HomeMy WebLinkAboutChecklist - As-Built Plan / Installation Certificate Form - 9 HAWKINS LANE 6/24/2024 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
As-built plan has a suitable scale;(I inch=40 feet or fewer for plot plans)
3) Street Address,Assessor's Map and Lot Number
4). v Lot lines and Location of Dwellings sen ed by the system
4Locations,Elevations and Dimensions of As-built system components,including reserve(if applicable)
6) V T' 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:
41 Subsurface,interceptor&foundation drains n of Nosh Andover
etch basin Town oW
_ perty lines
or other structures
Ova
to water supply or irrigation wells ,JUN 2 4 ZK4
ate
rcourses or wetlands
6 Locations of Wells,Drains,Wetland Resource Areas within I So feet of system Health nt
9 �7tion of water,gas,electric lines cable control panel(if applicable)
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10) lion of Structures within 6 Inches of F`jT fished Grade
11) Original Stamp&Signature
12 -' Location and holder of any easements which could impact the system
13 Impervious Areas;Driveways,etc 100Y" #11�1
14) Arrow
1') jxCation&Elevation of Benchmark used
1 G) STATEMENT 9iV FLAN(NA 5.3)
a. �"Icer�zfy the locations,elevations, ties,covermakrtal,•exposed component covers etc.,
shown on this as hudtsuhMmtraJlyaS=with the approvedplan andhave determined that the
hzrak out elevations,ifapplicable,have hmn met."
_ -5
Si of Designer Date
b. __`Yfa S77lCITJRAL WALL ISPRF.SENT(NA 4.9)a Lefter or statement on the as the - .
the wall-ores,or was not,,constructed in accordance with the.intended design and any
manufacturer's specifications"
Signature of Designer Date
As of:Tuesday,March 17,2015