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Home My WebLink AboutCertificate of Compliance - 602 BOXFORD STREET 9/12/2016 • Y PUBLIC HEALTH DEPARTMENT Town of North Andover Community and Economic Development Division CERTIFICATE OF COMPLIANCE As of: 9112116 This is to certify that the individual subsurface disposal system received a SATISFACTORY INSPECTION of the: Construction of an On-Site Sewage Disposal System By: Jesse Warren At: 602 Boxford Street (lot 10) Ma p 105C Lot 22 North Andover, MA 01845 T eance oft Cate sh 1 not be construed as a guarantee that the system will function satisfactorily. Grant Public Health Agent 1600 Osgood Street,North Andover,Massacheselts 01845 Phone 978.688.4540 Fax 978.688.8476 Web www.iownofnorthondover,com r rtr RECEIVED 'J'OWN p NOR'T11 ANDOVER 1.1L- LRi DEFIAI�THEW PUBLIC HEALTH DEPARTMENT Wuniunity Development Division TOWN OF NORTH ANDOVER SEPTIC DISPOSAL SYSTEM—INSTALLATION CERTIFICATION The undersigned hereby certify that the Sewage Disposal System(constructed; ( )repaired; By: W C `,c"u +rv1 q A ZVctC7{'•ut (PridName) / I..ocated at: (Installation Address) Was installed in conformance with the North Andover Board of Health approved plan, originally dated �` �.. .. and last revised on- � / mF ,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, Bottom of Bed Inspection Date: iJ+ g' p entative(Signature) me a res And—Print Name ` f, Final C nstruction inspection Date` 'e 2.Chb Engineer presentative(Signature) �, And—Print Name Installer (Signature) Date � �� And—Print Name Engine (Signature) Date: And—Print Name 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web littp://www.northandoverma.gov North Andover Health Department Community and Economic Development Division ONSITE WASTEWATER SYSTEM CONSTRUCTION NOTES LOCATION INFORMATION ADDRESS: 602 Boxford St— Lot 10 MAP: 105C LOT: 22 INSTALLER: Jesse Warren DESIGNER: Philip Christiansen PLAN DATE: 3/27/15 BOH APPROVAL DATE ON PLAN: 6/10/15 INSPECTIONS TANK INSPECTION: 4/21/16 DATE OF BED BOTTOM INSPECTION: 4/21/16 DATE OF FINAL CONSTRUCTION INSPECTION: 4/28/16 DATE OF FINAL GRADE INSPECTION: "'i OLD TANK ABANDONMENT: 03/30/2016 di SITE CONDITIONS N/A Contractor reports any changes to design plan N/A 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 ® Bottom of tank hole has 6" stone base ® Weep hole plugged ® 1500 gallon tank has been installed H-10 loading ® Monolithic tank construction ® Watertightness of tank has been achieved by visual testing ® Inlet tee installed, centered under access port ® Outlet tee installed, centered under access port (gas baffle/) ® 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 ® Inlet tee (if pumped or >0.08'/foot) ® Hydraulic cement around inlet & outlets ® Observed even distribution ® Speed levelers provided (not required) ® Schedule 40 PVC Pipe Comments: SOIL ABSORPTION SYSTEM (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 NIA 40 Mil HDPE barrier installed ® Laterals installed and ends connected to Deader (and vented if impervious material above) ® Elevations of laterals and chambers installed as on approved plan NIA Retaining wall (boulder 1 concrete I timber/ block) ❑ Final cover as per plan Comments: SOIL ABSORPTION SYSTEM (Gravel-less Chambers) ® Brand and Model of Chamber: High Capactiy Standard Quick 4 Infiltrator Chambers ® Number of chambers per row: 10 ® Number of rows (trenches): 2 Comments: Total Chambers = 20 FINAL GRADE Loamed Seeded Cover per plan Comments: k DOCUMENTS NEEDED ® Certification of Installation Form submitted By engineer and signed and dated by Engineer and installer Z As-Built Plan i i i 1 BM = 122.80 HR = 5.43 HI = 128.23 SYSTEM ELEVATIONS ROD AS-BLT INVERT DESIGN INVERT ELEVATION ELEV ELEV Benchmark Building Sewer OUT 4.39 123.49 123.48 Septic Tank IN 4.57 123.31 123.24 Septic Tank OUT 4.80 123.08 122.99 Distribution Box IN 4.98 122.90 122.84 Distribution Box OUT 5.16 122.72 122.67 Lateral 1 TOP 5.24 Lateral 1 INVERT 122.64 122.62 Lateral 2 TOP 5.24 Lateral 2 INVERT 122.64 122.62 Top of Chamber Bottom of Bed/Chamber, 121.64 121.66 R a 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 Banka 75 100 ® Wetlands bordering surface water supply or trio. (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 I0 (5) 20(10) ® Drywells 20 25 Suction line 222(2) Z 100 feet is a minimum acceptable distance and no variance is allowed for a lesser distance(NA 5.02). '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 BOARD OF HEALTH 400 OSGOOD STREET NORTH ANDOVER, MA 01845 TELEPHONE9 (978) 688-9540 APPLICATION FOR ABANDONMENT OT'SUBSURFACE DISPOSAL SYSTEM (SEPTIC SYSTEM) Pursuant to Section 310 CMR 15,354 of the State Environmental Code, Title V P Name -e Address Contractor hired far work: Name Phone Address U11 Date for scheduled abandonment---ncv' The septic system at the above address has been abandoned according to Title V specifications. Signature of Contractor Method of septic tank abandonment (check one). (L)°removal sandfill (14/crush other .................. Name of Offal Hauler This farm must be returned to the North Andover Board of Health. PLEASE DO NOT WRITE IN THE SPACE BELOW FOR HEALTH 4FP , SENTATIVVS USE ONL v7 e c ii"n g' Agent Date 4. Town of North Andover — Septic System - AS-BUILT CHECKLIST 1) All changes to the design plan have been reflected and noted on the as-built plan I/ 2) BAs-built plan has a suitable scale; (I inch = 40 feet or fewer for plot plans) 3) V Street Address,Assessor's Map and Lot Number I 4) _'LLot Lines and Location of Dwellings served by the system 5) Locations,Elevations and Dimensions of As-built system components,including reserve (if applicable) 6) Ties to all tank openings,d-box,and leach area from dwelling or Permanent Structure 7) Setback distances are shown on the as-built plan from system components to: Subsurface,interceptor&foundation drains Catch basins Property lines 14 ' Dwellings or other structures Private water supply or or wells (,dkp Watercourses or wetlands 8) Locations of Wells,Drains,Wetland Resource Areas within 150 feet of system ,I/ 9) Location of water,gas,electric lines,cable,control panel (if applicable) 10) 7Location of Structures within 6 Inches of Finished Grade I, 7Original Stamp &Signature 12) -Location and holder of any easements which could impact the system 13) Impervious Areas;Driveways,etc 14) North Arrow 15) ,,,Location &Elevation of Benchmark used 16) ✓ STATEMENT ON PLAN (NA 5.3) "I certify the locations, c1evations, ties, covet,material;exposed component covers etc., ShOW77 017 HVS as-built 811bStdJItiIJIIyqgvce with the,qpprovedplatiaiidlit.ve.determined that the break out elevations,if applicable,have been met." Signature of Designer Date b. "If a STUCTU94L WAR IS PRESENT(M 4.9)a Letter 01'statement 011 the a8-builf indicatit fI_Icwaij- was or was not, constructed in accordance with the intended desLn and an Signature qfr, )esigner Date b� el�o ......... i 4A P bb 7 : v -a > V Revised 3/i7/'15