HomeMy WebLinkAboutMiscellaneous - 649 FOREST STREET 11/2/2015 (2) PUBLIC HEALTH DEPARTMENT
Town of North Andover
Community Development Division
1��IIFI _3TI_E OT C 0M A C
As of:
eA,snif 6, 2011
This is to certify that the individual subsurface dzsposafsystem received a
SATISTAC01RT 1_ rSPEC710X of the:
instafiation of a New Individuaf
on Site Sewage osa[System
By
Wiffiam 5ei",' Sauyer
At:
649~akg~LotA-1 Torest Street
Wap—1 05.D,-AParce(-01 71
%o h,X over, 9WA 01845
The issuance o this cert�'cate shall not be construedas a guarantee that the system wifffunction satisfactorify.
us n T Sa. /
('u Cu MeaCth Director
1600 Osgood Street,North Andover,Massachusetts 01845
Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com
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PUBLIC REALM DEPARTMENT
Cornnrunity Developineni Division
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TOWN OF NORTH ANDOVER
SEPTIC DISPOSAL SYSTEM—INSTALLATION CERTIFICATION
The undersigned hereby certify that the Sewage Disposal System(4onstructed;( )repaired;
By: " %A W_'�EF,
(Print Name)
Located at:
(Installation Address)
Was installed in conformance with the North Andover Board of Health approved plan,originally dated
1� and last revised on t 'L"—"t — t p ,with a design flow of
li Aco 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.
a'
Bottom of Bed Inspection Date:
Engineer Represent tive(Signature)
And—Print Name (�
Final Construction Inspection Date: i / •�
Engineer Repr entative(Signature)
And—Print Name
Insta (Signature) Date: 7j /
And—Print Name
Enginer: �(QG�I/LGG� ffz/ GILL -jSignature) Date: t.2 S1 0'11151�9
And—Print Name
1600 Osgood Street, North Andover, Massachusetts 01845
Phone 978.688.9540 Fax 978668$.8476 Web http://www.townofnortliandover.com
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° Application for Septic Disposal System 3/20/2011
Construction rmlt — TOWN OF TODAY'S DATE
r
ORTH ANDOVER, 01845 $250.00—Full Repair
$125.00-Component
I
Important: Application is hereby made for a permit to:
When fining out
forms on the F0 Construct a new on-site sewage disposal system*
computer,use ❑ Repair or replace an existing on-site sewage disposal system*
only the tab key
to move your ❑ Repair or replace an existing system component—What?
cursor-do not
use the return
key. A. Facility Information
Address or Lot# ,.- d'„ S- 7- „
City/Town �1 , - I° '—d 41e7 .
2.-*TYPE OF SEPTIC SYSTEM*:
❑ Pump aGravity(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
Name
- 1 (e�1.
Address(if different f om above)
City own State Zip Code
Telephone Number
3. Installer Information
dd �,
Name Name of Company
_.....
Addr®s
Cityrrown Zip Code'
r - :
to 7 !6 _�,) _
Telephone Number(Cell phone#fl possible pf ollijo)
4. D
Name N ame of Company
Cc� r
(T 3tolo Zip code
Telephone Number(Best#to Reach)
Application for Disposal System Construction Permit•Page 1 of 2
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.� Application for Septic Disposal ystem
�Po TODAY'S DATE
Construction Permit — TOWN OF l
ORTH DOVER, MA 01845 2so.00-Fun Repair
$125.00-Component
PAGE 2OF2
A. Facility Information continued....
5. Type of Building: ❑Residential 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.
=..- ... W, h, , cr,�e"r c2.'..0
� .., : t
Name U Date
Application Approved By: (Board of Health Representative)
Name Date
Application Disapproved for the following reasons:
For Office Use Only:
1. Fee Attached? Yes v"f No
2. Project Manager Obligation Form Attached? Yes No
3. Pump System. Ifso 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 Imo'° No
Application for Disposal System Construction Permit-Page 2 of 2
`
SEPTIC SYSTEM INSTALLER PROTECT MANAGEMENT OBLIGATIONS
As the North Andover licensed installer for the construction for the septic system for the property at:
~—
(AdJ,eou°[sep6coyotem) For plans by
Relative m the application v[
And dated
(k yrylinM(late)
Dated
With revisions dated
0"'Isl revised(late)
I understand the following obligations for management nY this project:
1. As the installer,I xoz obligated to obtain all permits and Board oEHealth approved plans pdor to
performing any work nuusite. I must have the approved plans and the permit on site when any work is
being done.
