HomeMy WebLinkAboutAs-built Checklist - As-Built Plan / Installation Certificate Form - 851 JOHNSON STREET 9/26/2022 . ?51 o AI)5 on
Town of North Andover — Septic S stem - AS-BUILT CHECKLIST
1) All changes to the design plan have been reflected and noted on the as-built plan
2) ZAs-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) X t Lines and Location of Dwellings served by the system
5) /Location,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
etback distances axe shown on the as-built plan from system components to:
N^A Subsurface,interceptor&foundation drains
yCatch basins
—./' Property lines
✓ Dwellings or other structures
Private water supply or irrigation wells
L( Watercourses or wetlands
8) N//a, Locations of Wells,Drains,Wetland Resource Areas within 150 feet of system
9) ZLocation of water,gas,electric lines,cable,confrol panel (if applicable)
10) V Location of Structures within 6 Inches of FXn hed Grade
11) zoriginal Stamp&Signature
12) Location and holder of any easements which could impact the system
13) ✓ Impervious Areas;Driveways,etc
14) North Arrow ,
15 i Location&Elevation of Benchmark used
16) XSTATEA7 ON FLAN (NA 5.3)
a. I certify the locations, elevations,ties,cover material;exposed component covers etc.,
shown on this as-built sabstan Hey agive with the approvedplan andhave determined that the
bzmk out elevations,ffapplicable,have been met."
Signature of Designer Date
b. `9fa STMURAL WALL ISPP MAT(NA 4.9)a.L effor or statement on the asbuiltindicatinz
the wall-was,or was not,constructed in accordance with the intended design and anY
many tacfcrrer's specifications"
Signature of Designer Date
As of.Tuesday,March 17,2015