HomeMy WebLinkAboutCertificate of Compliance - 725 BOXFORD STREET 10/23/1998 TOWN OF NORTH ANDOVER
BOARD OF HEALTH
CERTIFICATE OF COMPLIANCE
October 23, 1998
This is to certify that
the individual subsurface disposal system
constructed (x) or repaired ( )
by North Andover Licensed Installer
Peter Breen
at
725 Boxford Street, North Andover, MA 01845
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 Approval date of January 28, 1997.
The Issuance of this certificate shall not be construed as a guarantee that the system will
function satisfactorily.
f oard of Health Inspector
TOWN OF NORTH ANDOVER SEWAGE DISPOSAL SYSTEM
INSTALLATION CERTIFICATION
The undersigned hereby certify that the Sewage Disposal System constructed;
re ired;
by v) Z C
located at 6c) A
was installed in conformance with the North Andover Board of Health approved plan,
System Desip-n Permit dated ' with an approved design
flow of 'AO gallons The materials used were in conformance with those
specified on the approved plan; the system was installed in accordance with the provisions
of 310 CNM 15.000, Title 5 and local regulations, and the final grading agrees
substantially with the approved plan, All work is accurately represente on the As-built
1
which has been submitted to the Board of Health.
Bed inspection date: < 5
Engineer Repi�sGhtative
Final inspection date: 1'61dl
Exgiheer Representative
Installer: (le
Lic.#: Date: / : lie
Dvsign-Engineev ......... Date:
T 7?,X16' '5" 61d 619
A.S-BUILT CHECKLIST
LOT NUMBER, STREET NAME
ASSESSORS MAP & PARCEL NUMBER
LOT LINES & LOCATION OF DWELLINGS
LOCATION & DEMENSIONS OF SYSTEM,
INCLUDING RESERVE
TIES TO LOT LINES & DWELLING, WELLS
a. FROM SEPTIC TANK
b. FROM LEACH AREA
LJ 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
INTERVIOUS AREAS -'DRIVEWAYS, ETC.
NORTH ARROW
FIl�T.ALICONTOURS
LOCATION & ELEVATION OF BENCHMARK USED
✓`` LOCUS PLAN