HomeMy WebLinkAboutCertificate of Compliance - 208 OLD CART WAY 6/6/2008 Na RTC q
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PUBLIC HEALTH DEPARTMENT
Community Development Division
C(FR2I FICArrcF OT C0914(.(I.qXCE
As of:
,dune 6, 2008
Tris is to certify that the individuaCsubsurface drsposaf ystem received a
SA97SZ4CT02,TrXS(P M0Xof the:
1Distri6ution Box, Repair
By,
Todd Bateson
.fit:
208 DCd Cart Way
. 9Yap 10T.B; (Parcef118
Xorth-X ndover, M q 01845
The Issuance of this certfcate shaCC not be construed as a guarantee that the system wiCC
function satisfactoay.
usan Sawyer
(Pu6ficWealth Director
i
i
i
1600 Osgood Street,North Andover,Massachusetts 01845
Phone 978.688.9540 Fox 978.688.8476 Web www.townofnorthandaver.com
k
r TOWN OF NORTH ANDOVER e �orh
Office of COMMUNITY DEVELOPMENT AND SERVICES
HEALTH DEPARTMENT
1600 OSGOOD STREET; Building 2-36
+pF�i�o �
NORTH ANDOV R, `MASSACHUSETTS 01845 "TV use`
Susan Y, Sawyer, RIMS/RS /F 978.688.9540—Phone
Public Health Direcfo► �� r '�� 978.688.8476—FAX
D BOX !�
Installed on stable stone base
Inlet tee (if pumped or X0.08'/foot)
❑ Hydraulic cement around inlet & outlets
If r 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
❑ 314-1 Y" double washed stone installed
❑ 118-1/2" (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
`
"ORTR Commonwealth of Massachusetts
Board of Health Pemik No
Disposal Works Construction Permit
Permission is hereby granted Todd Bateson
to(Repair)an Individual Sewage Disposal System.
as shown on the application for Disposal Works Construction Permit No. B --_��QOP016' Dated. May28,2CLO8
Issued On:May-28-2008 Board of He
l-' f
NORT Appl.ication for Septic Disposal System
- Construction Permit — TOWN OF TODA Y'S DATE
ORTH ANDOVER MA 01845 $ 250.00–Full Repair
A"P^� '� $125.00 - Component
Important: Application is hereby, made for a permit to:
When filling out ❑ Construct a new on-site sewage disposal system*
forms on the
computer,use ❑ Repair or replace an existing on-site sewage disposal system*
only the tab key
to move your epair or replace an existing system component—What? '
cursor-do not
key y the return A. Facility Information
C..4 N I r
rah Address or Lot#
§ '° J r�� f
Cityfrown
2.- TYPE OF SEPTIC SYSTEM*:
❑ Pump ❑ Gravity(choose one)
***If pump system,attach copy of electrical permit to application***
❑ Conventional System (pipe and stone system)
❑ Infiltrator or Biodiffuser(Gravel-Less) (Attach a copy of your certification to install this type of system.
❑ Pressure Distribution S.A.S. (No D-Box) (Attach Draft Maintenance Agreement)
❑ Pressure Dosed (D-Box Present) S.A.S.
2. Owner Information
V(t-
Name
o�— d('0 Ga, f t�vr y
Address(if different from above)
Cityrrown State Zip Code
Telephone Number
3. Installer Information _
Name Nam ompany
-----
Address
Cityrrown Stale Zip Code
Telephone Number(Cell Phone#if possible please)
4. Designer Informati n
Name Name of Company
Address
CitylTown State Zip Code
Telephone Number(Best#to Reach)
Application for Disposal System Construction Permit•Page 1 of 2
,F N°p� atio A,p, lication for Septic Disposal System
AConstruction Permit — TO OF TaDAY'SDA7E
W .��I
ORTH ANDOVER, MA 01845 $ 250.00- Fu!! Repair
$125.00 -Component
PAGE 2OF2
A. Facility Information continued....
5. Type of Building; tResidential Dwelling or[]Commercial
B. Agreement
The undersigned agrees to ensure the construction and maintenance of the afore-described
on-site sewage disposal system in accordance with the provisions of Title 5 of the
Environmental Code, as well as the Local Subsurface Disposal Regulations for the Town of
North Andover, and not to place the system in operation until a Certificate of Compliance has
been iss . iy this Board of Health.
Naryt Date
7
Applicatio Approved By: , , rd of Health Representative)
Name Date
/'Application Disapproved fort a following reasons:
For Office Use Only:
L Fee Attached. Yes No
2. Project Manager Obligation Form AttachedP Yes No
3. Pump System? Ifso,Attach cop v ofElectrical Permit Yes Na
4. Foundation As-Built?(new construction ronly); Yes No
(Same scale as approved plan)
5. Floor Plans?(new construction only). Yes No
Application for Disposal System Construction Permit Page 2 of 2
r ' �
SEPTIL SYSTEM INSTALLER PROJECT MANAGEMENT OBLIGATIONS
As the North Andover licensed installer for the construction for the septic system for the property at:
(Address of septic System) For plans by
Relative to the application of ( ,q �`e 5�fi✓
(Installer's name) And dated
Ira ate
Dated
oc ay s da te With revisions d�Zdl'
{Last re"ed date)
I understand the following obligations for:management of this project:
1. As the installer, I am obligated to obtain all permits and Board of Health approved plans prior to
performing any work on a site. I must have the approved plans and the permit on site when any work is
being done.
2. As the installer, I must call for any and all inspections. If homeowner,contractor,project manager, or any
other person not associated with my company schedules an inspection and the system is not ready, then
item three shall be applicable.
3. As the installer, I am required to have the necessary work completed prior to the applicable inspections as
indicated below. I understand that requesting an inspection,without completion of the items in accordance
with Title 5 and the Board of Health ieWgations ma result in a$50.00 fine being levied a ainst me and/or
MY companYr.
a. Bottom of Bed—Generally, this is the first (1s) inspection unless there is a retaining wall,which
should be done first. The installer must request the inspection but does not have to be present.
b. Final Construction Inspection---Engineer must first do their inspection for elevations, ties, etc.
As-built of verbal OK (or e-mail to: health.de t c townofnorthandoverxom) from the engineer must
be submitted to the Board of Health, after which installer calls for an inspection time. Installer must
be present for this inspection. With a pump system, all electrical work must be ready and able to
cause pump to work and alarm to function.
c. Final Grade--Installer must request inspection when all grading is complete. Installer does not
have to be on-site.
4. As the installer, I understand that only I may perform the work (other than simple excavation)and I am required
to complete the installation of the system identified in the attached application for installation. I further
understand that work done by others unlicensed to install sel2tic s stems in North Andover can constitute
reasons for denial of the system and or revocation or suspension of my license to operate in the Town of
North Andover, significant fines to all persons involved are also possible.
5. As the installer, I understand that I must be on-site during the performance of the following construction
steps:
a. Determination that the proper elevation of the excavation has been reached,
b, Inspection of the sand and stone to be used
c. Final inspection by Board of Health staff or consultant.
d Installation of tank, D-Box,pipes, stone, vent,pump chamber, retaining wall and other
components.
b. As the installer, I understand that I am solely responsible for the installation of the system as per the
approved fans. No instructions by the homeowner, general contractor, or an other persons shall absolve
me of this obligation.
Undersigned Licensed Septic Installer: (Today's Date)
( atne Print)ame— tg