HomeMy WebLinkAboutCertificate of Compliance - 28 JERAD PLACE 1/3/2002 Town of North Andover
Office of the Health Department a�o�'r486 6,`�OO
Community Development and Services Division
27 Charles Street
�f rip
North
North Andover,Massachusetts 01845 CHus�
Sandra Starr Telephone(978)688-9540
Public Health Director Fax(978)688-9542
TOWN OF NORTH ANDOVER
BOARD OF HEALTH
CERTIFICATE OF COMPLIANCE
DATE OF COMPLIANCE
01/03/02
This is to certify that
the individual subsurface disposal system
constructed () or repaired (K)
by
John Soucy
at
28 Jared Place Road
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.
ian J. LaGrasse
Board of Health Inspector
BOARD OF APPEALS 688-9541 BUILDING-688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535
i-im I- ,
TOWN' Off' �iOT rfH NBOVER SrWAGE DISPOSAL ,SYSTEM
I- ST ALLA'nON CERTIFICATION
'The uncersivned hereiv certify that the SexaLc Disposal Syste-n cor:su,icttid;
re^aired:
by
located at AP 0, 5-.-'> �p� A 4�. L'
was installed in canfcrnzance with the No:th Andover Board of He-with a--proves' plan.
Svstem Desigm Perm t dated. with an approved design
flow of�i ryailons per day The materalsuse%i were in conformance :vit`t those
specined oii the approved plan; the system Aas installed in accordance v,,ih the provisions'
of 310 CNN 15.000, Title 5 and local rq.-ilations, and the final grading agrees
substantially %,,ith the approved plan. .-' l work is accurateiv represented the As-built
which has been submitted to the Board c-''Health.
Bed inspection -date: I I zo o\
EnQineeC R prose .drive.
Final inspection c to --�2-11% 0k _ r�� r c> i
---
Encireer Represenlac.:e
L:c m Date:
R CHARD 4��
CesiLyn Engineer; _ C, . — _ Date:
r TA G RD
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AS-BUILT CRECKILIST
LOT+ffJMBER, STREET NAME
ASSESSORS MAP &PARCEL NUMBER
r LOT LINES & LOCATION OF DWELLINGS
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
a LOCATION OF WATER, GAS, ELECTRIC LINES, CABLE
DISTANCES FROM CORNERS OF HOUSE TO CENTER OF
TANK.&D-BOX
ORIGINAL STAMP & SIGNATURE
✓ IMPERVIOUS AREAS -DRIVEWAYS, ETC,
NORTH ARROW
LOCATION&ELEVATIONS OF BENCHMARK USED