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Miscellaneous - 325 BOSTON STREET 4/30/2018 (2)
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J Z X m Q W a H H OF O X m Q W a Z W IY ~ W i Q U U' 2 � « x U Z K m K m Q S O Z W � � W i a U U' 2 � N S U Z 2 N � m S O Z W � �' W i Q U = � M S U Z LL' rn � m x O Z W IY � W i ¢ U � � c x U Z CC - m K m S O a 0 Z a 0 Z a 0 Z a 0 Z a o Z J j Z g °� m J >�> Z g m J Z g k>� m J Z g m OF NORTH qti o m `SSA C PUBLIC HEALTH DEPARTMENT Town of North Andover Community and Economic Development Division CERTIFICATE OF COMPLIANCE As of: September 7, 2017 This is to certify that the individual subsurface disposal system received a SATISFACTORY INSPECTION of the: New Construction of an On -Site Sewage Disposal System By: Robert Daigle At: 325 Boston Street Map 107.D Lot 136 North Andover, MA 01845 of this ce' icateshall not be construed as a guarantee that the system will function satisfactorily. Nbthefe Grant Public Health Agent 120 Main St., North Andover, Massachusetts 01845 Phone 978.688.9540 Fax 978.688.9542 Web www.northandoverma.gov 8/23,,/2017 Town of North Andover Mail - 325 Boston Street NOR:OVER Massachusetts _ _ Toni Wolfenden <twolfenden@northandoverma.gov> 325 Boston Street 6 messages T.J. Melvin <TJ@csi-engr.com> Thu, Aug 3, 2017 at 9:19 AM To: "blagrasse@northandoverma.gov" <blagrasse@northandoverma.gov> Cc: "mgrant@northandoverma.gov" <mgrant@northandoverma.gov>, "twolfenden@northandoverma.gov" <twolfenden@northandoverma.gov> Good Morning, The expansion at 325 Boston Street has been located by our survey crew and looks to be in compliance with the design plan. The site is ready for your final inspection. THANKS. TJ Melvin, P.E. CHRISTIANSEN & SERGI, INC Professional Engineers & Land Surveyors 160 Summer Street, Haverhill, Ma. 01830 Telephone: 978-373-0310 Fax: 978-372-3960 Toni Wolfenden <twolfenden@northandoverma.gov> Wed, Aug 16, 2017 at 3:06 PM To: "T.J. Melvin" <TJ@csi-engr.com>, Michele Grant <mgrant@northandoverma.gov>, Brian LaGrasse <blagrasse@northandoverma.gov> Hi T.J., Please send a copy of the As -Built for 325 Boston Street. Thanks, Toni Toni K. Wolfenden Health Department Assistant 978-688-9540 [Quoted text hidden] hftps:Hmail-google.com/mail/u/0/?ui=2&ik=aOc6f4e4cf&jsver=NQ9OxUauj6O.en.&view=pt&search=inbox&th=15df10a29l d2f7b3&siml=15da840671352... 1/3 8/23/2017 Town of North Andover Mail - 325 Boston Street T.J. Melvin <TJ@csi-engr.com> Thu, Aug 17, 2017 at 11:33 AM� To: Toni Wolfenden <twolfenden@northandoverma.gov> Good Morning Toni, We have not prepared the as -built plan yet. Brian raised a question as to whether the D -box should be replaced. We have not heard anything further. We thought one as -built would be cleaner than two. If you have any information on the status of this please let me know. Thanks. From: Toni Wolfenden [mailto:twolfenden@northandoverma.gov] Sent: Wednesday, August 16, 2017 3:06 PM To: T.J. Melvin; Michele Grant; Brian LaGrasse Subject: Re: 325 Boston Street [Quoted text hidden] All email messages and attached content sent from and to this email account are public records unless qualified as an exemption under the Massachusetts Public Records Law. Visit us online at www.northandoverma.gov. Toni Wolfenden <twolfenden@northandoverma.gov> Thu, Aug 17, 2017 at 11:40 AM To: Michele Grant <mgrant@northandoverma.gov>, Brian LaGrasse <blagrasse@northandoverma.gov> Please see the email from T.J. about the d -box possible replacement. Thanks, Toni K. Wolfenden Health Department Assistant 978-688-9540 [Quoted text hidden] Toni Wolfenden <twolfenden@northandoverma.gov> To: "T.J. Melvin" <TJ@csi-engr.com> I have forwarded the email to Michele and Brian. I will have them look into the status. Take care, Toni Toni K. Wolfenden Health Department Assistant 978-688-9540 Thu, Aug 17, 2017 at 11:43 AM https:Hmail.google.com/mail/u/0/?ui=2&ik=aOc6f4e4cf&jsver-NQ90xUauj6O.en.&view=pt&search=inbox&th=15df10a291 d2f7b3&sim l=15da840671352... 2/3 8123/2017 [Quoted text hidden] Town of North Andover Mail - 325 Boston Street Michele Grant <mgrant@northandoverma.gov> To: TJ@csi-engr.com, Toni Wolfenden <twolfenden@northandoverma.gov> Hi TJ, The D -Box has been replaced. Sincerely, Michele E. Grant Public Health Agent Town of North Andover 120 Main Street North Andover, MA 01845 Phone 978.688.9540 Fax 978.688.9542 Email mgrant@northandoverma.gov Web www.NorthAndoverma.gov [Quoted text hidden] Thu, Aug 17, 2017 at 12:32 PM https://mail.google.com/mail/u/0/?ui=2&ik=aOc6f4e4cf&jsver=NQ9OxUauj6O.en.&view=pt&search=inbox&th=15df10a291 d2f7b3&siml=15da840671352... 3/3 it North Andover Health Department Community and Economic Development Division ONSITE WASTEWATER SYSTEM CONSTRUCTION NOTES LOCATION INFORMATION ADDRESS: 36 Hawkins Lane MAP: 106.0 LOT: 0122 INSTALLER: Todd Bateson DESIGNER: PLAN DATE: BOH APPROVAL DATE ON PLAN: INSPECTIONS Tank, D -Box, Pipe under driveway INSPECTION: 11/7/16 DATE OF BED BOTTOM INSPECTION.- DATE NSPECTION:DATE OF FINAL CONSTRUCTION INSPECTION: DATE OF FINAL GRADE INSPECTION: SITE CONDITIONS Comments: SEPTIC TANK X Contractor reports any changes to -design plan X Existing septic tank properly abandoned X Internal plumbing all to one building sewer X Topography not appreciably altered X Building sewer in continuous grade, on compacted firm base X Cleanouts per plan X Bottom of tank hole has 6" stone base ❑ Weep hole plugged X 1500 gallon tank has been installed H-10 loading X Monolithic tank construction X Water tightness of tank has been achieved by visual testing X Inlet tee installed, centered under access port X Outlet tee installed, centered under access port Comments: DISTRIBUTION -BOX (14" under cover) X Installed on stable stone base X H-20 D -Box ❑ Inlet tee (if pumped or >0.08'/foot) X Hydraulic cement around inlet & outlets X Observed even distribution X Speed levelers provided (not required) X Schedule 40 PVC Pipe Comments: speed levelers used, equal distribution (gas baffle/effluent filter) X inch cover to within 6" of finish grade installed over one access port X 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 (14" under cover) X Installed on stable stone base X H-20 D -Box ❑ Inlet tee (if pumped or >0.08'/foot) X Hydraulic cement around inlet & outlets X Observed even distribution X Speed levelers provided (not required) X Schedule 40 PVC Pipe Comments: speed levelers used, equal distribution Gmelch Industries, Inc. A Facility, Services Company Michael Kouloheras P.O. Box 193 Merrimac, Ma. R I 978 360 9964 mkoulie@gmaii.com GC License #79450 of aoRrM �� M3 M 3 0, n Town of North Andover HEALTH DEPARTMENT CHU CHECK #: ? s/7 DATE: y2 C//d LOCATION: �2 S /3 05 a S' H/O NAME: r - CONTRACTOR NAME: / O o rl _ Type of Permit or License: (Check box) ❑ Animal $ ❑ Body Art Establishment $ ❑ Body Art Practitioner $ ❑ Dumpster $ _ ❑ Food Service - Type: $ ❑ Funeral Directors $ ❑ Massage Establishment $ ❑ Massage Practice $ ❑ Offal (Septic) Hauler $ ❑ Recreational Camp $ ❑ Sun tanning $ ❑ Swimming Pool $ ❑ Tobacco $ ❑ Trash/Solid Waste Hauler $ ❑ Well Construction $ SEPTIC Systems ❑ Septic - Soil Testing $ ❑ Septic - Design Approval $ ❑ Septic Disposal Works Construction (DWC) $ ❑ Septic Disposal Works Installers (DWI) $ ❑ Title51nspector Title 5 Report �0 /"► $ ❑ Other: (Indicate) $ Hea gent Initials White - Applicant Yellow - Health Pink - Treasurer -�oT 7774 � P Town of North Andover ........ .:4' HEALTH DEPARTMENT SACMUSf CHECK #:�I D DATE: Z I LOCATION: J 2-57 �c)5to &j /t H/O NAME: CONTRACTOR NAME: t t � C)_ \o�e ii. S Type of'Permit or License: (Check box) ❑ Animal $ ❑ Body Art Establishment $ ❑ Body Art Practitioner $ ❑ Dumpster $ ❑ Food Service - Type: $ ❑ Funeral Directors $ ❑ Massage Establishment $ ❑ Massage,Practice -' $ ❑ Offal (Septic) Hauler $ ❑ Recreational Camp $ ❑ Sun tanning $ ❑ Swimming Pool $ ❑ Tobacco $ ❑ Trash/Solid Waste Hauler $ ❑ Well Construction $ SEPTIC Sustems: ❑ Septic - Soil Testing $ ❑ Septic - Design Approval $ Z-0 Septic Disposal Works Construction (DWC) $ ❑ Septic Disposal Works Installers (DWI) $ ❑ Title 5 Inspector $ ❑ Title 5 Report $ ❑ Other: (Indicate) $ Health Agent Initials White - Applicant Yellow - Health Pink - Treasurer Commonwealth of Massachusetts Map -Block -Lot 107.D0136 BOARD OF HEALTH -----------------. North Andover CERTIFICATE OF COMPLIANCE THIS IS TO CERTIFY That the Individual Sewage Disposal System (Construct) by Installer at No 325 BOSTON STREET has been installed in accordance with the provisions of TITLE 5 of the State Environmental Code as described in the application for Disposal Works Construction Permit No. BHP -2017-037 Dated April_ 25, 2017 ----------------------------------------------------------------- Printed ---- ---- On: ------Apr-25-2017 -- -------------- ------------ ----------------- -- ---- BOARD OF HEALTH Commonwealth of Massachi^"- BOAR '$ v � -AO Nor no DISPOSAL WORKS C Permission is hereby granted -_ to (Construct) an Individual Sewage Disposal System. at No 325 BOSTON STREET as shown on the application for Disposal Works Construction Issued On: Apr -25-2017 -- -------- ------ ----------------- I�,io Cod 115j p -Block -Lot °. D0136 ------------------ iit No •2017-0373 $175.00 0-11 ------------ b C) lam"` -------- 4 roe �0 .ter HEALTH_�- ,�. ------------ _. by Commonwealth of Massachusetts BOARD OF HEALTH North Andover CERTIFICATE OF COMPLIANCE THIS IS TO CERTIFY That the Individual Sewage Disposal System (Construct) Map -Block -Lot 107.D0136 ----------------- ------------------------------------------------------------------------------------------ Installer at No325 BOSTON STREET ---------------------------------------------------------------------------------------------------------------------------------------------------------- has been installed in accordance with the provisions of TITLE 5 of the State Environmental Code as described in the application for Disposal Works Construction Permit No. BHP -2017-037 Dated i125,_ 2017 ----------------------- ------ Apr ----------- --------------------------------------------------------------- Printed On: Apr -25-2017 BOARD OF HEALTH Commonwealth of Massachusetts Map -Block -Lot 107.D0136 BOARD OF HEALTH ----------------------- Perim it No -20 North Andover BHP17-0373 ----P-20------------ FEE $175.00 ----------------------- DISPOSAL WORKS CONSTRUCTION PERMIT Permission is hereby granted to (Construct) an Individual Sewage Disposal System. at No325 BOSTON STREET ---------------------------------------------------------------------------------------------------------------------------------------------------------- as shown on the application for Disposal Works Construction Permit No. BHP -2017-037 Dated April 25, 2017 --------------------------------------------------- Issued On: Apr -25-2017 BOARD OF HEALTH OF NOPT" q,L 32 0 O m A 4rSACH�1`�kS Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. I[�I Application for Septic Disposal System `l IV TODAY'S DAIE Construction Permit — TOWN OF $350.00 - Full Repair NORTH ANDOVER, MA 01845 $175.00 - Component Application is hereby made for a permit to: VCnstruct a new on-site sewage disposal system* pair or replace an existing on-site sewage disposal system* r ❑ Repair or replace an existing system component — What.) 1 A. Facility Information Address or Lot # City/Town e.i-M 2.