HomeMy WebLinkAboutChecklist - As-Built Plan / Installation Certificate Form - 24 FARNUM STREET 3/1/2023 Town of North Andover — Septic System - AS-BUILT CHECKLIST
1) `�11 changes to the design plan have been reflected and noted on the as-built plan
2) v As-built plan has a suitable scale; (I inch=40 feet or fewer for plot plans)
3) v 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) ✓ to all tank openings,d--box,and leach area from dwelling or Permanent Structure
i7 Setback distances are shown on the as-built plan from system components to:
Subsurface,interceptor&foundation drains
AIR 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 160 feet of system
9) Location of water,gas,electric lines,cable,control panel (if applicable)
10) Z- Location of Structures within 6 Inches of F;�rushed Grade
11) Original Stamp&Signature
12) Location and holder of any easements which could impact the system
13) V Impervious Areas;Driveways,etc
14) Z North Arrow
q ZLocation&Elevation of Benchmark used
16) ZSTATEMENT ON PLAN (NA 5.3)
a, `9'certify the locations, elevations,ties,cover material;exposed component covers eta,
shown on this as-builtsubstanfiallyagree m th the approvedplan andhave determined that the
break out elevations,if applicable,have beet met."
Signature of Designer Date
b. `Ifa STUCTURAL WALL IS PRESENT OVA 4.9)a Letter or statement on the as-buiffmdicattl7�
the wall was or was not,constructed in accordance with the intended desi�2n and any
manufacturrer's specifications"
Signature of Designer Date
As of.Tuesday,March 17,2015