Loading...
HomeMy WebLinkAboutCertificate of Compliance - 15 COLONIAL AVENUE 8/22/2017 s ' M ,fit N PUBLIC HEALTH DEPARTMENT Town of North Andover Community and Economic Development Division GERTI F I LATE OF COMPLIANCE As of: August 22, 201. 7 This is to certify that the individual subsurface disposal system received a SATISFACTORY INSPECTION of the: D- Box Repair On-Site Sewage :Disposal System By: Todd .Bateson, :Bateson Enterprises, Inc At: 1.5 Colonial Avenue Map 1. 07.B Lot 122 North Andover, NIA 01845 I"" , e f this cel i icat § 'all notff c construed as a guarantee that the system will function satisfactorily. G . ° rant Public Health Agent i 120 Main 5t.,North Andover,Massachusetts 01845 t Phone 978.688.9540 Fax 978.688.9542 Web www,northandoverma.gov M " • North Andover Health Department Community and Economic Development Division ONSITE WASTEWATER SYSTEM CONSTRUCTION NOTES LOCATION INFORMATION ADDRESS: 15 Colonial Avenue MAP: LOT: INSTALLER: Todd Bateson DESIGNER: PLAN DATE: BOH APPROVAL DATE ON PLAN: D-BOX August 22, 2017 Michele Grant INSPECTIONS TANK: INSPECTION: 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 ❑j 1500 gallon tank has been installed H-10 loading ❑ Monolithic tank construction ❑ Water tightness of tank has been achieved by 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 ❑ 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 ❑ Retaining wall (boulder 1 concrete /timber/ block) ❑ Final cover as per plan Comments: SOIL ABSORPTION SYSTEM (Gravel-less Chambers) ❑ Brand and Model of Chamber: Standard Quick 4 Infiltrator Chambers ❑ Number of chambers per row: ❑ Number of rows (trenches): Comments: Total Chambers = FINAL GRADE ❑ L.oamed ❑ Seeded ❑ Cover per plan Comments: DOCUMENTS NEEDED ❑ Certification of Installation Form submitted By engineer and signed and dated by Engineer and installer 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 I Coastal Banka 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/crib.) 50 100 Drains (intercept g.w.) 25 50 ® Drains (Other)Foundation 10(5) .20(10) ® DryweIls 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 • ' Commonwealth of Massachusetts Map-Block-Lot 107.Ba122 BOARD OF HEALTH PertnitNo North Andover Blip 2- 0535 P.1. FEF F.1. $175.00 DISPOSAL STORKS CONSTRUCTION PERMIT Permission is hereby granted Todd Bateson -------- - ,... to(Construct)an.Individual Sewage Disposal System. u, at No 15 COLONIAL, AVENU�? t as shown on the application for Disposal Works Construction Permit No. BHP-2017-053 Dated August 21,2017 ------------- Issued On:Aug-21-2017 I Il AL`I" • Commonwealth of Massachusetts Map-block-Lot 107.B01 22 BOARD OF HEALTH r North Andover CERTIFICATE OF COMPLI&NCE THIS IS TO CERTIF That the Individual Sewage Disposal System (Co'i� h uct) by .._Todd Bateson ""X . -------------- InStalle r at No 1.5 COLONIAL AVENUE has been installed in accordance with the provisions of TITLE 5 of the State Environmental Code as described iti,the application for Disposal Works Construction Pennit No. BLIP-20177053 Dated August 2_IZ 2017- ` ------------ - -- -_ I .....--------- Printed On:Aug-21-2017 BOARI)OF HEALTH ------------- _... -- Commonwealth of Massachusetts Map-Block-Lot 107 B0122 BOARD OF HEALTH -- ........ • t�err,,.t rrG f North Andover BHP 2017-0535 W $175.00 DISPOSAL WORKS tO�NSTRUCTION"-PERMIT Todd Bateson . -- - Pernutssion is hereby granted ,,,, -- N to(Construct)an Individual Sewage Disposal System. at No 15 COLONIAL AVENUE _. -------. - as shown on thea application for Disposal Works Cons tction Permit No. BHP 201 Dated August 21,2017 pp P - -----..... _. - ----- .... Issued On:Aug-21-201.7 BOARD OF HEALTH i Aication for S:e tic Disposal stem TpD s DATE Construction N'Permit — TOWOF $,2501.00-Full Repair NOR'T'H A1' DOVER, 01$45 � -Component Application is hereby made for a Penn itto: ❑construct a new on-site sewage disposal system" ❑Repair or replace an existing on-site sewage disposal'system* epair or,replace an existing system component—What? A. Facility Information Address or Lot# Cdtyffown 2.