HomeMy WebLinkAboutCertificate of Compliance - 60 ROCKY BROOK ROAD 7/16/1999 TOWN OF NORTH ANDOVER
BOARD OF HEALTH
CERTIFICATE OF COMPLIANCE
DATE OF COMPLIANCE:
07/16/99
This is to certify that
the individual subsurface disposal system
constructed (X) or repaired ( )
by
Peter Breen
at
1B Rocky Brook
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 # 879 dated 02/28/97.
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 DISP®SAL SYSTEM
INSTALLATION CEITT'IFICAT'I®Td
The undersigned hereby certify that the Sewage Disposal System ( ) constructed;
(
) repaired,-
by
located at
was installed in conformance with the North Andover Board of Health approved plan,
System Design Permit # c/a_, ; dated w - °°f with an approved 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 CNIR 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: 'y l
Enrentative
Final inspection date:
Engineer Representative
Installer: ,
Lie.#; Date:
Design Engineer: �YVl. 7'y] t Date: (0z1 � �
AS-BUILT CHECKLIST
(/ LOT NUMBER, STREET NAME
ASSESSORS MAP & PARCEL NUMBER
f� LOT LINES & LOCATION OF DWELLINGS
LOCATION & DEMENSIONS OF SYSTEM,
INCLUDING RESERVE
(L� TIES TO LOT LINES & DWELLING, bVE�'
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
v LOCATION OF WATER, GAS, ELECTRIC LIMES, CABLE
DISTANCES FROM CORNERS OF HOUSE TO CENTER OF
TANK & D-BOX
STAMP & SIGNATURE
IMPERVIOUS AREAS - DRIVEWAYS ETC.
V
NORTH ARROW
—1Z FINAL CONTOURS
LOCATION & ELEVATION OF BENCHMARK USED
(\�c� LOCUS PLAN