- *TYPE OF SEP IC SYSTEM*: 'fir ,Z�, "P, ➢ E]Pump CyGravity (choose one) p ***If pump syst m, attach copy of electrical permit to application*** P`e OR�NP�M�r1( ➢ ❑ onventional System (pipe and stone system)FN QPR ➢ Winfiltrator or Biodiffuser (Gravel -Less) (Attach a copy of your certification,�CrJ6ttl4type 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) Who is the Make? 2. Owner Inforr WY Sat is the Model? Name 3-� !S� A60- Addre s VXere from above) Ci y/Town State Zip Code Email address Installe Information 0A Name , own a. Designer Information Name Address City/Town Telephone Number UZ' Name of Company 6 rii- �o State Zip Cole M3 Telephone Number (Cell Phone # if possible please) Name of Company State Zip Code Telephone Number (Best # to Reach) Application for Disposal System Construction Permit • Page 1 of 2 SEPTIC SYSTEM INSTALLER PROJECT MANAGEMENT OBLIGATIONS As the North Andover s of septic system) Relative to the applicati0 of (Installer's Dated o ( ay s ate for the construction for the septic system for the property at: n rl For plans by (Engineer) And dated With revisions dated I understand the following obligations for management of this project: (Original ate (Last revised date) 1. As the installer, I am obligated to obtain all permits and Board of Health approved plans pLior 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 Regulations may result in a $50.00 fine being levied against me and/or my companya a. Bottom of Bed — Generally, this is the first (1'� 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: healthdeptgtownofnorthandover.com) 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 septic systems 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. 6. As the installer, I understand that I am solely responsible for the installation of the system as per the me of this obligation. Undersigned Licensed Septic Installer: (Name —Print) (To ay Dat ta 4—Signed) I 1J I 1 NORry * SSA C H Us�� North Andover Health Department fommunity and Economic Development Division ONSITE WASTEWATER SYSTEM CONSTRUCTION NOTES LOCATION INFORMATION ADDRESS: 325 Boston Street INSTALLER: Robert Daigle DESIGNER: PLAN DATE: BOH APPROVAL DATE ON PLAN: MAP: 107.D LOT: 136 INSPECTIONS TANK INSPECTION. DATE OF BED BOTTOM INSPECTION:���r E j DATE OF FINAL CONSTRUCTION INSPECTION: DATE OF FINAL GRADE INSPECTION: SITE CONDITIONS 19r," 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 stone base ❑ Weep hole plugge ❑ 1500 gallon tt as been installed H-10 loading ❑ Mon itfiiic tank construction ❑ ater tightness of tank has been achieved by visual testing ❑ Inlet tee installed, centered under access port ❑ Outlet tee installed, centered under access port (gas baffle/effluent filter) ❑ 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 ❑ Watertightness of tank has been achieved by testing ❑ Hydraulic cement around inlet & outlet Comments: CONTROL PANEL ❑ 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 H-20 D-Box k Inlet tee (if pumped or >0.08'/foot) Hydraulic cement around inlet outlets Observed even distribution-Gu) Speed levelers provided (not required) be— [ Schedule 40 PVC Pipe Comments: Cam J/tt� (j�-j ay--� SL L S 0-- 0 - - ,r SOIL ABSORPTION SYSTE(General) Bottom