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Home My WebLink AboutCertificate of Compliance - 101 SPRING HILL ROAD 11/16/2015 I, m. 0 � Y PUBLIC HEALTH DEPARTMENT Town of North Andover Community Development Division CERR-TIFICATE OF COMPLIANCE As of: 11/16/15 This is to certify that the individual subsurface disposal system received a SATISFACTORY INSPECTION of the: Complete Repair of an On-Site Sewage Disposal System By: Robert Daigle Ate . 101 Spring HIM Rd@ MapIVA Lot 0241 North Andover, MA 01845 The Issuance of this certificate,'sh'all not be�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.coni 1 I I •l��"lll�ll�1��// ��Ali RECEIVED NOV 0 6 ?o��l TOWNS OF OKTIµi ANDOVER PUBLIC HEALTH DEPARTMENT HEALTH DEPAK ENT Community Development Division TOWN OF NORTH ANDOVER SEPTIC DISPOSAL SYSTEM—INSTALLATION CERTIFICATION The undersigned hereby certify that the Sewage Disposal System(V constructed;00 repaired; By: RUA (Print Na ) Located at: to/ J u (,- 1-4'1 L_t FZS-�> (Installation Address) Was installed in conformance with the North Andover Board of Health approved plan,originally dated 2 2 I and last revised on ) j . � with a design flow of ' 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: C} ` w) f Engineer Representative gnature) C5�s J,�c J And-Print Name C ^ ' Final Construction Inspection Date: :I /.5— Engineer Rep resentati (Signature) And-Print Name � �,�, w, ��.r , ,.,..� . , ., �,u, X. Installer: r�✓'� n "* (Signature) Date. And-Print I,$ame Engineer: - (Signature) Date: P"I a nd-Print Name 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web http://www.townofnorthandover.com I Commonwealth mf Massachusetts City/Town of ANDOVER ��"o�~��~�� N��0~�� ~~~~~ �.~~~~��~~~ ~~. _-~~~..K~..~~~~~~~_ Form 3 DEP has provided this form for use by local Boards of Health. Other forms may be used, but the information must be substantially the same as that provided here. Before using this form, check with the local Board of Health to determine the form they use. This is to Certify that the following work on an On-Site Sewage Disposal SysteRECEIV'ED Important:When filling out forms Construction ofa new system NOV n 6 2015 on the computer, Z Repair V[replacement ofan existing system use only the tab —1 Repair or replacement ofanexisUnQ system component T0WNOF NORTH ANDOVER key m move your HEALTHDEPARTME0T numnr-dnnot use the return Has been done in accordance with Title 5 and the Disposal System Construction Permit(DSCP): key. DSCPNumhur DSCP Date �--� Daniel M D fh Facility Owner 1O1 Spring Hill Road ----- Street Address nr Lot# North Andover MA 01845 Cityrrnwn State Zip Code Designer Information: B None Num Name of Company October 29, 2015 Dahe Installer Information: | Rob Daigle Name Name n{Company Signature Date Use of this system is conditioned on compliance with the provisions set forth below: The issuance of this certificate shall not be construed as a guarantee that the system will function as � designed. Approving Authority Signature Date t5fonn8.duo~0603 Certificate of Compliance^Page 1o*1 I Town ®f North Andover — Septi c }rstem - AS-BUILT CHECKLIST l 1) All changes to the design plan have been reflected and noted on the as-built plan F 2) As-built plan has a suitable scale; 0 inch= 40 feet or fewer for plot plans) 3 Street Address Assessor's Ma p and Lot Number 4) _ _Lot Lines and Location of Dwellings served by the system 5) Locations,Elevations and Dimensions of As-built system components,includip reserve (if applicable) - 7— 6) \ Ties to all tank openings,d-box,and leach area from dwelling or Permanent Structure Setback distances are shown on the as--built