HomeMy WebLinkAboutAs Built Checklist - As-Built Plan / Installation Certificate Form - 25 Beechwood Drive 12/27/2022 25 -D"Ve_-
Town of North Andover — Septic System - AS-BUILT CHECKLIST
1) _Y,A11 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
ZLocations,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:
Subsurface,interceptor&foundation drains
-Catch basins
Property lines
-Dwellings or other structures
_ Private water supply or irrigation wells
_Watercourses or wetlands
8) ✓ .Locations of Wells,Drains,Wetland Resource Areas within 150 feet of system
7 9) Location of water,gas,electric lines,cable,control panel(if applicable)
10) /Location of Structures within 6 Inches of Finished Grade
11) 7original.Stamp&Signature
12) " Location and holder of any easements which could impact the system
13) y Impervious Areas;Driveways,etc
14) ✓ North Arrow ,
q Location&Elevation of Benchmark used
16) `-/STATEMEENT ON PLAN (NA 5.3)
a. J `Q,cerkfy the locations, elevations, ties, cover material;owposed component covers etc.,
shown on this as bazdtsubstantiallyagree with the approvedp)am andhave determined that the
break out elevations,if applicable,have been met."
Signature of Designer Date
b. 11fa STUCTURAL WALL ISMSSEIVT OVA 4.9)a Letter or statement on the as-hadfkdicaftn�
the wall-was,or was not constructedin accordance with the intended design and any
manufacA rer's specificatz'ons"
Signature of Designer Date
As of:Tuesday,March 17,2015