HomeMy WebLinkAboutChecklist - As-Built Plan / Installation Certificate Form - 40 DUNCAN DRIVE 12/28/2023 z) 1-2 C Ozyz' Z)/-;
Town of North Andover ---. $QtL
AS-BUILT CHECKLIST
1) changes to the design plan have bftn reflected and noted on the as-built plan rt
2) plan has a suitable scale; (I inch:=40 feet or fewer for plot plans),,/,"
3) ---Strw-i Address,Assessor's Map and Lot NumberV'
4.). __JoL Lines and Location of Dwellings served by the system.
5) Elevations and Dimensions of Is-built system Components,including reserve Of applicable)
0) ._-Ties to all tan1c openings,&box,and leach area,from.dwelling or PennanentStractmc
Setback distances axe shown. on the as-built plan frorn system components to:
int9rcepLor&foundation drains
Catch basins ,"
__Jtoperty lines
wcl1fi1gs or other struct=es
...-Private water supply or irrigation wells
—..---Watercourses or wetlandsv"
8) ------,Locations of Wells,Drains,Wetland Resource Areas within 1,90 feet of system
9) of water,gas,electric jffic'S7 cable,control panel (if applicable)
10) of structures within 6 Inches of l'inished Grade
/11) Star r d/np&Sigiiatv - j j,,&1 6
12) and holder of any casem(mts-which could hupact the systein'//
13) Areas;Driveways,
14) -h Arrow
.15) adon,&Elevation of Bandhmaxk used
16) _.._._._5'PATEMENT ON PLAN (NA 5.3)
a. "T certify the locations, alevafj(,=r ,Hay,covermataii° d;exposed catvponevt co7uf.�cte.,
s,howv on this w& Me approved plan andhave deterrnined that the
break out clevat(oms,, if applicable,ha iv been met
Signature of Designer Date
b. 'WaSYNCTUWAL WALL ISBIUSTNT( a Leffer ov,,Aatanlant ov ale
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rttqfgtjn.a.qqo T.d'i.tice,with the hitanded gsf, .11 14dkly
Signature of Designey., Date
As of."Nesday,March 17,2015
Toym of North Andover AS-BUILT CHECKLIST JVAtp
i) All cha.nges to the de, i, hinh ave bcwx-
P
L/ _-As-bhalf p1mi has as scale; (I inc 0 fi,, �t orft wvr for,plot plarls)
3) --Street Address,Assessor's Map mad Lot Numbet,
4) L/--"Lotl'incs uld lmalhm of Dwe'llixw sel"w"d by ffie� sysit,stn
5 JAICUUM,�S,E.I.evations and Dirnartsions ofAs-built syste;yn (�if itp
) - -4 ,plicabIC
6) Ties to at. tin.k.ope-Iiings d-bux and,leildil airmi Croni,dwelling I C or I'arinanerat StIl GLUX
7) S(,,,,Iba(�k distances are showri on the as-bLdlt plan from-sy sierra mmponents,to:
�111.)STII±Ica,intereqAor&fimmdafion,dn'Un's
busirls
1, xv fines
lowell'ings, or other str ucifllres
M"atercoursc.s,or weAkin ds
8) jxx;adions of Wells,Drains,Wedand Re mirage Areas within 1,150 fcet of qM-em
9) gas clec"i 11C ca"ble,C(-YII lrx)] ayael (if—,Locafiorl of water
0) _Loca tion of Situct1wes wiEhh"i G Inches of Fjriished Grade
&
I z) Loca Lion u,rd holder o�f zany msexrier.As which couki jmjm,(��t ffi rystCl I I
4'1111taarvious Areas;Dliveways etc,
cid h A rrow,
&Meval on of Betichulark,used
Ott) ).S'MITMENTON PLAN (NA 63)
bitmik out elcya 66118,JT111a a rraa alq, ha yu In
(NA,4tW as Le".11ur or Shikment 017 the
A-A-1z Jtm t w,
uddi the hifewdedde. wzd
w,,rznufq,ctqivq�'7 �r ar atar G lions.
Sigywturie'of Desi,� ner, a,
Jrs ofi'�u"sday,Ma4ch 11,2015