HomeMy WebLinkAboutCertificate of Compliance - 15 LONG PASTURE ROAD 8/13/1999 TOWN OF NORTH ANDOVER
BOARD OF HEALTH
CERTIFICATE OF COMPLIANCE
DATE OF COMPLIANCE:
08/13/99
This is to certify that
the individual subsurface disposal system
constructed (X) or repaired ()
by
Louis Baldoumas
at
Lot#7 Long Pasture
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# 869 dated 12/05/97.
The Issuance of this certificate shall not be construed as a guarantee that the system will
function satisfactorily.
Board of Health Inspector
f xr,
ice•
TOWN OF NORTH ANDOVER
SEWAGE DISPOSAL SYSTEM
INSTALLATION CERTIFICATION
The undersigned hereby certify that the Sewage Disposal System( constructed; ( )repaired;
Sby L_. a ,fi ...w , ,..
located at - �;, ... ' ° .—,µ_ � �_ a „ " e.wl ,1'
was installed in conformance with the North Andover Board of Health approved plan, System
Design Permit# dated with an approved design flow of
g per day. The ma used` re 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 t As-built which has been submitted to the Board of Health.
Installer: � . #:
Date:
s / �
Design
9 „
gn . Date: °,
AS-BUILT CHECKLIST
LOT NUMBER, STREET NAME
ASSESSORS MAP & PARCEL NUMBER
LOT LINES & LOCATION OF DWELLINGS
LOCATION & Dfi%/IENSIONS 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
LOCUS PLAN