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HomeMy WebLinkAboutCertificate of Compliance - 657 FOREST STREET 8/30/2010 00R,41 ,LED r R cac 1-- n p0,4 T @R � 640- PUBLIC HEALTH DEPARTMENT Community Development Division CERTIEICATE -r August 3 0, 2010 This is to certify that the individuafsu6surface disposal system receiveda V IS XTO1RTI.. TECTIONof the: 'FuffSeptic m` Eor an On—Site By: WiTwm qWomas Sawyer At: 657 Torest Street WbttfiAndover, 9VA 01845 The Issuance of this certificate shaft not 6e construed as a guarantee that the system wiff function satisfactoriCy. WicheCe E. Grant 1 Mfic Yfealth Inspector 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com Regarding Septic Installation:Lot:21,657 Forest St North Andover MA To Whom it May Concern: I,George Haseltine,owner of 657 Forest ST North Andover MA absolve the town of North Andover,MA and the installer,Tom Sawyer of Arco Escavation,of any and all liability due the absence of finish loam and seeding of the yard,specifically referring to the yard over the septic system. This note is indented to provide relief of liability in order to have the Board of Health municipality approve the finish grade over the septic system without the finish loam and seeding being completed. If you have any qu io s or need anything further please feel free to email me or call me. George Haseltine 603.85.8768 cell George.Haseltine@gmail.com CD 0-;--�ti 1 --� ® a c� , � Q 0 U) �o cn �I ro G o tj Pilo U) cn AWL CA Cd C ° O CL) c :H CD ® O a — CD PIZ fl- ca O �. ca w�` m e A o V °— co Ea CO) Q� e W o co a CD C.2 CL ts CD �, W y C N N CO uj CIO N'C `j ) W RJ: `° o N y w CD 0 cm u ® Cc W cm ts co cc ca -P14 r V N_ O O ' Z O O w rm ~ a+ c CL O c Q m CD COD d N C .c ® J.1 .Z, L w C. EL LILJ H N d5 O C y oC E v'fl CID N CD • V ® ® m C O en FE to ` N CD F- s ja C.4=... 00 ,tN Commonwealth of Massachusetts City/Town of NORTH ANDOVER Certificate of ompliance Form 3 DEP has provided this form for use by local Boards of Health.Other forms may be used,but the information must be substantially the same as that provided here.Before using this form.check with the local Board of Health to determine the form they use. This is to Gertifv that the following work on an On-Site Sewaae Dsposai Svstem important when ON out ® Construction of a new system *wme on the © Repair or replacement of an existing system Coo u roauicey ❑ Repair or replacement of an existing system component only to move your cursor-do not Has been done in accordance with Title 5 and the Disposal System Constr action Permit(DSCP): use the return kev. DSCP Number DSCP Date w Fadfity Owner 657 FOREST STREET Street Address or Lot k NORTH ANDOVER MA 01845 Ckvfrown state Zip Code Designer Information: BENJAMIN C.OSGOOD,JR. NONE NA" Name of Comoonv t_-_2 d 8-26-10 liMpoW Date Inetallar Infnnnatinn _ !. r � XCG-v0.ZIP/'S ante G Name of Company -r S�oneturo _�. Data� � Use of this system is conditioned on compliance with the provisions set forth below; The Issuance of this certificate shall not be construed as a guarantee that the system will function as designed. ' Approving �thoff y f p y Sfgnapire t5f0rm3.doa OB/OCCt J / GntNcate of Comolisnoe•Pa"i of 1 TOWN OF NORTH ANDOVER Office of COMMUNITY DEVELOPMENT AND SERNWES HEALTH DEPARTMENT I�e-d 4"OSCOOD STREET NORTH ANDOVER, MASSACHUSETTS 01845 r - Susan Y.Sawyer,REHSIRS 978.688.9540—Phone 978.688.8476—FAX Public Health Director UMAIL:heal thdeptatownofnorthandover com W EBSITE:htto:.www townofnorthandover com TOWN OF NORTH ANDOVER SEPTIC DISPOSAL SYSTEM-INSTALLATION CERTIFICATION The undersigned hereby certify that the Sewage Disposal System constructed;( )repaired; by (Print N ) located at � FoRt cl S�- 1J- A Ntw€2 (Installation Address) was installed in conformance with the North Andover Board of Health approved plan,originally dated /ci d last Revised on -5'1011D ,with a 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. 1 Bed inspection date: Z iD l D Engineer Representative(Signature) And-Print Name Final Inspection date: Engineer Representative(Signature) And-Print Name .+n..�wr.- ..�ru -.raw..•.. ._..,rrs�o .,,,.,..IrrM..�,.. Installe. (Signature) Date:__ L .%nd-Print Name Engineer: T(Signature) Bate: And-Print Name o 16 0 rx coc lcf n° SA U PUBLIC HEALTH DEPARTMENT Community Development Division QNSITE WASTEWATER SYSTEM TI NOTES LOCATION INFORMATION ADDRESS: 657 Forest Street MAP: 105D LOT: 21 INSTALLER: Tam Sawyer DESIGNER: Ben Osgood, Jr. PLAN DATE: 3/20/10 BOH APPROVAL DATE ON PLAN: 5/20/10 INSPECTIONS TANK INSPECTION: (� DATE OF BED BOTTOM INSPECTION: �� DATE OF FINAL CONSTRUCTION INSPECTI N: 8/26/10 DATE OF FINAL GRADE INSPECTION: � � �� o SITE CONDITIONS NA 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 hale has 6" stone base Weep hole plugged ® 1500 gallon tank has been installed H-10 loading ® Monolithic tank construction ® Water tightness of tank has been achieved by 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688,9540 Fax 978.688.8476 Web www.townofnorthandover.com Inspection Form June 2008 t'!1 2D r y q AC HU" & PUBLIC HEALTH DEPARTMENT (ommunity Development Division Visual testing ® Inlet tee installed, centered under access port ® Outlet tee installed, centered under access port (effluent filter) ® 24" inch cover to final grade installed over outlet access port ® Hydraulic cement around inlet & outlet Comments: DISTRIBUTION-BOX ® Installed on stable stone base ® H-20 D-Box NA Inlet tee (if pumped or >0.08'/foot) ® Hydraulic cement around inlet & outlets ® Observed even distribution NA Speed levelers provided (not required) Comments: SOIL ABSORPTION SY TEM (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 NA Retaining wall (boulder/ concrete /timber/ block) Final cover as per plan Comments: 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.corn Inspection Form June 2008 o x`11 V, w so ra w ^&" Q CpCdWIC�w6 woew "X• "4' PUBLIC HEALTH DEPARTMENT Community Development Division COIL ABSORPTION SYSTEM (Gravel-less Chambers) ® Brand and Model of Chamber: Standard Quick 4 Infiltrator Chambers ® Number of chambers per raw: 8 ® Number of rows (trenches): 5 Comments: Total Chambers = 40 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www townoMorthandover.carn Inspection Form June 2008 OF 0 a° rs `V SA US PUBLIC HEALTH DEPARTMENT Community Development Division BM = 98.48 HR = 5.26 HI = 103.74 SYSTEM ELEVATIONS ROD ELEVATION AS-ELT INVERT ELEV DESIGN INVERT ELEV Benchmark 5.26 98.48 Building Sewer OUT 100.98 Septic Tank IN 3.86 99.53 99.38 Septic Tank OUT 4.17 99.22 99.13 Distribution Box IN 4.50 98.89 98.93 Distribution Box OUT 4.68 98.71 98.76 Lateral 1-5 TOP 4.76 Lateral 1-5 INVERT 98.63 98.66 Top of Chamber 4.76 98.98 99.00 Bottom of Bed/Chamber 5.76 97.98 98.00 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www,lownofnorthandover.com Inspection Form June 2008 riTp-i `.. n 0 ACH PUBLIC HEALTH DEPARTMENT Community Development Division 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnor*ndover,crrni Inspection Form June 2008 V%ORTfl .y M-I D 0 I • saena gwrx sc�"• ACHU PUBLIC HEALTH DEPARTMENT Community Development Division 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 1001 50 • Irrigation well 75 100 ® Surface Water 25 50 • Bordering Vegetated Wetland , Salt Marsh, Inland/Coastal Bank 3 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 1600 Osgood Street,North Andover,Mosso(husetts 01845 Phone 978.688.9540 Fox 978.688.8476 Web www,townofnorilrundover.rom Inspection Form June 2008 DelleChiaie, Pamela From: DelleChiaie, Pamela Sent: Thursday, August 26, 2010 11:35 AM To: Grant, Michele Subject: FW: 657 Forest Street- Septic As Built and Certification Attachments: image002.gif FYI. Susan has the paperwork. I will prepare a COC for Monday for you. From: Sawyer, Susan Sent: Thursday, August 26, 2010 11:11 AM To: DelleChiaie, Pamela Subject: RE: 657 Forest Street- Septic As Built and Certification 0l< Remember if the owners wane:to submit a letter stating they absolve the installer of the obligation to loam and seed, they can have an inspection of the final grade without those items. From: DelleChiaie, Pamela Sent: Thursday, August 26, 2010 11:04 AM To: Sawyer, Susan Subject: 657 Forest Street - Septic As Built and Certification Hi Susan, George from Forest Realty Trust came by and dropped off the As Built for 657 Forest Street. He has the state issued COC form with Ben's signature. I gave him our local form. He asked if the signature on the other form could be used and attached to our form, as Ben is difficult to meet up with due to his schedule. He also wanted to schedule a Final Grade which Michele can do on Monday....so, if you have time today, the As Built and form need to be reviewed and approved before I can issue the COC for him. VeO r Pamela DelleChiaie Departmental Assistant I Community Development I Health Department Town of North Andover 1600 Osgood Street I Bldg 20 1 Suite 2-36 North Andover,MA 01845 ph: 978-688-9540 fax: 978-688-8476 "We can never see thepaat/a of our 1?fi?ij'we are too bus,p foc°u,ing oil the pebbles under o ut-ftet:"a .. 4aaollyntolls 1 .. i 1. , r ND .1'