HomeMy WebLinkAboutCertificate of Compliance - 50 SHERWOOD DRIVE 10/29/1999 TOWN OF NORTH ANDOVER
BOARD OF HEALTH
CERTIFICATE OF COMPLIANCE
DATE OF COMPLIANCE:
10/29/99
This is to certify that
the individual subsurface disposal system
constructed (X) or repaired ( )
by
Raymond Fraser
at
Lot 3 (50) Sherwood Drive
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# 829 dated 5/2/96. o
The Issuance of this certificate shall not be construed as a guarantee that the system will
function satisfactorily.
�% Board of Health Inspector
10-26-1 999 IL
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P.
TOWN OF NORTH ANDOVU
SEWAGE DISPWAL SYSTEM
INSTAbL,LATIO TIFIC"AUON
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AS-BULL T C'IILCKI.,1S'1
LOT NUMBER, STREET NAME
ASSESSORS MAP & PARCEL NUMBER
LOT LINES & LOCATION OF DWELLINGS
LOCATION & DEMENSIONS OF SYSTEM,
INCLUDING RESERVE
TIES TO tOT 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.. K
W/IN 150' OF SYSTEM
LOCATION OF WATER, GAS°, ELECTRIC LINES, CABLE)
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l./ DISTANCES FROM CORNERS OF HOUSE TO CENTER OF
TANK & D-BOX
_ STAMP& SIGNATURE
a ,( o AT IMPERVIOUS AREAS -DRIVEWAYS, ETC,
NORTH ARROW
0" FINAL CONTOURS
LOCATION & ELEVATION OF BENCHMARK USED
LOCUS PLAN
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® FORM U - LOT RELEASE FORM
INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from
Boards and [departments having jurisdiction have been obtained. This does not relieve
the applicant and/or landowner from compliance with any applicable or requirements.
APPLICANT FILLS OUT THIS SECTION
APPLICANT 5 LL PHONE
LOCATION: Assessors Map Number /DS�G PARCEL
SUBDIVISION ,J 2'/AG LOT (S)
STREET ,SA9,^W 06 1 10 t ST. NUMBER
USE
RECOMMENDATIONS OF TOWN AGENTS:
CONSERVATION ADMINISTRATOR DATE APPROVED
DATE REJECTED
COMMENTS
TOWN PLANNER DATE APPROVED
rl1 DATE REJECTED
COMMENTS
FOOD INSPE - -HEALTH DATE APPROVED —
DATE REJECTED _
_,,,-SEPT) INSPE C TOR-HEALTI4 DATE APPROVED
DATE REJECTED
COMMENTS
PUBLIC WORKS -SEWER/WATER CONNECTIONS
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DRIVEWAY PERMIT Z).->W Mva r Nfvd 'Po51r100 s 101fe 7'a ffff z-11v
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FIRE DEPARTMENT `` << (F
RECEIVED BY BUILDING I SPECTO __ DATE