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Home My WebLink AboutCertificate of Compliance - 94 SHERWOOD DRIVE 4/20/2006 Ir Commonwealth of Massachusetts — W City/Town of N R Certificate le 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 Certify that the following work on an On-Site Sewage Disposal System Important: When filling out ❑ Construction of a new system forms on the ® Repair or replacement of an existing system computer, use ❑ Repair or replacement of an existing system component only the tab key to move your cursor-do not Has been done in accordance with Title 5 and the Disposal System Construction Permit (DSCP): use the return key. DSCP Number DSCP Date Q Jian Wen &Judy Hou - Facility Owner - - Lot 7, 94 Sherwood Drive Street Address or Lot# North Andover MA 01845 City/Town State Zip Code Designer Information: John M. Morin, PE The Neve-Morin Group, Inc. Name Name of Company — --- --- Date--- - --- Installer Information: Peter Breen °" �, r' .. "� �.� p, a Name Name of Company Signature Date 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 Authority Signature Date t5form3.doc•06/03 Certificate of Compliance•Page 1 of 1 TOWN 011"'NORT11 ANDOVER Office of C(Y IML.AfTY DEVE1,0PNIENTAIND SERV[CES 'AL111 DEPAR'I'MEW '0 400 OSGOOD STRI-TT NORTH ANO(WHR, MASSACHUSFIA"T's 018115 'S SA us I SLIS;111 Y. Sawyer, REHS/RS 978.688,95,10 Phone PUbliC I lealth Director r 978,688.8476 FAX QNSITE WASTEWATER SYSTEM CONSTRUCTION NOTES LOCATION INFORMATION I//� ADDRESS- MAP: LOT: INSTALLER: DESIGNER: PLAN DATE: BOH APPROVAL b TE ON PLAN: INSPECTIONS --TA� INSPECTION: DATE OF BED BOTTOM INSPECTION: DATE OF FINAL CONSTRUCTION INSPECTION: DATE OF FINAL GRADE INSPECTION: SITE CONDITIONS ❑Existing septic tank properly abandoned ❑Internal plumbing all to one building sewer ❑Topography not appreciably altered Comments: SEPTIC TANK ❑d Bottom of tank hole has 6" stone base ❑ Weep hole plugged 1500 gallon tank has been installed H-10 loading Monolithic construction Water tightness of tank has been achieved q (Visual or Vacuum Test or Water held for 24hrs) Inlet tee installed, centered under access port ❑-" Outlet tee (gas baffle or effluent filter) installed, centered under access port ❑ 24" inch cover to within 6" of final grade installed over one access port, must be over outlet of tank if effluent filter is present V, Hydraulic cement around inlet & outlet Wastewater System Documentation—Feb 2006 Page 1 of 6 TOWN OIL NORTH ANDOVER Q NORTp Office of COMMUNITY DEVELOPMENT AND SERVICES 4" HEALTH DEPARTMENT T 400 OSGOOD STREET NORTH ANDOVER, MASSACHUSETTS 01845 CtHi Susan Y. Sawyer, REHSIRS 978.688.9540—Phone Public Health Director 978.688.8476—FAX Comments: PUMP CHAMBER ❑ Bottom of tank hole has 6" stone base ❑ Weep hole plugged ❑ Combo Tank installed. Size: ❑ 1000 gallon Pump Chamber installed H-10 loading Monolithic 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 ❑ 24" inch cover to within 6" of final grade installed over pump access port ❑ Water tightness of tank has been achieved Visual testing ❑ Hydraulic cement around inlet & outlet Comments: ADVANCED TREATMENT TECHNOLOGY ❑ Type of treatment device: ❑ Installed per manufacturers requirements ❑ All components working in accordance with manufacturer's requirements Comments: Wastewater System Documentation—Feb 2006 Page 2 of 6 TOWN OF NOR, u ANDOVER 17T{q Office of COMMUNITY DEVELOPMENT' AND SERVICES ��o�,TI