HomeMy WebLinkAboutCertificate of Compliance - 485 FOREST STREET 9/24/1999 TOWN OF NORTH ANDOVER
BOARD OF HEALTH
CERTIFICATE OF COMPLIANCE
DATE OF COMPLIANCE:
09/24/99
This is to certify that
the individual subsurface disposal system
constructed (x) or repaired ( )
by
Lou Baldoumas
at
Lot IA Long Pasture Estates
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# 876 dated 4/4/97.
The Issuance of this certificate shall not be construed as a guarantee that the system will
function satisfactorily.
Board of Health Inspector
TOWN OF NORTH ANDOVER
SEWAGE DISPOS JU SYSTEM
INSTALLATION CERTIFICATION
The undersigned hereby certify that the Sewage Disposal System constr-ucted, repaired-
bv /11d 4L>z, k�l d
located at
was installed in conformance with the North Andover Board of Health approved plan, System
Design Permit 4 dated /14' with an approved desip flow of
gallons per day. The materials used"were in conformance with those specified on the approved
plan; the system was installed in accordance with the provisions of 310 CNIR 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 submi ed to,th
d,
Bed inspection date:
41.Final inspection ct(4t
Inspector 1�0
Installer: 7� Lie. 9:1 C Date:
qQ_ Design Engineer: Date:
Z-
AS-BUILTCHECKLIST
LOT NUMBER, STREET NAME
ASSESSORS MAP & PARCEL NUMBER
Lf 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
LOCATIONS OF DEEP HOLES & PERC
TESTS
V/ ELEVATIONS OF DISPOSAL SYSTEM
TOP OF FDN ELEVATION
LOCATIONS OF WELLS, DRAINS, WATERCOURSES
W/TN 150' OF SYSTEM
LOCATION OF WATER, GAS, ELECTRIC LINES, CABLE
DISTANCES FROM CORNERS OF HOUSE TO CENTER OF
TANK & D-BOX
STAMP & SIGNATURE
IMPERVIOUS AREAS - DRIVEWAYS, ETC,
NORTH ARROW
FINAL CONTOURS
LOCATION & ELEVATION OF BENCHMARK USED
LOCUS PLAN