HomeMy WebLinkAboutChecklist - As-Built Plan / Installation Certificate Form - 288 FOSTER STREET 11/7/2022 Zgg osYzr 5
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; (I inch=40 feet or fewer for plot plans)
3) Street Address,Assessor's Map and Lot Number
4) y Lot Lines and Location of Dwellings served by the system
5) Xocatioris,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:
r';r Subsurface,interceptor&foundation drains
%P'-Catch basins
;/ Property lines
1Dwellings or other structures
—7`Private water supply or irrigation wells
�-Watercourses or wetlands
,!'iA ff i`h /
8) ZLocations of Wells,Drains,Wetland Resource Areas within I50 feet of system
9) Location of water,gas,electric lines,cable,control panel (if applicable)
10) /location of Structures within 6 Inches of Fj nished Grade
11) Original Stamp&Signature
12) W/A Location and holder of any easements which could impact the system
13) 2 Impervious Areas;Driveways,etc
14) /North Arrow ,
q ocation&Elevation of Benchmark used
16) STATEMENT ON PLAN (NA 5.8)
a. // `9'certffy the locations, elevations, ties,covermaterial;exposed component covers etc.,
shown on this as-hunt substantially agz ee wrth the approved plan and have determined that the
break out elevations,ifapplicahle,have been met."
Signature of Designer Date
b. Ni'/ `Ifa STUCTURAL WALL ISPIYESEIVT W 4.9)a Letter or statement on the as-huiltindicatznz
the wall-was or was not constructedin accordance with the intended design and any
man Ufa ctuter's specifications"
Signature of Designer Date
As of.Tuesday,March 17,2015