HomeMy WebLinkAboutCertificate of Compliance - 101 ROCKY BROOK ROAD 1/27/1999 TOWN OF NORTH ANDOVER
BOARD OF HEALTH
CERTIFICATE OF COMPLIANCE
DATE OF COMPLIANCE:
1/27/99
This is to certify that
the individual subsurface disposal system
constructed (X) or repaired ( )
by Peter Breen
at Lot 14B - Rocky Brook Rd
has been installed in accordance with the provisions of Title V of the State Sanitary Code
and with the North Andover Board of Health regulations as described in the Design
Approval Site System Permit #1030 dated 7/29/98
The Issuance of this certificate shall not be construed as a guarantee that the system will
function satisfactorily.
Board of Health Inspector
TOWN OF NORTH ANDOVER
SEWAGE DISPOSAL SYSTEM
INSTALLATION CERTIFICATION
The undersign?d hereby certify that the Sewage Disposal System (/Iconstructed; ( ) repaired;
by
;7
located at
was installed in conformance with the North Andover Board of Health approved plan, System
Design Permit rr ' dated .' "W^rr O` S" , with an approved design flow of
gallons per day. The materials used were in conformance with those specified on die approved
plan, the system was installed in accordance with the provisions of 310 CivIR 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.
Bed inspection date: ` _I / Yq Motes
-Inspector : }
Final inspection date: ` .3�/ )o
Inspector mx
r
C r
Installer: Oe z. Lie. #: Date: c
Design Engineer: _ Date: `
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AS-BUILT CHECKLIST
LOT NUMBER, STREET NAME
ASSESSORS MAP &PARCEL NUMBER
LOT LINES & LOCATION OF DWELLINGS
LOCATION & DEMENSIONS OF SYSTEM,
INCLUDING RESERVE
TIES TO LOT LINES & DWELLING, WELLS
a. FROM SEPTIC TANK
b. FROM LEACH AREA
LOCATIONS OF DEEP HOLES & PERC
TESTS
ELEVATIONS OF DISPOSAL SYSTEM
TOP OF FDN ELEVATION
LOCATIONS OF WELLS, DRAINS, WATERCOURSES
W/IN 150' OF SYSTEM
LOCATION OF WATER, GAS, ELECTRIC LINES, CABLE
DISTANCES FROM CORNERS OF HOUSE TO CENTER OF
TANK& D-BOX
STAMP & SIGNATURE
IMPERVIOUS AREAS -DRIVEWAYS, ETC.
-" NORTH ARROW
FINAL CONTOURS
LOCATION & ELEVATION OF BENCHMARK USED
LOCUSPLAN
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