HomeMy WebLinkAboutCertificate of Compliance - 213 CARLTON LANE 12/13/2013 PUBLIC HEALTH DEPARTMENT
Town of North Andover
Community Development Division
CERTIFICATE OF
COMPLIANCE
As Of. 12/13/13
This is to certify that the individual subsurface disposal system received a
SATISFACTORY INSPECTION of the:
Complete Repair and Construction
On-Site Sewage Disposal System
By: James Kellett
At®
213 Carlton Lane
Map 107A Lot 0208
North Andover, MA 01845
The Isspqnce of this cent. cate shall not be construed as a guarantee that the system will function satisfactorily.
`A,,
S/Wan Saw=yer
Public Health Agent
1600 Osgood Street,North Andover,Massachusetts 01845
Phone 978.688.9540 fax 978.688.8476 Web www.townof north an dove r.corn
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SEPTIC DI"tiPOSAL, sY4'mm - INS"1'AI,I,A"I 1()l' ('[e",!Cr!Fl(:'Al'!O?N
Hw cuidersipned herein ertii'y Chart the sew1we 1:1iVosal Sys wm( )c<.rnsu"tew WPM:
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(Print Name) � �
Imeawd at 21.1 x r I fo pi if
(haoxta llation Address)
Was insmIled in cmilirrnrrn a%Ah Ow North alndc,vcrr lirr,u�d on ic,orldr nplrrcrvcd pWn,corionally dated
au d lost revised«rr �_� t G��V � �� 0 with to design flaw crh
_ p tollcrrrs per daya, 'I hu nrarmrals used were in Coll1"errnrance with Chases specified oa tirr°
approved phrn,the system wars installed in acc ordtrncQ wilh the provisions ral"I 10, C NIR l:"+.UC O `Fitle�S soma loran
rcp,ulatiwc;and the Finsrl t rrtdAg oat„roes sAst witrlly with ke srl'rlarowd play r^cll wmt K nmmmet wpivscrawl or)
the As-built which has becn sobrrritted to the Board of,I lcidth.
Bounin of Bed Inspection Mae:
F?,lap„incer Itclarcwcrrtartivc(signature)
Aml - Print Name
e
Finsal('crnstrncMm lospoi-on "Me:
I^nitincer Repr"Critaativc(signarturc:)
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lowtaallca`". .. . IT _ w m ...,.._—(Sigoaturc) l7;rtct_ ., ' .._." ...... .... ........
And Print Name
Luke R(`Y
And Print Mmic
1600 Osgood Street, Borth Anduvw� Nklsst itusotts 01845
Phone 978. USIS40 Fn 97BABB 8476 Mkb l ittp://www,towtaalaaorthunclovela.coili
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RECEIVED
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� Certificate Compliance
Form
DEP has provided this form for rise by local Boards of Health. Other forms may he used, but the
information must be substantially the sanre as that provided hers.. Before usirrrf thti.yrforrn, check with
the local Board of Health to determine the forrat they use.
"fitis is to Cerlifyr that the following work on an On Site Sewage Disposal System
Iwtrem fll nn;#anal �,• Construction of a new system
forms on tr,c Repair or replacc�rrtc��snt of an existing system
comr)tatAr 61-, y. existing
only the l air k", Repair or r�place�rraenk of an r xi,�tirtg systr rt�r component
f�tr�ar�fent
to rnaave Your
arrsor ato not Has been stone in accordance with"Fitle 5 and the Disposal System Construction Permit(t);W,G P):
use the return
key.
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Facility
Own(:r
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r;ity/lawn Slane Zip Gorda
Designer information!
1-q r ), o c 0 .
Nam Name er ;ntp t
q
ttrrEaturs+ Dears.
Installer Information:
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Use of this system is conditioned on compliance with the provisions set forth below:
The issuance of this certificate small riot be construed as a guarantee that the syste rt will function as
designed.