-*TYPE OF SEP g:�jYSTEM A ❑ Pump Gravity(choose one) ***!f pump syn em,attach copy of electrical permit to application*** A onventional System (pipe and stone system) ➢ ❑ Infiltrator or Blodiffuser(Gravel-Less)(Attach a copy of yourcertifrcation to install this type of system.) ➢ ❑ Pressure Distribution S.A.S.(No D-Bax) ➢ ❑ 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) W15 at is the Make? What is the Modrt 2. Owner Information r Name Address(if different from above) .- _._... ✓ Cityfrown State Zip Code Telephone Number 3. Installer Information Name Name of Compan Address ANDOVER,MA alEf1u ; /� Ciwi'own State Zip Code Telephone Number(Cell Phone#If possible please) 4. Designer'Informwationr Name Name of Company __... Address - Cltyffown State Zip Code i Telephone Number(Best#to Reach) Application for Disposal System Construction Permit•Page 1 of 2 d Alication. ..for.SB Vc iaiS osai stern 7 77 T�Da 1 +e * ',constrructi P rrrrit on r�t(� r7 1'�✓� V 1"S AAT * � .t Full �7►"V 01845 ftpalr s��HU� 12500;-Can'06'. t _PAGE 2 OF 2 A. Fad,111N.Infc rmatiax�gontinuedw... 5. Type of Buiddinq: esldentlal.Dwelling or MOOMMerclal B. Agreement The underslgned agrees to ensure the constructlon and maintenance of the afore•descrlbed on-site sewagedlsposal system,ln accordance with tho.pravlsl©ns of Tltle 3 of the Envlr`anr�enta/Code ;srwell as the Local Subsurface D1s;odsal Regulatlons for the Town of North Andover, and not to place;the system 1noperation unt11 a CertJflcate of Compllarrce has been Issued this Board of Health. �- r '7 Name bate �. 11 anti n pp; ro ,� � �'d of.-. alth Representative) � ....y am110,e bate Applicationp ' Disa pratre :for the fallowing reasons:"• ' • • Far Offlao.Use Only: ; 1. "Fee Attached? Yes No 2,• PlOVect.f9t}2get 0bYpaoa Fo=Attached? Yes No ; 31: PM z5cfs,_ter? Ifso),Attach coke No 4. F6turda#i6r2As:Burlta?(hew canstructlon ronly); :Yes No (Same SC21C as apptoyedp)at) A FlootPlans?'(he;w doristruotlon•only): acs Nom Applrb titin�ar,pf�pgsaC y�`ysterSr: oi�strucElaii Penn-Pan 2 cit 7 �Px`IC S"i�3`!"��1i+�•�' � �'�RO�' .�lily►'�1T�."f���'�''���,iGh'�I4�S As die-Nglth Aaclova=Jk=sed&iamgar fr} C nat t tQsx fpx t �epiia ayete u fcxx,the Cpex Yat: to exr of�eprtc�temE) P'er pUm by �tr,�stnra to tl�.appffc�cat� ��� � ..��' .• coltbaef 490 AM dsW Daredt —!'1 a o ; A Wft tlevidons dated (Laii rcvfred doc) I undentaad the following OUgations fot MOMS=Gat offs P,,poet: ,- i. .Aa&e fosb &r,I'am.oblipW ip 6bft6 supem2ks and Bond oMcalth�ppxovcd glace.Prim to Pm o='tg any.*Wp lr da a sit&. 2. "JaWle;I. ,04-f stir and i�&� Eha ca ,.pso�ectasattaget,ars�p o tesr,pate=sic t arlsttOd Whh mp 460=piny s` itlar•sn ldsproc#m and the mtgh is uotmct4 than �cm�bxe•skill.b�,�pluwtble. •'• . �; A.t-t�l���r1�r;I;�r,ar'eq to I��reuery - et�dpi :to�h�.spP�rb�e ie��s s:$ b a b -dan the pact ori 4C[b&fldt h me to bo prtsar6eISO AAA. . ' cr ,teh<fitapera i'arcvIions�tom.crc. t o 'it OIC(cu ea'm*il•fo: from the rdg#neca wast =bit6bidt#ed•to .Boud"afHoa ,t t: fotwii a tispae,'I st criri�ift 6eprst f+or ,� a F �' i Few*sock nbte to- . -. 'e�uae p►itt3cp.t+b-+oocz�c i .to�.. . . -.. .' ' - . �- �tIac mit seque� Aapc [oa ovlteir]Igs�d# ratnpi�te; Iustsifcrai dot . eve#o bar�ute.' ��' •' °:. • . . ' 4. As to iu,+ts 'I uad&i=d that eaitly tf�sy p 3 k' et6Erl�c�r asMMWm)ani Auitocpked en aot�ptetelietaltl oftl agtairk ;eedxppao ,fozhsati�a: . dim-Ribi�gct�t Eno IHA�Wdhi� ". .. Ab tie at lte�ri eztrder�t it tI a Ott: iax•of rhe&Ucwiq consbm , �iC�C17QtI1�g�0t�,�lAt.t���flt��fl1.'G��Nt�t4ft�teC�q�t+��"��t�catr,Iiea�• . . . b. �S►��CI►���IC aitt�l�J�� ,QC�b�tC TI�L'� ,' , _ •'... . L~ •P�srlAdflCQ�O�b,y�OJt�O��l�t,�!�IOI4'A�79p�'• . d Cl of rk,l]- a e pylp9s,atone, vet Pres ft b ;r4� wrtU rtl ofhar .