HomeMy WebLinkAboutCertificate of Compliance - 55 SHERWOOD DRIVE 4/4/2000 TOWN OF NORTH ANDOVER
BOARD OF HEALTH
CERTIFICATE OF COMPLIANCE
DATE OF COMPLIANCE:
4/4/00
This is to certify that
the individual subsurface disposal system
constructed (X) or repaired
by
Ben Osgood, Jr.
at
Lot 17 Sherwood Drive (55)
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.
Thy 'Lssuance of this certificate shall not be construed as a guarantee that the system will
fu0ion satisfactorily.
-2'e
Board of Health�Inspector
TOWN OF NORTH ANDOVER SEWAGE D.ISPOSAL SYSTEM
INSTALLATION CERTIFICATION
The undersigned hereby certify that the Sewage Disposal System /Constructed;
( ) repaired:
by
located at
was installed in conformance with the North Andover Board of Health approved plan,
System Design Permit # I dated with an approved design
flow of -41;�Qallons 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 CNM 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 date:
Engineer Representative
Installer:
LieA Date:
Design Engineer: (.A-,
Date:
AS-BUILT CHECKLIST
V�
LOT NUMBER, STREET NA /fE
ASSESSORS MAP & PARCEL NUMBER
LOT LINES & LOCATION OF DWELLINGS
LOCATION & DEMENSIONS OF SYSTEM
INCLUDING RESERVE
TIES TO LOT LINES & DWELLNG, WELLS
(=-a FROM SEPTIC TANK
FROM LEACH AREA
s LOCATIONS OF DEEP HOLES & PERC
TESTS
ELEVATIONS OF DISPOSAL SYSTEM
C� TOP OF FDN ELEVATION
LOCATIONS OF WELLS, DRAMS, WATERCOURSES
W/IN 1 50' OF SYSTEM
LOCATION OF WATER, GAS, ELECTRIC LNES, CABLE
V° DISTANCES FROM CORNERS OF HOUSE TO CENTER OF
f� TANK & D-BOX
STAMP & SIGNATURE
LtiIPERVIOUS AREAS - DRIVEWAYS, ETC.
_.
NORTH ARROW
�' l � FNAL CONTOURS
LOCATION & ELEVATION OF BENCIUvIARK USED
LOCUS PLAaN
LOT NUMBER, STREET NAME
ASSESSORS MAP & PARCEL NUMBER
LOT LINES & LOCATION OF DWELLINGS
LOCATION & DEMENSIONS OF SYSTEM,
INCLUDING RESERVE
TIES TO LOT LMS& DWELLING, WELLS
a, FROM SEPTIC TANK
b. FROM LEACH AREA
GIB LOCATIONS OF DEEP HOLES & PERC
��hhJ i�I rll� TESTS
ELEVATIONS OF DISPOSAL SYSTEM
C/ 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
r�,-OU16PI P-P IMPERVIOUS AREAS -DRIVEWAYS, ETC.
v--' NORTH ARROW
Cora �eO FINAL CONTOURS
✓� LOCATION & ELEVATION OF BENCHMARK USED
h�I 5C� LOCUS PLAN
yr i
AS-It U I LTC 1-1 EC KL I ST
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
UA. W LOCATIONS OF DEEP HOLES & PERC
r)ehL4,0 r� 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
IMPERVIOUS AREAS - DRIVE-WAYS, ETC.
A If -7-1 OF �u 1 tvgy
NORTH ARROW
Mora eO FINAL CONTOURS
LOCATION & ELEVATION OF BENCHMARK USED
lfi LOCUS PLAN
TOWN OF NORTH ANDOVER SEWAGE DISPOSAL SYSTEM
INSTALLATION CERTIFICATION
The undersigned hereby certify that the Sewage Disposal System ( instructed;
( ) repaired:
by
located at Zef ff
was installed in conformance with the North Andover Board of Health approved plan,
System Destign Permit # . dated with an approved design
----------
flow of allons 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 C&M 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 date:
Engineer Representative
Installer: Lic.#: Date:
Design Engineer: Date: