HomeMy WebLinkAboutCertificate of Compliance - 37 CARLTON LANE 9/13/2001 Form No.4
Town of North Andover, Massachusetts
BOARD OF HEALTH i
-���—e1 het' I "
CERTIFICATE OF COMPLIANCE
This is to certify that
the Individual Soil Absorption Sewage Disposal System constructed ( ) or repaired
by-
INSTALLER
at i 'T�it �L°r Alo T�1, A-ad,J� A
SITE LOCATION
has been installed in accordance with Board of Health Regulations as described in the Design
Approval Site System Permit No. l� dated
The issuance of this certificate shall not be construed as a guarantee that the system will
function satisfactorily.
BOARD OF H rT, *WxI:bJ:eC=r
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' ,l O�Y� O 1..' ,'�Q l l,�'A 1.i A IN B O V E R S E 1'V.`7.CY r,,� 1...J I J 1 O�r.`".,-1 d: ,J 1,* 1 E i 1. .
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The under si�:ned bete V ceriry that the -e`.ti'aoe Disposal Syste 1
� ) reC air ed
located at � 7 Ckat, Al o`�1 r2�7°!/ f ro
was installed in cbntcmance with the No.-ih Andover.Board of Heaith v-�provec plan,
Svstem Design Pet`rit = dated _ wit , an aocroved design
Flow of nailons per day The materia:s uses were in conformance �.vlrh those
specined oh the approved plan; the system vas installed in accordance v ith the provisions`
of v 10 C.VM 1 5.000, Title 5 and local replations, and the Final QradlM agrees
substantially With the approved plan. ,-ail worn ;s accurateiv represented ;)c the As-built
which has been submitted to the Board ci Health
Bed inspecticn date: 7/21 o/
EnP_lneer R ese ;stive
Final inspect:cn rate -_
� r _ -- --
EnCineer Represe^tar:%e
Installer: L;c �. Date
— �
Cesi<=n Engineer: -o ' Date _
��° �tl�� t�ts�• � .
.,
ION I/i 1
y ,\
AS-BUILT IST
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, DRAINS, WATERCOURSES
WITHIN 150' OF SYSTEM
LOCATION OF WATER, GAS, ELECTRIC LINES, CABLE
CORNERS OF HOUSE TO CENTER OF
TANK D BOX '.
ISTANCES,FRO
ORIGINAL STAMP &
SIGNATURE
IMPERVIOUS AREAS - DRIVEWAYS, ETC.
NORTH ARROW
LOCATION&ELEVATIONS OF BENCI-DAARK USED
INSPECTION CHECKLIST FOR SEPTIC SYSTEMS
Yes NO 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 fi•om foundation,etc.
Comments:
B. Retaining Wall n ._,...•.�„�
1. Wall height and width as specifie °`
2. Waterproofed' .
3. Wall minimum 10'to leaching f c
4 W ility
meets specifications ofpla
Commen°ts ......"
C, Building Sewer
I. Pipe diameter minimum 4"
2, Schedule 40 pipe `"`"
3. Watertight joints
4. Inlet to tank cemented
5. Slope minimum 0.01 or 1/8"per foot minimum -°
6. Pipe properly set on compact firm base- mw.,..a._e,_v
7. Pipe laid on continuous grade in straight line ��~°°�°'
8. Cleanouts precede all change in alignment and grade `'
9. Manholes at any 90°change
10. 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 grade d '
5. Manholes over center and each tee <
6. 3-20"manholes
7. Inlet tee minimum 12"under invert
8. Outlet tee minimum 14"under invert
9. Outlet line cemented
10. Air space 3"above tees
11. 2"-3"drop from inlet to outlet
12. Pipe set
13. Compact base with 6"of 1/4"crushed stone under tank
14. Tank is watertight
Comments:
Yes NO
E. Pump Chamber
separate from compact base tof/4
2. Minimum 2 P i e to d-box t g avit sy stem "s,kon�underneath -"-"
3. 20"access manhole
4. Tank level -�
5. Watertight
6. Tank size agrees wi 6 specification
7. Manhole to gr4dd""
8. Check valye and bleeder hole present
9. Alarm in building on separate circuit
10. Alarm functions
11. Manual operating switch
12. Pump delivers liquid to d-box
Comments:
F. Distribution Box
1. D-box level °
2. Minimum 0.17"(2")drop fi•om inlet to outlet .."-"
3. Minimum 6"sump
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
Comments:
G. Soil Absorption system
1. All stone double-washed-'/4"- 1 ''/z'°
-pea stone
Bucket test done? �M
2. Minimum 2"of pea stone above distribution lines
3. Minimum 6"stone beneath pipe
4. Distribution ScPP e or concted fn
g ether
5. Grading meets 3lsla � ...
6. Minimum of 9"of fill graded over system
7. Toe of slope stops minimum 5' from edge of property; if not,then swale.
Comments:
H. Leach Trenches
1. Minimum 2 trenches
2. Length of trenches agree with plan. (Max, length 100')
3. agree P mutn.,,,2,',°,rtt'aximum-4%
4. Vent present f<50 feet or�specified.,w�.."""° ",...,
-Min
5. Distance between trenchp,mimmum 4' and maximum of 6'
�..
6. Minimum distanp,between trenches 10'
7. ..
Pip §lo e-nfi umum 0.005 or 6"per 100'
8. Depth of trenches below outlet invert minimum of
.. Yes 1�
9. Pipes set on stable base.
Comments:
1. Leach Field
1. Maximum length of field 100' ro
2. Pipe slope minimum 0.005 or 6"per 100' �.... ..
3. Separation between pipe 6'maximum
4. Pipes connected at end
5. Separation between adjacent fields 10'minimum A'r
6. Pipes set on stable base
7. Maximum 4'separation from edge of field to first line -
8. Minimum two distribution lines a�
9. Maximum pert rate 20 mpi °
Comments:
I Leaching Pits
�,
1. Minimum inlet pipe 4,,
p P " ..m
2. Pits of concrete
between 12 and 4 'wide
4. Access lrhholes on each it
5. Pipep,Cemented with hydraulic cam°
nt
Comments:"
K. Final Grade
1. Slope over soil absorption system minimum 0.02
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