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Home My WebLink AboutMiscellaneous - 981 JOHNSON STREET 9/30/2015 Town of North Andover HOR*M Office of the Health Department �_ ' '° -'° o Community Development and Services Division * ; 400 OSGOOD STREET North Andover, Massachusetts 01845 ss"C US � 1LHU5� Susan Y. Sawyer,REHS/RS 978.688.9540-Phone Public Health Director 978.688.8476-Fax C21RVg7jCA2E OF C0911(Dr T ONCF As of: ,dune 15, 2005 This is to certif that the individuaCsu6surface disposal system Constructed(-� or Repaired— Septic Tank 6� 10-Boat(-4) by ToddBateson at 981 Johnson Street Yorth Andover, WA 01845 has been instaffed in accordance with the provisions of Titfe v of the State Sanitary Code and with the North Andover Board of Yfealth regulations. The issuance_o f this certificate shaft not 6e construed as a guarantee that the system wirr function actorify. /' S n T Sawyer Bu6fic ifeafth Director BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 TOWN OF NORTH ANDOVER Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT 27 CHARLES STREET NORTH ANDOVER, MASSACHUSETTS 01845 Susan Y. Sawyer,REHS/RS 978,688,9540—Phone Public Health Director 978,688,9542,—FAX SEPTIC SYSTEM CONSTRUCTION NOTES f ADDRESS: qk ..'4—MAP: LOT: INSTALLER: 6�� - &,"bon DESIGNER: 44 4 PLAN DATE: e. BOH APPROVAL DATE ON PLAN: Al. DATE OF BED BOTTOM INSPECTION: w « 4- DATE OF FINAL CONSTRUCTION INSPECTION: DATE OF FINAL GRADE INSPECTION: X I SELECT SYSTEM TYPE GRAVITY DISTRIBUTION PRESSURE DISTRIBUTION PRESSURE DOSING HOLDING TANK ADVANCED TREATMENT OTHER COMPONENT SUMMARY FROM PLAN GALLON TANK = 15b v LOADING OF SEPTIC TANK GALLON PUMP CHAMBER = LOADING OF PUMP CHAMBER TYPE OF SAS DIMENSIONS AND DETAILS OF SAS: SITE CONDITIONS Existing septic tank properly abandoned Internal plumbing all to one building sewer Topography not appreciably altered Comments: Page I of 2 TOWN OF NORTH ANDOVER �A�TH Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT 27 CHARLES STREET NORTH ANDOVER,MASSACHUSETTS 01845 CHUS Susan Y.Sawyer,REHS/RS 978.688.9540—Phone Public Health Director 978.688.954" FAX 1 I SEPTIC TANK Bottom of tank hole has 6" stone base ❑ ' Weep hole plugged ® jallon tank has been installed (H-10 or H-20) (monolithic or 2 piece) ❑ Water tightness of tank has been achieved (Visual or Vacuum Test or Water held for 24hrs) ❑ Inlet tee installed, under access pork Outlet tee(gas baffle or effluent filter) installed, under n access port ❑ inch cover to within 6" of final grade'installed over one access pork, must be over outlet of tank if effluent filter is present Hydraulic cement around inlet & outlet Comments: PUMP CHAMBER ❑ Bottom of tank hole has 6" stone base ❑ eep hole plugged ❑ on Pump Chamber installed (H-10 H-20) (monolithic or 2 piece) ❑ Inlet tee in Iled, under access park ❑ Pump(s) instal on stable base ❑ Alarm float working ❑ Pump On/Off float works ❑ Drain hole in pressure line t ❑ inch cover to within 6" of fin rade installed over one access port l ❑ Water tightness of tank has been achi d Visual or Vacuum Test or Water he or,24 hrs ❑ Hydraulic cement around inlet & outlet Comments: i Page 2 of 2 TOWN OF NORTH ANDOVER Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT 27 CHARLES STREET NORTH ANDOVER.,MASSACHUSETTS 01845 CHU Susan Y, Sawyer,REHS/RS 978,688.9540'—Phone Public Health Director 978.688.9542—FAX f D-BOX J Installed on stable stone base Inlet tee if pumped or>0.08'/foot Hydraulic cement around inlet & outlets Observed even.distribution Speed levelers provided (not required) ' I Comments: SOIL ABSORPTION SYSTEM 1 ❑ Bottom of SAS excav ed to soil layer, as ; provided on plan j Size of SAS exca t as pe plan ❑ Title 5 sand inst I d, if spec' ied on plan 3/4-1 Y2" daub h"ed sto a installed 1/8-1/2" (pe ne) double ached stone installed lateral M Ins led and ends connected to header(and vent d if i pervious mat ial above) O ` ices 5 & 7 o'clock ositions ravel ss disposal systems: type, number and ocati as per plan Elev ions of laterals installed as on approved plan 40 