HomeMy WebLinkAboutChecklist - As-Built Plan / Installation Certificate Form - 125 GRAY STREET 4/1/2024 Town of North Andover I&C IST
1)
_A11 clut1We s to the design plan Issue been rallecte'd arid noted on th 's e a -built plan
2) _As-built plan has a suitable scale; (I inch =40 feet or fewer for plot plans)
Stmet Address,Assessor's Map and.Lot Number
4) Lol Lines and Location of Dwellings seaved by the system
jAxaljoxis,E'I evations and Dimensions of As-built system components,including reserve(if applicable)
6) __�_'des to gall tank openings,d-box,and]each area,front dwelling or Permanent Structure-
"1 _Sethack-distances are shown on,The as-built plan frornsystem components to:
-_—Subsurface,interceptor&foundation drains
line-S
____J-)vvellings or other stz.*uctures
.........Mvate water supply or irrigation wells
c.,___,__Water r4crt=cs or. wetlands
—Locations of,Wells,Drains,Wetland Resource Areas within 160 feet of system
9) - jocation of water,gas,electric lines,cable,control panel (if applicable)
10) ._,_' �Cx afion of Structures within 6 inches of 11nished Grade
111) riginal Stamp&Signature-
14 cation and holder of any casenients which could impact the system
J __-Dupervious Areas;Driveways,etc,
14) -V/—North Arrow
1"i) _..`"Location&Vevation of Benchrnafk used,
10 _Z�STMAUMr ON MkN (NA 6.8)
a. _ "'9'Ceddjr the loodfions,elevado1g, tiaq,(�Vvar rn'etczya.;arpowd component Covam ela,
.4jown an this as-hu&szdVtaj7fik1braSxw ;idth Me 8ppromdplan andhavo defamined the the
bjmk out cloyabionsY apl,71ioahlehave het wrt
Signature of Definer bate........
b. L '7' 1 Let fez,o2- t
div
Sj,giiatore of Designer hate
As of:Tuesday,March 17,2015