HomeMy WebLinkAboutCertificate of Compliance - 116 SHERWOOD DRIVE 9/27/1999 TOWN OF NORTH ANDOVER
BOARD OF HEALTH
CERTIFICATE OF COMPLIANCE
DATE OF COMPLIANCE:
09/27/99
This is to certify that
the individual subsurface disposal system
constructed (x) or repaired ()
by
Ray Fraser
at
Lot 9 116 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# 892 dated 4/6/98.
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 DISPOSAL SYSTE M
Dig STALLATION CERTIFICATION
The undersigned hereby certify that the Sewage Disposal System (,4) constructed
( ) repaired;
by
located at /o T 9 )1 6- 4 ke T>r.;Vc
was installed in conformance with the North Andover Board of Health approved plan,
System Design Permit m ly,2 dated ,i,, with an approved design
flow of Qailons 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 510 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 submitted to the Board of Health.
Bed inspection date: 7/1 J99 ` � t✓ .�,-��
Engineer Representative
Final inspection date: 715/99 _ QA '"y✓1;�.
EnQi eer Representative
Installer. :-. LiC.�r Date: :
Design Engineer: c � , r !c , Date: ` � 1
R T CHECKLIST
T f
AS-BUILT CHECKLIS A
LOT NUMBER, STREET NAND
ASSESSORS MAP & PARCEL NUMBER
(/ LOT LINES & LOCATION OF DWELLINGS
LOCATION & DEMENSIONS OF SYSTEM,
INCLUDING RESERVE
V TIES TO LOT LINES & DWELLING, YELLS
a. FROM SEPTIC TANK
b. FROM LEACH AREA
LOCATIONS OF DEEP HOLES & PERC
TESTS
ELEVATIONS OF DISPOSAL SYSTEM
G J TOP OF FDN ELEVATION
LOCATIONS OF WELLS, DRAINS, WATERCOURSES
W/IN 1 50' OF SYSTEM
LOCATION OF WATE GAS ELECTRIC LINES CABLE
DISTANCES FROM CORNERS OF HOUSE TO CENTER OF
TANK & D-BOX
STAMP & SIGNATURE
l/ ItiIPERVIOUS AREAS - DRIVEWAYS, ETC.
NORTH ARROW
Gam` FINAL CONTOURS
LOCATION & ELEVATION OF BENClEv ARK USED
t/ LOCUS PLAN
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