HomeMy WebLinkAboutCertificate of Compliance - 350 FOREST STREET 8/12/2002 Town of North Andover of NoRT►, A.
Office of the Health Department
a �
Community Development and Services Division
27 Charles Street
North Andover, Massachusetts 01545
�QSSaCHUstitts
Sandra Starr Telephone (978)688-9540
Health Director Fax(978)688-9542
TOWN OF NORTH ANDOVER
BOARD OF HEALTH
CERTIFICATE OF COMPLIANCE
DATE OF COMPLIANCE
08/12/2002
This is to certify that
the individual subsurface disposal system
constructed O or repaired (X)
by
Mike Reilly
at
350 Forest 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.
The Issuance of this certificate shall not be construed as a guarantee that the system will
function satisfactorily.
Board of Health Inspector
BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVXRON 688-9530 NURSE 688-9543 PLANNING 688-9535
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i ' JSA 0r1A } v` LYTO Y O NORJ ANDOVER SDV " GIR, I
I-STAZ,LA'fION CERTIFICATION ,
'The unce:si :,ed here0v cerifv that the Se%vage Disposal System i ! consuructed;
by
located at ,5G 6z;e Q T SI- e e
was installed in contcrmance with the loth An.Ove-r Board of Hea.ith a-:provec plan,
System Design Pe:fit' , dated: svit h an approved design
flow of gallons per day The mater a:s used were in coniormar,.e %vith those
specined opt the appro4ea plan; the system was installed in accor&xxt ,,,,7th the provisions
of 310 CNfP\ 15.000, Title 5 and local rc-,tlations, and the final 2radirry agrees
substantially %with the approved plan. Ail work is accurately represented or the As-built
:which has been submitted to the Board c:Lllealth.
Bed inspection date: �2-i/6 2
Engineer R �resz ;stive.
Final inspect-on cats: _ 6/7/
p Z
r ' Enciret: Represe:-:tat:Ve
C. Date: ^ _ x
Lesi<4n Engineer, ®•O' R.ItHA Rp �� -- Date:
C.
?ANGARD H
ONAL
1 _
� �z1 �l�Z
AS-BUILT CHECKLIST
LOT NUMBER, STREET NAME
ASSESSORS MAP &PARCEL NUMBER
L ` LOT LINES & LOCATION OF DWELLINGS
1/f LOCATIONS &DIMENSIONS 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
WITHIN 150' OF SYSTEM
LOCATION OF WATER, GAS, ELECTRIC LINES, CABLE
DISTANCES FROM CORNERS OF HOUSE TO CENTER OF
TANK&D-BOX
ORIGINAL STAMP & SIGNATURE
t� IMPERVIOUS AREAS - DRIVEWAYS, ETC.
NORTH ARROW
(� LOCATION&ELEVATIONS OF BENCHMARK USED