of SAS excavated down to C soil layer, as provided on plan Size of SAS excavated as per plan �� l�, ❑ 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 / 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 ❑ Loamed ❑ Seeded ❑ Cover per plan Comments: DOCUMENTS NEEDED ❑ Certification of Installation Form submitted By engineer and signed and dated by Engineer and installer ❑ As -Built Plan SYSTEM ELEVATIONS ROD AS -BLT INVERT DESIGN INVERT ELEVATION ELEV ELEV Benchmark Building Sewer OUT Septic Tank IN Septic Tank OUT Pump Chamber IN Pump Chamber OUT Distribution Box IN Distribution Box OUT Lateral 1 TOP Lateral 1 INVERT Lateral 2 TOP Lateral 2 INVERT Lateral 3 TOP Lateral 3 INVERT Lateral 4 TOP Lateral 4 INVERT Lateral 5 TOP Lateral 5 INVERT Lateral 6 TOP Lateral 6 INVERT Top of Chamber Bottom of Bed/Chamber SKETCH PLAN I/. CRITICAL SETBACK DISTANCES Mark those distances checked in the field against the design plan and regulatory setback 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 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 trib. (in Watershed) 150 150 ® Trib. to surface water supply 325 325 ® Public well 400 400 ® Interim Wellhead Prot. 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TOWN OF NORTH ANDOVER Community & Economic Development HEALTH DEPARTMENT 120 Main Street NORTH ANDOVER, MASSACHUSETTS 01845 978.688.9540 — Phone 978.688.9542— FAX E-MAIL: healthdept@northandoverma.gov WEBSITE: http://www.northandovertna.gov SEPTIC PLAN SUBMITTAL FORM Date of Submission: Site Location: SNfj 3 SkCe e \—Engineer: New Plans? YesX$275/Plan Check # (o q b (includes 1St submission and one re- review only) Revised Plans?Yes $125/Plan Check # Site Evaluation Forms Included? Yes Local Upgrade Form Included? Yes Telephone #:9-19-3773' 4 -b ko NoK— No_,,V Fax #: `^�1'l `S - 17-1Z - �M(,0 i E-mail \ �j CS cc) Homeowner Name: OFFICE USE ONLY When the submission is complete (including check): ➢ Date stamp plans and letter ➢ Complete and attach Receipt ➢ Copy File; Forward to Consultant ➢ Enter on Log Sheet and Database Plans Submitted ❑ Plans Waived Certified Plot Plan ❑ Stamped Plans ❑ J TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/MassageBody Art ❑ Swimming Pools ❑ Well Tobacco Sales ❑ Food Packaging/Sales ❑ �❑ Private (septic tank, etc. L7 Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT Reviewed On . Signature, COMMENTS CONSERVATION Reviewed on Signature COMMENTS TH COMMENTS /U¢ Reviewed on 46c0MAo,4e Coat +z) jss'mJ sfo�c- S' 5�cr'\ Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comme Conservation Decision: Comments Water & Sewer Connection/Signature & Date Driveway Permit DPW Town Engineer: Signature: Located 384 FIRE DEPARTMENT - Temp Du mpster on site yes no Located at 124. Main Street Fire Department signatureldate COMMENTS) Street I Ja1eaH aalum 6uixsix3 Q1EMEER I r c o � N� fuilsi I - k4 335 Y4 in l ` I N z M s Q' 7 N--1 FA fffy fi FA of NORrH qti � o0 `SSA C HUSH coov PUBLIC HEALTH DEPARTMENT Town of North Andover Community Development Division CERTIFICATE OF COMPLIANCE As of: 12/12/13 This is to certify that the individual subsurface disposal system received a SATISFACTORY INSPECTION of the: Complete Repair and Construction of an On -Site Sewage Disposal System By: Bill Hall At: 325 Boston Street Map 107D Lot 136 North Andover, MA 01845 of this ceicate shall not, construed as a guarantee that the system will function satisfactorily. Michele Grant Public Health Agent 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com pORT1{ air "•'° .. •. oc F d iSSACHUSEt PUBLIC HEALTH DEPARTMENT (ommunity Development Division TOWN OF NORTH ANDOVER