plan from system components to: Subsurface,interceptor&foundation drains Catch basins =Property lines Dwellings or other structures Private water supply or irrigation wells Watercourses or wetlands 8) \I tLocations of Wells,Drains,Wetland Resource Areas within 150 feet of system 9 () Location of atµ....,.., _ w er,gas,electric lines,cable,,c)ontr panel (if applicable) 10) Location of Structures within 6 Inches of Finished Grade 11) Original Stamp&Signature 12) A`_Location and holder of any easements which could impact the system 13) Impervious Areas;Driveways,etc 14) North Arrow 15) Location&Elevation of Benchmark used 16) .� 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,ifapplicable,have been rnet." Signature of Designer Date b. "If a STUCTURAL WALL IS PRESENT(NA 4.9)a Letter or statement on the as-built indicating the wall- was or was not, constructed in accordance with the intended design and any manufactimer's specifications." Signature of Designer Date Revised 3/17/15 1 i 1 North Andover Health Deportment Community and Economic Development Division ONSITE WASTEWATER SYSTEM CONSTRUCTION NOTES LOCATION INFORMATION ADDRESS: 101 Spring Hill Rd. MAP: 107.A LOT: 0241 INSTALLER: Rob Daigle DESIGNER: Ben Osgood Jr. PLAN DATE: 6/22/15, rev 7/13/15 BOH APPROVAL DATE ON PLAN: 7/23/15 INSPECTIONS TANK INSPECTION: 10/9/15 DATE OF BED BOTTOM INSPECTION: DATE OF FINAL CONSTRUCTION INSPECTION: 10/22/15 DATE OF FINAL GRADE INSPECTION: i12�j 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: Filter fabric used instead of peastone above leach field which meets Title 5 requirements. EXISTING SEPTIC TANK N/A Building sewer in continuous grade, on compacted firm base N/A Cleanouts per plan N/A Bottom of tank hole has 6" stone base N/A Weep hole plugged N/A 1500 gallon tank has been installed N/A H-10 loading N/A Monolithic tank construction N/A Water tightness of tank has been achieved by visual testing i N/A Inlet tee installed, centered under access port ® Outlet tee installed, centered under access port 1 (effluent filter) ® 18" inch cover to finish grade installed over outlet access port ® Neoprene boots around inlet & outlet Comments: Tank is being re-used. 3 covers have decayed somewhat. Will be changed out. New pipe, location of pipe will be replaced. DISTRIBUTION-BOX ® 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) ® Schedule 40 PVC Pipe 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 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: ° e FINAL GRADE Loamed Seeded Cover per plan ,'° 1 i "Comments: r, DOCUMENTS NEEDED Certification of Installation Form submitted By engineer and signed and dated by Engineer and installer As-Built PI BM = 226.83 (manhole cover) HR = 2.18 HI = 229.01 SYSTEM ELEVATIONS ROD AS-BLT INVERT DESIGN INVERT ELEVATION ELEV ELEV Benchmark Exist. Septic Tank OUT 4.37 224.29 224.75 Distribution Box IN 6.26 222.40 222.23 Distribution Box OUT 6.45 222.21 222.06 Lateral 1 TOP 6.67 /6.85 Lateral 1 INVERT 221.99 /221.81 221.96 /221.75 Lateral 2 TOP 6.67 /6.85 Lateral 2 INVERT 221.99 /221.81 221.96 /221.75 Lateral 3 TOP 6.67 / 6.85 Lateral 3 INVERT 221.99 /221.81 221.96 /221.75 Lateral 4 TOP 6.67 / 6.85 Lateral 4 INVERT 221.99 /221.81 221.96 / 221.75 Lateral 5 TOP Lateral 5 INVERT Lateral 6 TOP Lateral 6 INVERT Bottom of Bed 220.81 220.75 1 I 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 10' ® Private drinking well 75 1002 50 ® Irrigation well 75 100 ® Surface Water 25 50 ® Bordering Vegetated Wetland , Salt Marsh, Inland/Coastal Bank 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 I 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 i