HomeMy WebLinkAboutCertificate of Compliance - 767 JOHNSON STREET 10/22/1999 TOWN OF NORTH ANDOVER
BOARD OF HEALTH
CERTIFICATE OF COMPLIANCE
DATE OF COMPLIANCE:
10/22/99
This is to certify that
the individual subsurface disposal system
constructed O or repaired (X)
by
Bill Hall
at
767 Johnson Street
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# 1001 dated 6/1/98.
The Issuance of this certificate shall not be construed as a guarantee that the system will
function satisfactorily.
Board of Health Inspector
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TOWN OF NORTH ANDOVER SMV.-GF MSPO,SAT. SYSTEA
z-tSTALLA,rION CERTIFICATION
The undersigned here;-,v certify that the Sewage Disposal System ( ? constrtrl;tcd,
( ) recaired:
by�
was installer) in conformance with the North A-ndover Board of Heaith asproved plan-
Svstem Des],--,n Permit ^f , dated " ;" _ with in accroved desii7n
flow of � C)Igailons per day The materzalsused were in coniormar.cw �.vit'7 thasF°
specipea on the approved plan; the system was installed in accordance the provisions
of 3 10 C.VI t-S 000, Title 5 and local regulations, and the nrral grading agrees
substantially with the approved plan. Adl work is accurateiv represented on the As-built
which has been submitted to the Board o'Health.
Bed inspecthcn datei m
]v�n�i eer R;::�resL�`ative : ----
Final inspect;on date r
Installer: Date.
Cesh<_rn LnCir,eer r Date d
/I
AS-BUILT CHECKLIST
LOT NUNEBER, STREET NANLE
ASSESSORS MAP & PARCEL NUMBER
LOT LINES & LOCATION OF DWELLINGS
l/ LOCATION & DEMENSIONS OF SYSTEM,
INCLUDING RESERVE
TIES TO LOT LINES & DWELLING, WELLS
a. FROM SEPTIC TANK
/ b. FROM LEACH AREA
v
LOCATIONS OF DEEP HOLES & PERC
TESTS
ELEVATIONS OF DISPOSAL SYSTEM
TOP OF FDN ELEVATION
LOCATIONS OF WELLS, DRAINS, WATERCOURSES
WdN 150' OF SYSTEM
LOCATION OF WATER, GAS, ELECTRIC LINES, CABLE
DISTANCES FROM CORNERS OF HOUSE TO CENTER OF
TANK & D-BOX
STAMP & SIGNATURE
LvTERVIOUS AREAS - DRIVEWAYS, ETC.
(/ NORTH ARROW
FINAL CONTOURS
LOCATION & ELEVATION OF BENCHMARK USED
LOCUS PLAN