HomeMy WebLinkAboutChecklist - As-Built Plan / Installation Certificate Form - 463 WINTER STREET 10/26/2022 Town of North Andover — Septic System - AS-BUILT CHECKLIST
1) 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
5) ✓ 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
Setback distances are shown on the as-built plan from system components to:
�/A Subsurface,interceptor&foundation drains
N A Catch basins
Property lines
Dwellings or other structures
rivate water supply or irrigation wells
Watercourses or ands
8) Locations of Wells,Drains,Wetland Resource Areas within 150 feet of system
9) 'X Location of water,gas,electric lines,cable,control panel (if applicable)
10) Z—Location of Structures within 6 Inches of Finished Grade
11) Zotiginal Stamp&Signature
12) �/n Location and holder of any easements which could impact the system
13) /Impervious Areas;Driveways,etc
14) �North Arrow ,
l� Location&Elevation of Benchmark used
16) STATEMENT,ON PLAN (NA 5.3)
a. ✓ `�certify the locations, elevations,Pies, cover material;exposed component covers etc,,
shown on this as-huiltsubstanfrallyagree with the approvedplan andhave determined that the
break out elevations,if applicable,have been met."
Signature of Designer Date
b. `2fa STUCTURAL WALL ISPRbSENT(NA 4.9)a Letter or statement on the as-ha dtindicatzn�
the wall-was,or was not cons&uctedm accordance with the intended design and any
manufacturer's specifications"
Signature of Designer Date
As of.Tuesday,March 17,2015