SEPTIC DISPOSAL SYSTEM — INSTALLATION CERTIFICATION The undersigned hereby ) By: I l that the Sewage Disposal Systemconstructed; ( ) repaired; Name) Located at: 5 f'} 0-S TPW S 1--n e E-7— (Installation Address) Was installed in conformance with the North Andover Board of Health approved plan, originally dated 712,31 /� and last revised on%f /� , with a design flow of 1 I/ Td 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: And — Print Name Final Construction Inspection Date: And — Print Name Installer: (Signature) Enginer ignature) Engineer Representative (Signature) Engineer Representative (Signature) Date• And — Print Name Date: Pl�/«P CHO� 45J-7/-�N'5 EAI -- And — Print Name 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web. http://www.townofnorthandover.com No. THE COMMONWEALTH OF MASSACHUSETTS FEE KC97H 19NL)og l BOARD OF HEALTH CERTIFICATE OF COMPLIANCE Description of Work: ❑ Individual Component(s) "X Complete System The undersigned hereby certify that the Sewage Disposal System; Constructed( ), Repaired ( ), Upgraded ( ), Abandoned ( ) by: at /L) 5 / has been installed in accordance with the provisions of 310 CMR 15.00 (Title 5) and the approved design plans/as-built plans relating to application No. dated Approved Design Flow (gpd) Installer �-. inspecLur Oate The issuance of this certificate shall not be construed as a guarantee that the system will function as designed. FORM 3 - CERTIFICATE OF COMPLIANCE DEP APPROVED FORM 5/96 3 0 Towry Cir HEALTH NO V ro wN of . North Andover Health Department Community Development Division ONSITE WASTEWATER SYSTEM CONSTRUCTION NOTES LOCATION INFORMATION ADDRESS: 325 Boston Rd. MAP: 107D LOT: 136 INSTALLER: Bill Hall DESIGNER: Christiansen & Sergi PLAN DATE: 9/9/13 (rev. 10/4/13) BOH APPROVAL DATE ON PLAN: 10/8/13 INSPECTIONS TANK INSPECTION: 11/12/13 DATE OF BED BOTTOM INSPECTION: DATE OF FINAL CONSTRUCTION INSPECTION: 11/21/13 DATE OF FINAL GRADE INSPECTION: SITE CONDITIONS ® 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: Tank was moved in order to provide straight building sewer line. 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 X 1500 gallon tank has been installed H-10 loading X Monolithic tank construction ® Water tightness of tank has been achieved by visual testing ® Inlet tee installed, centered under access port �� // N/A Comments: Neoprene boots DISTRIBUTION -BOX Comments: Outlet tee installed, centered under access port (gas baffle) 24" inch cover to within 6" of finish grade installed over outlet access port Hydraulic cement around inlet & outlet ® Installed on stable stone base ® H-20 D -Box N/A Inlet tee (if pumped or >0.08'/foot) ® Hydraulic cement around inlet & outlets ® Observed even distribution ® Speed levelers provided (not required) 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 N/A 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 N/A Retaining wall (boulder / concrete / timber/ block) ❑ Final cover as per plan Comments: internal 29'x48 5'overdig 38' 58' SOIL ABSORPTION SYSTEM (Gravel -less Chambers) ® Brand and Model of Chamber: Standard Quick 4 Infiltrator Chambers High Capacity ® Number of chambers per row: 12 ® Number of rows (trenches): 3 Comments: Total Chambers = 36 FINAL GRADE ❑ Loamed ❑ Seeded ❑ Cover per plan Comments: SrWn) � " �Yi ra, DOUENSTA.E/EDED 1 Chit7t," 4 � <b,z�Ql,Yl✓2 1 � Certification of Installation Form submitted By engineer and signed and dated by Engineer and installer ID As -Built Plan A. BM = 105.13 HR= 6.70 HI = 111.83 SYSTEM ELEVATIONS ROD ELEVATION AS -BLT INVERT ELEV DESIGN INVERT ELEV Benchmark Building Sewer OUT 1.30 110.18 110.09 Septic