HomeMy WebLinkAboutCertificate of Compliance - 135 RALEIGH TAVERN LANE 10/13/1999 TOWN OF NORTH ANDOVER
BOARD OF HEALTH
CERTIFICATE OF COMPLIANCE
DATE OF COMPLIANCE:
10/13/99
This is to certify that
the individual subsurface disposal system
constructed O or repaired (X)
by
John Soucy
at
135 Raleigh Tavern Lane
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 # 1098 dated 9/27/99.
The Issuance of this certificate shall not be construed as a guarantee that the system will
function satisfactorily.
r
Board of Health Inspector
TOWN OF NORTH ANDOVER SEWAGE DISPOSAL SYSTEM
INSTALLATION CERTIFICATION
The ndersigned hereby certify that the Sewage Disposal System ( ) constructed;
( repaired:
by tJ
located at 1ZALL16,lJ Ta,.r c z-t3 L�r.�
was installed in conformance with the North Andover Board of Health approved plan,
System Design Permit# dated , with an approved design
flow of+h_2 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 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:
Engineer Representative
Final inspection d e:
Engineer Representative
Installer: Lic.#: Date: /0
Design En ' e`er: i �(, Date: . jU-I Z-�Z
AS-ItUILT CFIECA.I..1S'I'
LOT NUMBER, STREET NAME
ASSE"SORS 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
LOCATIONS OF DEEP HOLES & PERC
TESTS
ELEVATIONS OF DISPOSAL SYSTEM
TOP OF FDN ELEVATION
=/ LOCATIONS OF WELLS, DRAINS, WATERCOURSES
WIIN l S0' OF SYSTEM
LOCATION OF WATER, GAS', ELECTRIC LINES, CABLE
DISTANCES FROM CORNERS OF HOUSE TO CENTER OF
/ TANK &D-BOX
STAMP& SIGNATURE
�t IMPERVIOUS AREAS -DRIVE-WAYS, ETC.
NORTH ARROW
FINAL CONTOURS
LOCATION & ELEVATION OF BENCHMARK USED
LOCUSPLAN