it HDPE barrier installed ❑ Re wining wall (boulder/ concrete /timber/ block) ❑ Fi al cover as per plan Comments: l PRESSURE DISTRIBUTION ❑ inch manifold ❑ laterals installed with egad sweeps size; material: El Squirt test ft in height. ❑ Equal distribution to all laterals orifice size inch as per plan Comments: Page 3 of 3 1 TOWN OF NORTH ANDOVER T Office of COMMUNITY DEVELOPMENT AND SERVICES ,*0 HEALTH DEPARTMENT 27 CHARLES STREET NORTH ANDOVER,MASSACHUSETTS 01845 CHO Susan Y. Sawyer,REHS/RS 97808.9540—Phone Public Realth Director 978.688,9542—FAX CONTROL PANEL ❑ Alarm & Pump are on separate circuits 0 Alarm sounds when float is tripped ❑ Location of control panel: El Rated for exterior if placed outside Comments: SYSTEM ELEVATIONS Benchmark: Rod at Benchmark: Height of Instrument: INVERT ON DESIGN PLAN ELEV @ TOP OF PIPE INVERT ELEVATION Building Sewer OUT Septic Tank IN Septic Tank OUT Pump Chamber IN Pump Cham ber OUT Distribution Box IN D-Box OUT Manifold Lateral 1 HIGH Lateral 1 LOW Lateral 2 HIGH Lateral 2 LOW Lateral 3 HIGH Lateral 3 LOW Lateral 4 HIGH Lateral 4 LOW Lateral 5 HIGH Lateral 5 LOW Page 4 of 4 �� - �� I �� n U�� H �� ' �� ` �� m�v iomo� X16 � mu �� .� �� u�„ � u� I'" �V �� ii a �; o� � 0 ii � m�� µu � � M'�' �� a� �.. �.�i. �. � �p W� ium iii uu .�i � iiR ��„ . �� G A V"�up �.�„ -'� �a �� ,u ��IV III III III• � �� i��i ii �� m �U � II ii u� 0 I 0 UI II �II � � �� w�� oe j, ,.: . �m��i f �°� � � � � *� � P��m obi � �i, �..� �� , I TOWN OF NORTH ANDOVER c� Nom T'4,,�o Office of COMMUNITY DEVELOPMENT AND SERVICES �.,• o HEALTH DEPARTMENT 400 OSGOOD STREET NORTH ANDOVER, MASSACHUSETTS 01845 4ga°t4C a�cHUs 978.688.9540—Phone Susan Y.Sawyer, REHS/RS 978.688.9542—FAX Public Health Director hea lthde2t(@townofnorthandover.com-e-mail www.townofnorthandover.com-website APPLICATION FOR DISPOSAL WORKS CONSTRUCTION PERMIT DATE: Of LOCATION: LICENSED INSTALLER NAME: PLEASE PRINT SIGNATURE: d TELEPHONE# CHECK ONE: FULL SYSTEM REPAIR: ($250) COMPONENT REPAIR(indicate what parts): �� ' aX ($125) * NEW CONSTRUCTION: * If NEW CONSTRUCTION, please attach the Foundation As-Built Plan. $250.00 or 125 Fee Attached? Yeses Y ' No,. Project Manager O i n rom Attached? Yes No_ Foundation As-Built? Yes No Floor Plans? � Yes No Approval of Health Agent Date: �� INSTALLER PROJECT MANAGEMENT OBLIGATIONS As the North Andover licensed installer for the construction of the septic system for the at I Je h��,W 3- Y relative to the application property of ° d ��'dated 3-`r c Z °` for plans by and dated with revisions dated 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 manger,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 Tile 5 and the Board of Health Regulations may result in a$50.00 fine being levied against my company. a) Bottom of Bed - generally first inspection unless there is a retaining wall which should be done first. Installer must request the inspection but does not have to be present. b) Final inspection — Engineer must first do their inspection for elevations, ties, etc. As-built or verbal OK from engineer must be submitted to Board of Health, after which installer calls for inspection time. Installer must be present alarm to With system all electrical work must be ready and able to pump to work and C) Final Grade—Installer must request inspection when all grading is complete. Does not have to be on site. 4. As the installer I understand that only I.may perform the work(other than simple excavation) required to complete the 'installation of the system identified in the attached application for installation. I further understand that work 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. m chamber, retaining wall and other d) Installation of tank, D-box, pipes, stone, vent, p p components. 6. As the installer I understand that I am solely homeolwner, installation of tort or any other per the approved plans. No instructions y the persons shall absolve me of this obligation. Undersig ed Licensed Septic Installer �._ Date: Disposal Works Construction Permit#