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HomeMy WebLinkAboutApplication - 165 FOREST STREET 8/25/2015 PUBLIC HEALTH DEPARTMENT Town of North Andover Community Development Division CERTIFICATE OF COMPLIANCE As o£ 8/25/15 This is to certify that the individual subsurface disposal system received a SATISFACTORY INSPECTION of the: Repair of D-box and Tee By: Todd Bateson At: 165 Forest Street Map 106.A Lot 0180 Nrorth Andover,MA 01845 Tliellssuange of this ce ficatk shall riot be construed as a guarantee that the system will function satisfactorily, 'iV L Michele Grant Public Health Agent 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townafnorthandover.mm North Andover Health Department Community and Economic Development Division ONSITE WASTEWATER SYSTEM CONSTRUCTION NOTES ADDRESS INFORMATION Forest MAP:p�.\ ,h tJ1OI„1 '..',. i �1P LOT: INSTALLER:Todd Bateson DESIGNER: PLAN DATE: BOH APPROVAL DATE ON PLAN: INSPECTIONS D-box and Tee INSPECTION:8/25/15 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 LIJ 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 El 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) ❑j Schedule 40 PVC Pipe Comments: Commonwealth of Massachusetts Mae-nmck-Lm BOARD OF HEALTH 106n01e0 Permit No P.I. North Andover BHP-2015-0341 I F.I. FE, --_ $125.00 DISPOSAL WORKS CONSTRUCTION PERMIT Permission is hereby granted Todd Buteson to(Construct)an Individual Sewage Disposal System. atNo 165 FOREST STREET as shown on the application for Disposal Works Construction Penat No BHP 20t5 034. Dated August 12,2015 i I Issued On:Aug-12-2015 -- - - - -_ _---- ----- -----_ - BOARD OF HEALTH -- - - I � lj��� ,r•, Commonwealth of Massachusetts Mae-01 k_of BOARD OF HEALTH os.nmao North Andover ....,, CERTIFICATE OF CO LIANCE THIS 15'TO CEftT(FY,'Ph3'Ct ndivid, ewage Disposal System(Construct) by Todd Bateson at No 165 FOREST STREET has been installed in rdanee dh th p v Ions of TITLE 5 ofthe State Env- meat Code as described in the apPl at a f Disp s I Wpws Co lnlcnon Potmit No BNP-2015 034 Dated August 12,2015 Printed O r Ang-12-2015 --- --- -— —— - _ BOARD OF HEALTH ' Application for Septic Disposal System -)i- TODATS DATE Construction Permit-TOWN OF ($250101 Full Repair- , NORTH ANDOVER MA 01$45 stuoo-Grump onett> Important: Application is hembv made fora permit to: When filling out ❑Construct a new on-site sewage disposal system' '.. forms on the '.. computer,use ❑Repair or replace an existing on-site sewage disposal system" onlythetab key pair or replace an existing system component What? 0J-Lt:� (,,zv_- -' '>< to moot a your usedo not the return A.Facility Information key. Adtlress or Lot# � , Nt>. /44,,w­ /'/,h C'dyfiown ]il} 2: TYPE OF SEPTIC SYSTEM`: D PPE Gravity(choose one) I "'lfpump sy��1em,attach copy of elechtcatpermit to application— 94 itd D [5'ConvenUOnaI System(pipe and stone system) D ❑Infiltrator or Biodiffuser(Gravel-Less)(Attach a copy ofyour cerifficafion to install this type ofsystem.) ➢ ❑Pressure Distribution S.A.S.lNo D-Box) '.. D ❑Pressure Dosed(D-Box Present)S.A.S. D ❑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) WhetistheM,k,? Whatis dh Mded' _..___ 2. Owner Information ` Name Address(ifdNfW. from above) - Cilyff-n State C� Zip Code Telephone Number 3. Installer Information o Name N e of C mpany _._ DATMoN l N1 r:ti"1' SrlW� Address 21/W.' 4-a 2 i%�i I ANUS i�V�li�M tlo u I Cilyr-own - - Stale ZiP Code Telephone Number(Cell Phone#/fpossl6le please) a. Designer Information E— _—N,,—,of COmpa y State Zip Catle Telephone Number(Best#fo Reach) Application far Disposal System Constmction Permit-Page 1 of 2 e Application.for Septic rD��isp�orsT�a7l:Sy7s�tem �-/�-Is- - 3 '"C.orlstr•U CtIU11'i?ermlt—lO W.{r.O,P TODAY'S DATE 'tip ' ORTHANDOVR,MA 01845 $.260.00-Fell Repair $125.00-Component PAGE 2 OF 2 A.Fadilitv.lnformation continued.... S. Type of BuNding: esidentlal Dwelling or OCommercial 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 s 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. _ mm Application Approved By:(Board of Health Representative) Nama Date Application Disapproved for the following reasons:' For Office Use Only 1.-Fee Attached: Yes_ No 2- PrajectA?aaager Obligation Form Attached.? Yes - No 3: R�cg tem?Ifsor Anach cogyQfEl cuicaz p rt'�.: Yes_ No 4. FoundadonAs-Builc'(new Construction ronl ; No (Same scale as approyedplaa) lr) Yes 5. FloorPlaas?(new corrstruction only). No_ . 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