HomeMy WebLinkAboutAs Built Check list - As-Built Plan / Installation Certificate Form - 62 BANNAN DRIVE 9/14/2023 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) 7 -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) _)(6,ot Lines and Location of Dwellings served by the system
V Locations,Elevations and Dimensions of As-built system components,including reserve (if applicable)
6) V Ties to all tank openings,d-box,and leach area from dwelling or Permanent Structure
r Setback distances are shown on the as-built plan from system components to:
Subsurface,interceptor&foundation drains
Catch basins
Property lines
_ wellings or other structures
Private water supply or irrigation wells
Watercourses or wetlands
g) cations of Wells,Drains,Wetland Resource Areas within I So feet of system
9) Location of water,gas,electric lines,cable,control panel (if applicable)
10) Location of Structures within 6 Inches of 1�ir1i.shed Grade
11) Original Stamp&Signature
12) " Location and holder of any easements which could impact the system
13) / Impervious Areas;Driveways,etc
14) —7 orth Arrow
15 Location&Elevation of Benchmark use
d
16) /STATEMENT ON PLAN (NA 5.3)
&. `,T cez*Tjr the locations, elevations, ties,covermaterial;exposed component covers etc.,
shown on this as-builtsubstantiallyagree with the approvedplarr andJxave det.:rmined that the
bzrakout elevations,ifappEcable,have been met."
Signature of Designer Date
b. "Ii a S7UC7TIW WALL IS a Letter or statement on the as-built irldieatirz�
the wall- wastor was not constructed in accordance with the intended desistn andv
manufacturer's soecif'cations
Signature of Designer Date
As of:Tuesday,March 17,2015
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