HomeMy WebLinkAboutChecklist - As-Built Plan / Installation Certificate Form - 56 CRICKET LANE 10/27/2022 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
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:
t'lA Subsurface,interceptor&foundation drains
Catch basins
✓ Property fines
-Dwellings or other structures
7 Private water supply or irrigation wells
N�f�Watercourses or wetlands
N'^ N1'�
8) Locations of V�e11s,Drains, /Wetland Resource Areas within 150 feet of system
9) t/ Location of water,gas,electric lines,cable,control panel (if applicable)
10) ✓ ocation of Structures within 6 Inches of Finished Grade
11) Original Stamp&Signature
12) Location and holder of any easements which could impact the system
13) &pervious Areas;Driveways,etc
14) /North Arrow
q ✓ Location&Elevation of Benchmark used
16) ✓ STATEME ON PLAN (NA 5.3)
a. 19cerffy the locations, elevations, ties, cover material;exposed component coversetc.,
shown on this as-built substantially agree with the approvedplan andhave determined that the
break out elevations,if applicable,have been met,"
Signature of Designer Date
b. "If a STUCTURAL WALL IS PRESENT W 4.9)a Letter or statement on the as-builtindicafznz
the wall- was,or was not,constructed in accordance with the intended desiQrr and any
manufacturer's sz ifzcations."
Signature of Designer Date
As of.Tuesday,March 17,2015