HomeMy WebLinkAboutCertificate of Compliance - 201 RALEIGH TAVERN LANE 11/7/2016 ,.�. •
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PUBLIC HEALTH DEPARTMENT
Town of North Andover
Community and Economic Development Division
CERTIFICATE OF
COMPLIANCE
As of: 11 /7/16
This is to certify that the individual subsurface disposal system received a
SATISFACTORY INSPECTION of the:
Repair of Outlet tee and D-box
By: Todd Bateson
At:
201 Ralei!h Tavern Lane
Map 106.0 Lot 0117
North Andover, MA 01545
The ssuance of this crifi tI s1a11 not be construed as aaranfiee that the system will function satisfactorily.
M chele Grant
Public Health Agent
120 Main 5t.,North Andover,Massachusetts 01845
Phone 978.688.9540 fax 978.688.9542 Weh www.northandoverma.gov
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North Andover Health Department
Community and Economic Development Division
ONSITE WASTEWATER SYSTEM CONSTRUCTION NOTES
LOCATION INFORMATION
ADDRESS: 201 Raleigh Tavern Lane MAP: 106.0 LOT: 0117
INSTALLER: Todd Bateson
DESIGNER:
PLAN DATE:
BOH APPROVAL DATE ON PLAN:
INSPECTIONS
Outlet tee and D-box INSPECTION: 1 11 V
DATE OF BED BOTTOM INSPECTION:
DATE OF FINAL CONSTRUCTION INSPECTION:
DATE OF FINAL GRADE INSPECTION:
SITE CONDITIONS
❑ 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 hole 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
visual testing
❑ Inlet tee installed, centered under access port
F-1 Outlet tee installed, centered under access port
{gas baffle/effluent filter)
Iter)
❑ inch cover to within 6" of finish grade
installed over one access port
❑ Hydraulic cement around inlet & outlet
Comments:
PUMP CHAMBER
❑ Bottom of tank hole has 6" stone base
❑ Weep hole plugged
❑ 1500 gallon Pump Chamber installed
❑ H-10 loading
❑ Monolithic tank 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
❑ cover at final grade installed over pump
access port
❑ Water tightness of tank has been achieved by
testing
❑ Hydraulic cement around inlet & outlet
Comments:
CONTROLPANEL
❑ Alarm & Pump are on separate circuits
❑ Alarm sounds when float is tripped
❑ Location of control panel: basement
❑ Alarm signal located inside: basement
Comments:
DISTRIBUTION-BOX
❑ Installed on stable stone base
F%] 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:
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Commonwealth of Massachusetts Map-Block-Lot
s{`� •� 106.G0117
BOARD OF
-----------------------
HEALTH
Permit No
BHP-2016-0457
North Andover -----------------------
FEE
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$175.00
DISPOSAL WORKS CONSTRUCTION P5RMIT
Permission is hereby granted Todd BateSOn -----------.--------
to(Repair)an Individual Sewage Disposal System.
at No RALEIGH TAVERN LANE---------
-------------------------- ---
as shown on the application for Disposal Works Construction Permit No: BHP-2016-045 Dated October 28,2016
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Issued On: Oct-28-2016 BOARD Ol`IAL
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T Application for Septic Disposal System
TODAY'S DATE
Construction Permit — TOWN OF
$2501.00—Comp epairNORTH ANDOVER, MA 01845 $126.00;- onent
Application Is hereby made for a permit to:
E] Construct a new on-site sewage disposal system*
❑Repair or replace an existing on-site sewage disposal system*
[gige—pair or replace an existing system component—What?
A. Facility Information
Address or Lot#
Ityff own _
2.-*TYPE OF SEPTIC SYSTEM*:
➢ ❑ Pump B'19kavity(choose one) TM OF N011TH ANDOVER
"t pump system,attach copy of electrical permit to application— WLTH MENT
➢ ❑Conventional System (pipe and stone system)
➢ ❑ Infiltrator or Biodiffuser(Gravel-Loss)(Attach a copy of your certification to install this type of system.)
➢ ❑ Pressure Distribution S.A.S.(No D-Box)
> ❑Pressure Dosed(D-Box Present)S.A.S.
> [:] Does the system require an effluent filter? Yes No_ '=°�°
If yes, does'plan specify make and model of filter? YES=(no further info. needed)
NO=(installer must specify brand of filter before DWC issuance)
What is the Make? whatis the M0&4�_
2. Owner Information L11 E�Ilv
-Name
——---------
Address(if different from above)
JVW AM
Cityrrown _State Zip Code
Telephone Number
3. Installer Information
µif Alp
Name Name of Compa,fnqF— I:T, M
ARGILLA HOAR
Address
City/Town State Zip Code
Telephone Number(Celt Phone#if possible please)
4. Designer Information
Name Name of Company
Address
City/Town State Zip Code
Telephone Number(Best_#to—Reach)
Application for Disposal System Construction Permit•Page 1 of 2
_ 1
Nth
?l_i anon for Septic Disposal V sten
J Gonsfuction P rn�rit � QF roaArs Art=
$:.250.00�-Pali Re air
�. ORTH AN OV��t� 01845
CRUS , $125.00..Component
PAGE 20F 2
A. Faciiityl!]formation continued_...
S. TyRe,of Buflding: esldential Dwelling or❑Commerclal
B. Agreement
The undersigned agrees to ensure the constructlon and maintenance of the afore-descrlbed
on-site sewage dlsposal systom,In accordance with the provisions of Title 5 of the
Environmental Code, as well as the Local Subsurface Disposal Reguiatlons forthe Town of
North Andover,and not to place the system 1n operation until a Certificate of Compllanee has
been Issued 6 Is Board of Health.
Name Date
Ap !i to Approrre ar�Oftpresentativq)1
N me Date— �-L�
1 Application Disapproved.for the following reasons:••' r
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For Office Use Only
I , Fee Attached? Yes
No
2• ProjectAlAdager Obligation Forte AttaehcdP Yes No
3.: Pum�,4=dM? Ifso) 1 P 't Yes
No
4. FbundadhaAs Built?(hew construction•ronly), Yes No
(Same scale ss approyedp.1ka)
5. FloorPlazrs?(hew construction'only). eS No
Application for,t7lsppsaf Sj!sterSl: orlstraetldrS Permff Parae 2 rir 7
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