Tank IN 1.63 109.85 109.76 Septic Tank OUT 1.93 109.55 109.51 Distribution Box IN 2.02 109.46 109.43 Distribution Box OUT 2.18 109.30 109.26 Lateral 1 TOP 2.30 Lateral 1 INVERT 109.18 109.16 Lateral 2 TOP 2.93 Lateral INVERT 108.55 108.46 Lateral 3 TOP 3.58 Lateral 3 INVERT 107.90 107.86 Bottom of Bed/Chamber 3.65 4.28 4.81 108.18 107.55 107.02 108.20 107.55 106.90 CRITICAL SETBACK DISTANCES Mark those distances checked in the field against the design plan and regulatory setback 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 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 10' 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 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 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 .. . .. . .... PROPEPTY INES SHOWN WERE 7AKL-,,4 FROM Ex,'lS-,'No S PiANS AND Pr'--CORDS- 't L i 2.1 H! S PLAN 1-5 IN -J, ENDED FOR NORTH AN!LQnVY LCP BOARD OIF -,"ALTH PURPOSE ONLY. r-777 Fo UAi M22 Zl� C_7L_ C_ Vli�7 V—T 162,74, Town of North Andover — Septic System - AS -BUILT CHECKLIST 1) "'All changes to the design plan have been reflected on the as -built 2)Is of suitable scale; (one inch = 40 feet or fewer for plot plans and one inch = 20 or fewer for details of system components) 3) ✓ Lot number, Street Name, Assessors Map and Parcel Number 4) ✓ Lot Lines and Location of Dwellings served by the system 5) c/ Locations, Elevations and Dimensions of system, including reserve (if applicable) 6) Ties to dwelling or Permanent Structure & Wells , a. From Septic Tank & Distribution (D) Box b. From Leach Area v Ties to Lot Lines from leach area 8) Locations of Deep Holes & Peres 9) —4, -"/Top of Foundation Elevation 10) ✓ cations of Wells, Drains, Watercourses within 150 feet of system V_ 11) ql ,of water, gas, electric lines, cable 12) c_ -'Location of Structures within 6 Inches of Finished Grade 13)Original Stamp & Signature 14)�Location and holder of any easements which could impact the system 1 Im ervious Areas Driveways, etc � ' `1 N p Y / v �� 16) ilVorth Arrow 1' cation & Elevations of Benchmark used 18) STATEMENT ON PLAN (NA 5.3) a. "I certify the locations, elevations, ties, cover material; exposed component covers etc., shown on this as -built substantially agree with the approved plan and have determined that the break out elevations, if applicable, have been met." Signature of Designer Date b. "If a STUCTURAL WALL IS PRESENT W 4.9) a Letter or statement on the as -built indicating wall - was, or was not, constructed in accordance with the intended design and anvmanufacturer's specifications." Signature of Designer Date As of: Monday, December 02, 2013 Blackburn, Lisa From: Sawyer, Susan Sent: Thursday, December OS, 2013 3:24 PM To: phil@csi-engr.com Cc: Blackburn, Lisa Subject: lot 13 Boston Road Phil, I reviewed the As -built. I understand the driveway is not in yet, which is ok, but I do not see where the water line ended up going in or any other utilities. I hate to waste trees, but this is a detail that future owners ask about. Could you put in on and send a signed and stamped copy please? All else looks great. Thank you Susan Susan Sawyer Public Health Director Town of North Andover 1600 Osgood Street Suite 2035 North Andover, MA 01845 Phone 978.688.9540 Fax 978.688.8476 Email mailto:ssawver@townofnorthandover.com Web www.TownofNorthAndover.com Please note the Massachusetts Secretary of State's office has determined that most emails to and from municipal offices and officials are public records. For more information please refer to: http://www.sec.state.ma.us/pre/preidx.htm. Please consider the environment before printing this email. 