HomeMy WebLinkAboutCertificate of Compliance - 236 SUMMER STREET 4/13/2000 TOWN OF NORTH ANDOVER
BOARD OF HEALTH
CERTIFICATE OF COMPLIANCE
DATE OF COMPLIANCE:
4/13/00
This is to certify that
the individual subsurface disposal system
constructed () or repaired (X)
by
John Soucy
at
236 Summer Street
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.
The Issuance of this certificate shall not be construed as a guarantee that the system will
function satisfactorily.
Board of Health Inspector
t
TOWN OF NORTH ANDOVER SEWAGE DISPOSAL SYSTEM
INSTALLATION CERTIFICATION
Thn Rdersigned hereby certify that the Sewage Disposal System ( ) constructed;
( � repaired; `.
by V\ r� GLC
located at ` f ' (Yk rYr IM
was installed in conformance with the North Andover Board of Health approved plan,
System Design Permit dated with an approved design
flow of aaillons 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 aid 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. v
7� r e,. F ��a
Bed inspection date: -� •�
.. En �. )rsen;�Ative
w�
Final inspection dat 9 h&
in er Representativ
Installer: �Vc Date;
�.
Design Enc-pin _r; ,;, � :� Date:
ppp q
• ,1 ii� U tm"
J
AS-BUILT CHECKLIST
LOT NUMBER, STREET NAME
ASSESSORS MAP & PARCEL NU[viBER
LOT LINES & LOCATION OF DWELLNGS
LOCATION & DEMENSIONS OF SYSTEM,
NCLUDING RESERVE
TIES TO LOT LINES & DWELLING, WELLS
a. FROM SEPTIC TANK
b. FROM LEACH AREA Al 0.
y LOCATIONS OF DEEP HOLES & PERC
TESTS
ELEVATIONS OF DISPOSAL SYSTEM
TOP OF FDN ELEVATION
LOCATIONS OF WELLS, DRAENS, WATERCOURSES
WJN 150' OF SYSTEM
/ LOCATION OF WATER,-GAS, ELECTRIC L.NES, CABLE
y DISTANCES FROM CORNERS OF HOUSE TO CENTER OF
TANK & D-BOX
v STAMP & SIGNATURE
IMPERVIOUS AREAS - DRIVEWAYS, ETC.
NORTH ARROW
FINAL CONTOURS
LOCATION & ELEVATION OF BENCIUly ARK USED
LOCUS PLAN
AS-BUILT CHECKLIST
LOT NUMBER, STREET NAME
V ASSESSORS MAP &PARCEL NUMBER
LOT LINES &LOCATION OF DWELLINGS
LOCATIONS & DIMENSIONS 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
WITHIN 150' OF SYSTEM
LOCATION OF WATER, GAS, ELECTRIC LINES, CABLE
r/ DISTANCES FROM CORNERS OF HOUSE TO CENTER OF
TANK& D-BOX
ORIGINAL STAMP & SIGNATURE
IMPERVIOUS AREAS - DRIVEWAYS, ETC.
NORTH ARROW
tx� LOCATION & ELEVATIONS OF BENCHMARK USED