 inch = 40 feet or fewer for plot plans) 3) Street Address,Assessor's Map and Lot Number 4) Lot Lines and Location of Dwellings served by the system 5) Locations,Elevations and Dimensions of As-built system components,including reserve (if applicable) 6) Ties to all tank openings,d-box,and Leach area from dwelling or Permanent Structure 7) Setback distances are shown on the as-built plan from system components to: i Subsurface,interceptor&foundation drains k Catch basins Property lines Dwellings or other structures Private water supply or irrigation wells Watercourses or wetlands 0 Locations of Wells,Drains,Wetland Resource Areas within 150 feet of system 9) ° Location of water,gas,electric lines,cable,control panel (if applicable) 10) Location of Structures within 6 Inches of Finished Grade 11) " Original Stamp&Signature 12) L Location and holder of any easements which could impact the system 13) Impervious Areas;Driveways,etc 14) North Arrow 15) Location&Elevation of Benchmark used 16) STATEMENT ON PLAN (NA 5.3) a. "I certify the locations, elevations, tics, cover material;exposed component covers etc., shown on this as-built substantially agree with the approved plan and have determined that the break out elevations,ifapplicable,have been met." Signature of Designer Date b. "If a STUCTURAL WALL IS PRESENT W 4.9)a better or statement on the as-built indicatln the wall- was, or was not,constructed in accordance with the intended design and an v manufacturer's specifications." Signature of Designer Date Revised 3/17/15