HomeMy WebLinkAboutAsbuilt Checklist - As-Built Plan / Installation Certificate Form - 1230 SALEM STREET 12/17/2021 Town of North Andover — Septic System - AS--BUILT CHECKLIST
v 1) y All changes to the design plan have been reflected and noted on the as-built plan
/2) As-built plan has a suitable scale; (1 inch = 40 feet or fewer for plot plans)
/3) Street Address,Assessor's Map and Lot Number
�4) : ' Lot Lines and Location of Dwellings served by the system
V/ 5) " -r Locations,Elevations and Dimensions of As-built system components,including reserve (if applicable)
✓ 6) �Ties to all tank openings,d-box,and leach area from dwelling or Permanent Structure
v _ ' Setback distances are shown on the as-built plan from system components to:
NAB N /A Subsurface,interceptor&foundation drains
O' —Catch basins
✓ Property lines
�,,� ,/ �► Dwellings or other structures
i r'� Private water supply or irrigation wells
/ ✓ Watercourses or wetlands
,/ 8) � Locations of Wells,Drains,Wetland Resource Areas within 150 feet of system
9) Location of water,gas,electric lines,cable,control panel (if applicable) WLF—1 V`Il) f I k,Aj C�
/0) L' Location of Structures within 6 Inches of Finished Grade
✓11) :! Original Stamp&Signature
12) hl Location and holder of any easements which could impact the system
13) : Impervious Areas;Driveways,etc
X4) " North Arrow
✓ 15) _:� Location&Elevation of Benchmark used
16) V STATEMENT ON PLAN(NA 5.3)
V/a. "1 certify the locations,elevations, des,cover material;exposed component covers etc.,
shown on this as-built substantially agree with the approved plan and have determined that the
break out elevations,if applicable,have been met."
Signature of Designer Date
b. 'Va STUC7ML WALL ISPRESEAT W 4.9)a Letter or statement on the as-buikindicatin�
the wall- was,or was not,conducted in accordance with the intended design and any
manufacturer's specifications."
Signature of Designer Date
Revised 3/17/15