no s e"oL HEALTH DEPARTMENT 0 400 OSGOOD STREET * " NORTH ANDOVER, MASSACHUSETTS 01845 '�SV CHUSe��' Susan Y. Sawyer, REHSiRS 978.688.9540—Phone Public Health Director 978.688.8476—FAX D-BOX ❑ Installed on stable stone base ❑ 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 ❑ Bottom'of SAS excavated down to soil layer, as provided on plan ❑ Size of SAS excavated as per plan ❑ Title 5 sand installed, if specified on plan ❑ 3/4-1 Y2" double washed stone installed ❑ 1/8-1/2" (peastone) double washed stone installed ❑ Laterals installed and ends connected to header ❑ Laterals vented if impervious material above ❑ Orifices @ 5 & 7 o'clock positions ❑ Gravel-less disposal systems: type, number and location as per plan ❑ Elevations of laterals installed as on approved plan ❑ 40 Mil HDPE barrier installed ❑ Retaining wall (boulder/ concrete /timber/ block) ❑ Final cover as per plan Comments: Wastewater System Documentation—Feb 2006 Page 3 of 6 TOWN OF NORTH ANDOVER a Nn pTH Office of COMMUNITY DEVELOPMENT AND SERVICES � �``` '' HEALTH CEO T ENT 400 OSGOOD STREET NORTH ANDOVER, MASSACHUSETTS 01845 �9SSAcNus , Susan Y. Sawyer, REHS/RS 978.688.940—Phone Public Health Director 978.688.8476—FAX PRESSURE DISTRIBUTION ❑ -- inch manifold ❑ laterals installed with end sweeps size: material: ❑ Squirt test ft in height ❑ Equal distribution to all laterals ❑ orifice size inch as per plan Comments: CONTROLPANEL ❑ Alarm & Pump are on separate circuits ❑ Alarm sounds when float is tripped ❑ Location of control panel: ❑ Rated for exterior if placed outside Comments: Wastewater System Documentation—Feb 2006 Page 4 of 6 TOWN OF NORTH ANDOVER Office of COMMUNITY DEVELOPMENT AND SERVICES � o��`'"� "°�� HEALT H DEPARTMENT � p 400 OSGOOD STREET NORTH ANDOVER, MASSACHUSETTS 01845 �'ss'i«aus Susan Y. Sawyer, REHS,RS 978.688.9540—Phone Public Health Director 978.688.8476—FAX 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 -- F-1 Waterline 10 10 10' ❑ Private drinking well 75 1002 50 ❑ Irrigation well 75 100 ❑ Surface Water 25 50 ❑ Bordering Vegetated Wetland , Salt Marsh, Inland/Coastal Bank 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 ' Suction line 222(2) 2 10 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 1030,respectively, pursuant to 15.211(3),also by NA wetland bylaws Wastewater System Documentation—Feb 2006 Page 5 of 6 Office CO NIT tltl N �v��A`p�1�i?ORTfldY�gAl'VYg�Y�O V�EY�l�p�, q,� t NORTN Office of' ONITW��1 rIT L Y9 A�V ELIJY NIE�1V�l AL�Y� SERVICES ICES �tO��T�eo �yOL O - A HEALTH DEPARTMENT ENT 400 OSGOOD STREET ` 4 NORTH ANDOVER, MASSACHUSETTS 01845 Susan Y. Sawyer, REHS/RS 978.688.940—Phone Public Health Director 978.688.8476—FAX SYSTEM ELEVATIONS INVERT ON DESIGN PLAN FIELD INVERT ELEV. Building Sewer OUT Septic Tank IN Septic Tank OUT Pump Chamber IN Pump Chamber OUT Distribution Box IN Distribution Box OUT Lateral 1 HIGH Lateral 1 LOW Lateral 2 HIGH Lateral 2 LOW Lateral 3 HIGH Lateral 3 LOW Lateral 4 HIGH Lateral 4 LOW Lateral 5 HIGH Lateral 5 LOW Wastewater System Documentation—Feb 2006 Page 6 of 6 i l r ri �i �w 0 �Vi 9n I al uw r'' r p W r� iu � r 4 it II w• N6 b""" i s � rf iA '„ ;I y P M� 4 irk Y ue h .I .. ,�� i✓� Vii, '' -: „ur. r�Nir�Y1r��i,�� ,,, ,. ,. , I I� i I i x' r� u ...,. j E �f 7 r r 0 i tv hid r My ^x mJ�r Y ! MINX, 7 ✓�J �l�m r %�y��hm� :✓m ��r�m�r ! � u� u�!rW,a�ri y✓iww � �'�', Y. 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