1 Commonwealth of Massachusetts Map -Block -Lot BOARD OF HEALTH ----------- Permit No ------------ North Andover - BHP -2013-0916 ---------------------- FEE $250.00 DISPOSAL WORKS CONSTRUCTION PERMIT Permission is hereby granted Bill -Hall -Inc. to (Construct) an Individual Sewage Disposal System.- il r at No 325 BOSTON STREET ---------------------------------------------------------------------- I -CC -Py ---------------- as shown on the application for Disposal Works Construction Permit No. BHP -2013-091 Dated October 02, 2013 Issued On: Oct -02-2013 BOARD OF HEALTH ----------------- Q I Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. OCT 0 2 2013 Application for Septic Disposal System 00G _THANDC AConstruction Permit — TOWN OF TODAYr$bA7ExtMEl ORTH ANDOVER MA 01845 $ 250.0 —Full Repair .00 -Component Application is hereby made fora permit to: LM Construct a new on-site sewage disposal system* ❑ Repair or replace an existing on-site sewage disposal system* ❑ Repair or replace an existing system component — What? A. Facility Information Lo+ %3 BLX Address or Lot # Mg, k4zlvqr- City/Town 2.- *TYPE OF SEPTIC SYSTEM*: ❑ Pump EgGravity (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 J+Phe^ Fr-O.gCveSC'._ Name j � 1 F -m -,-m P_J Address (if different from above) City/Town State Zip Code 9'78 34d 7673 Telephone Number 3. Installer Information (2>/ C 14n.-ct Name v 'k , Name of Company i/ Address �j� / �e. l��? cue r► SMR ®c IFC( City/Town State Zip Code 9 -7d' ?4 0 &'d S 2 Telep onh a Number (Cell Phone # if possible please) 4. Designer Information 11 �' A f-4 5'Ti �� g �.� �-- � I Name Name of Company Address // f © W3 0 City/Town State Zip Code �79' 37 3 03to Telephone Number (Best # to Reach) Application for Disposal System Construction Permit • Page 1 of 2 „ N°;T"h Application for Septic Disposal System Lo -'I -i `pWlel Construction Permit — TO OF TODAY'S DATE $ 250.00 - Full Repair FSACHUSe�`� ORTH ANDOVER, MA 01845 $125.00 -Component PAGE 2 OF 2 A. Facility Information continued.... 5. Type of Building: KResidential 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 issued by this Board of Health. Name Date Application: (Board of Health Representative) Name Date Application Disap�rverthe following reasons: For Office Use Only: L Fee Attached. Yes No 2. Project Manager Obligation Form AttachedP Yes No 3. Pump System? If so, Attach copy ofElectrical Permit Yes No 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 SEPTIC 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 rt1.1"Jkin S b--\ 4— II —� ' f (Engineer) Relative to the application of Y 1 l' � 1 (Installer's name) And dated q Z 3 Za 1 rigina ate) Dated `p—A (Tb Way's ate With revisions dated (Last revised 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 Regulations may result in a $50.00 fine being levied against me and/or my company, 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: healthdept(@townofnorthandover.com) 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 septic systems 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 bas been reached. b. Inspection of the sand and stone to be used. c. Final inspection by Board of Healtb staff or consultant. d. Installation of tank, D -Box, pipes, stone, vent, pump ebamber, retaining wall and other components. 6. As the installer, I understand that I am solely responsible for the installation of the system as per the approved clans. No instructions by the homeowner. general contractor, or anv other persons shall absolve me of this obligation. Undersigned Licensed Septic Installer: �'�p -�- f� (Today's Date) (Name — Print) (Nam—e — Signe