HomeMy WebLinkAboutCertificate of Compliance - 107 GRANVILLE LANE 3/17/1999 Form No.4
Town of North Andover, Massachusetts
BOARD OF HEALTH
—MV, / 7 19
CERTIFICATE OF COMPLIANCE
This is to certify that
the Individual Soil Absorption Sewage Disposal System constructed ( ' Or repaired ( )
by �G 1�,L� ��lyC? X
INSTALLER
at C,7
SITE LOCATION
has been installed in accordance with Board of Health Regulations as described in the Design
Approval Site System Permit No. 9FC5— dated �(-'V A/ 1 g c�
The issuance of this certificate shall not be construed as a guarantee that the system will
function satisfactorily.
BOXRD OF HEALTH ENGINEER
TOWN OF NORTH :ANDOVER
SEWAGE DISPOSAL SYSTEM
INSTALLATION CERTIFICATION
The undersigned hereby certify that the Sewage Disposal System( ) constructed; ( repaired;
by r soy, _
located at / , �
was installed in conformance with the North Andover Board of Health approved plan, System
Design Permit 4_4,!�dated �% 22 with an approved design flow of
gallons per day. The material's used 'ere in'conformance with those specified on the approved
g P Y P
plan;the system was installed.irraccordance with the provisions of 310 Cy1R 15.000, Title 5 and
local regulations, d the final grading-agrees substantially with the approved plan. All work is
accurately represeie on the As-built which has been submitted to the Board of Health.
Installer: r`r I Lic. #: Date:
Design Engin Date:
TOWN OF NORTH ANDOVER
SEWAGE DISPOSAL SYSTEM
INSTALLATION CERTIFICATION
The undersigned hereby certify that the Sewage Disposal System( instructed; ( ) repaired;
by
located at
was installed in conformance with the No h Andover Board of Health approved plan, System
Design Permit# dated with an approved design flow of L(C�
gallons per day. The materials used ere 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 the As-built which has been submitted to the Board of Health.
Bed inspection date:
Inspector
Final inspection date:
Inspector
Installer:
4lict�J' Lie. #: Date:
f ;
J
Design E 'veer: Date:
AS-BUILT CHECKLIST LOT NUMBER, STREET NAME
ASSESSORS MAP & PARCEL NUMBER
LOT LINES &LOCATION OF DWELLINGS
r LOCATION & 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
W/IN 150' OF SYSTEM
LOCATION OF WATER, GAS, ELECTRIC LINES, CABLE
i DISTANCES FROM CORNERS OF HOUSE TO CENTER OF
TANK& D-BOX
i STAMP & SIGNATURE
IMPERVIOUS AREAS -'DRIVEWAYS, ETC.
NORTH ARROW
FINAL CONTOURS
LOCATION & ELEVATION OF BENCHMARK USED
LOCUS PLAN