Approving Arr070rity
>¢Oraalraras
Date
151oaroldre.06103 C a„itit tale of f,om pti nc"o-Paago' t of 1
Blackburn, Lisa
From: Isaac Rowe <irowe @ mill riverconsulting.com>
Sent: Friday, June 21, 2013 12:49 PM
To: Blackburn, Lisa; 'Susan Sawyer(ssawyer @townofnorthandover.com)'
Cc: 'Isaac Rowe'; 'Dan Ottenheimer'; plally @millriverconsulting.com
Subject: RE: 213 Carlton Lane
Attachments: 213 Carlton Lane.doc
Susan/Lisa,
Attached is the inspection form for the above referenced property. Everything looked good.
Let me know if you have any questions.
Thanks,
Isaac M. Rowe,R.S.
Project Manager
Mill River Consulting
6 Sargent Street
1
Q °
North Andover Health Department
Community Development Division
QNSITE WASTEWATER SYSTEM CONSTRUCTION NOT
LOCATION INFORMATION
ADDRESS: 213 Carlton Lane MAP: 107A LOT: 0208
INSTALLER: James Kellett
DESIGNER: LJR Engineering
PLAN DATE: 2/27/2013
BOH APPROVAL DATE ON PLAN: 3/5/2013
INSPECTIONS
TANK INSPECTION: 6/12/2013
DATE OF BED BOTTOM INSPECTION:6/18/13
DATE OF FINAL CONSTRUCTION INSPECTION:
DATE OF FINAL GRADE INSPECTION:7/15/13
SITE CONDITIONS
N/A 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
N/A Cleanouts per plan
X Bottom of tank hole has 6" stone base
X Weep hole plugged
X 1500 gallon tank has been installed
H-10 loading
X Monolithic tank construction
® Water tightness of tank has been achieved by
visual testing
® Inlet tee installed, centered under access port
Z Outlet tee installed, centered under access port
(effluent filter)
® 24" inch cover to within 6" of finish grade
installed over one access port
® Neoprene boots around inlet & outlet
Comments:
DISTRIBUTION-BOX
® Installed on stable stone base
® H-20 D-Box
N/A Inlet tee (if pumped or >0.08'/foot)
® Hydraulic cement around inlet & outlets
® Observed even distribution
® Speed levelers provided (not required)
Comments:
SOIL ABSORPTION SYSTEM (General)
X Bottom of SAS excavated down to C soil layer,
as provided on plan
X Size of SAS excavated as per plan
X Title 5 sand installed, if specified on plan.
1 load
N/A 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: corner of house to post 20', 16.4x32'2", 26.4x42'4"
SOIL ABSORPTION SYSTEM (Gravel-less Chambers)
® Brand and Model of Chamber: Standard Quick
4 Infiltrator Chambers
® Number of chambers per row: 8
® Number of rows (trenches): 5
Comments: Total Chambers = 40
FINAL GRADE
X Loamed
X Seeded
X Cover per plan
Comments: All set, 7/15/13
DOCUMENTS NEEDED
Certification of Installation Form submitted
By engineer and signed and dated by
Engineer and installer
As-Built Plan
BM = 100.00
HR = 2.45
HI = 102.45
SYSTEM ELEVATIONS
ROD AS-BLT INVERT DESIGN INVERT
ELEVATION ELEV ELEV
Benchmark 2.45
Building Sewer OUT 4.23 97.87 97.85
Septic Tank IN 4.40 97.70 97.65
Septic Tank OUT 4.66 97.44 97.40
Distribution Box IN 4.86 97.24 97.27
Distribution Box OUT 5.04 97.06 97.10
Lateral 1 TOP 5.18
Lateral 1 INVERT 96.92 96.97
Lateral 2 TOP 5.17
Lateral 2 INVERT 96.93 96.97
Lateral 3 TOP 5.17
Lateral 3 INVERT 96.93 96.97
Lateral 4 TOP 5.17
Lateral 4 INVERT 96.93 96.97
Lateral 5 TOP 5.17
Lateral 5 INVERT 96.93 96.97
Top of Chamber 5.13 97.32 97.3
Bottom of Bed/Chamber 6.13 96.32 96.3
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 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
I Suction line 222(2)
2 100 feet is a minimum acceptable distance and no variance is allowed for a lesser distance(NA 5.02).
s 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