2. /\x the installer,T must call for any and all inspections. IE homeowner, contractor,project manager, oruny
other person not associated with my company schedules an inspection and the system is not ready, then
item three shall 6eapplicable.
3. An the installer,Iom required to have the necessary work completed prior to the applicable inspections as
indicated below.
with Title 5 and the Board of Health Re�_ulations may result in a$50.00 fine being levied against me and/oi
my-clmql29n�� �
u. Bottom of Bed—Generally, this is the first(l'� inspection unless there is retaining wall,which �
should bo done first. The installer must request the inspection but does not have tobopresent. �
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b. Final Construction Inspection—Engineer must Bzot Jo their inspection for clevudoox' bcx` oco.
As-built of verbal()IC(or e-mail to: bedfladep from the engineer couot
6o submitted w the Board oF Health,after which installer calls for on inspection time. Installer must
be present for this inspection. With a pi-irnp system,all electrical work must be ready and able to
cooeepomnp to work and alarm 1ofunction.
c. Final Grade—Installer must request inspection when all grading is complete. Installer does not
have to6con-ybc.
4. As the installer,I understand that only I may perform the work (olber tban simbk excapation)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 sel2tic 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, siWificant fines to all persons involved ate also possible.
S. 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 xxxmvutirw has been rvuxheo[
b. Imspxx6*w of the sand and stone to be used.
c. Final in�x'�vw � �o�n/ of���/� ���ormw�w/�m� �
^ ., .' = �
d. Iwx/ollv/iou of tank, /J-Bvx�pipxs, xh*wx/ vent,pump chamber, retaining wall and other �
c*mP»wxw1r. �
6. As the installer,I understand that I am solely responsible for the installation of the system as per the �
approved plans. No instructions by the homeowner, general contractor,or any other persons shall absolve
me of this obligation.
Undersigned Licensed Septic Installer: (Today"s Date)
777-107- Print)
North Andover Health Department
Community Development Division
QNSITE WASTEWATER SYSTEM CONSTRUCTION NOT
LOCATION INFORMATION
ADDRESS: 649 Forest St. (a.k.a.) Lot 1-A MAP: 105D LOT: 171
INSTALLER: Tom Sawyer
DESIGNER: Vladimir Nemchenok
PLAN DATE: 10/26/10 rev. 12/9/10
BOH APPROVAL DATE ON PLAN: 12/15/10
INSPECTIONS
TANK INSPECTION:
DATE OF BED BOTTOM INSPECTION:
DATE OF FINAL CONSTRUCTION INSPECTION: 3/31/11
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: New construction (no existing tank)
SEPTIC TANK
® Building sewer in continuous grade, on
compacted firm base
❑ Cleanouts per plan /A
❑ Bottom of tank hole has 6" stone base
® Weep hole plugged
® 1500 gallon tank has been installed
H-10 loading
® Monolithic tank construction
®
Watertightness 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 final grade
installed over one access port
® Hydraulic cement around inlet & outlet
DISTRIBUTION-BOX
® Installed on stable stone base
® 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)
Comments:
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/ concrete /timber/ block)
❑ Final cover as per plan
Comments:
SOIL ABSORPTION SYSTEM (Gravel-less Chambers)
® Brand and Model of Chamber: Low Profile
® Number of chambers per row: 10
® Number of rows (trenches): 4
Comments: Total Chambers = 40
SYSTEM ELEVATIONS
AS-BLT INVERT DESIGN INVERT
ELEV ELEV
Benchmark
Building Sewer OUT 98.00 99.56
Septic Tank IN 95.50 95.66
Septic Tank OUT 95.25 95.43
Distribution Box IN 95.00 95.05
Distribution Box OUT 94.83 94.87
Lateral 1 INVERT 94.78 94.78
Lateral 2 INVERT 94.78 94.79
Lateral 3 INVERT 94.78 94.78
Lateral 4 INVERT 94.78 94.80
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/Coastal Bank3 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