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TO: NORTH ANDOVER, MASS s -e p7` •Z/ 19 8S—
BOARD OF HEALTH
FROM:
DESIGN ENGINEER
Re: Soil Absorption Sewage
System Inspection
This is to certify that I have inspected the construction of the said disposal system at
O 7'� -ZI Jo A AV NV�North Andover, Mass.
SITE LOCATION
The grades and construction are as specified in mW plans and specifications dated
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Board of Health
North AndPverr maBs. SEPTIC SISTER
INSTAIIATICK CHECK LIST
— C1VED DATE DI WPSUVa
eaimnst
FAIL I OK
(7- IF
1. Distance Tot
a. Wetlands
b. Drains
c.. Well
2. Water Line Location
LOT'S --
AVATI CEJ OK FA
3. No PVC Pipe
4. Septic Tank
a. ..Tess -_Length & To Clean Out Covers.
b. Cement Pipe to Tank On Both Sides of Tank
5. Distribution Box
a. Covers & Box - No Cracks
b. All Lines.Flowing Equal Amounts
c. No Back Flow
6. • Leach Field or Trench
a.
Dimensions
b.
Stone ,Depth
c.
Capped Inds
d.
Clean Double Washed Stone
7. Leach Pits
a.
Dimensions
b.
Stone Depth
c.
Splash Pads
d.
Tees
e.
Cenuent Pipe to Pit Both Sides
f.
Clean Double Washed Stone
8. No Garbage Disposal
9. -Anal Grading Inspection
10. Barricading Covered System
11. As Built Submitted
a. Lot Location
b. Dimensions of System
c. Location with Regard -to Pere Test
d. Elevations
e.' Water Table
I -
c:
. ' Health
.aidoTer,Mass
APPROVED
Provided:
DATE
SUBMRFACE DISPOSAL DESIGN CHECK 'SS.
DISAPPROVED DATE
Reasons:
Title V
Reg 2.5
Reg 6
Reg 10.2
Reg 10.4
FAIL
CK
`
The submitted plan must show as a minimums
a) the lot to be served -area dimensions lot #,abutters
b location and log deep observation hoes -distance to ties
c location and results percolation testa-CLetance to ties
d design calculations & calculations showi.ig required leaching area
(e) location and dimensions of system-ineluitng reserve area
f) existing and proposed contours
(g) location any wet areas within 100' of se ;age disposal system or
disclaimer -check wetlands mapping
(h) surface and subsurface drains within LOC' of sewage disposal
system or disclaimer
(i) location any drainage easements with -'1 3101 of sewage disposal
system or disclaimer -Planning Board filer
(j) known sources of Water supply within 2001 off' sewage disposal b
system or disclaimer
(k) location of any proposed Well to serve lot -1001 from leaching facility
(1) location of Water lines on property -101 from leaching facility
(m) location of benchmark
(n) driveways
(o) garbage disposals
(p) no PVC to be used in construction
(q) profile of system -elevations of basement, plumb, pipe, septic tank,
distribution box inlets and outlets, distribution field piping and
Other elevations
(r) maximum ground water elevation in area sewage disposal systema
(s) plan must be prepared by a Professional Engineer o"r other
professional authorized by law to prepare such plans
Septic Tanks '
(a) capacities -150% of flog, water table, tees, depth of tees,
access, pumping
(b) cleanout
(c) 101 from cellar wall or inground swimmi ; pool
(d) 251 from subsurface drains
Distribution Boxes
(a) s pe greater than 0.08
b) suP `
,4106 60
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