HomeMy WebLinkAboutChecklist - As-Built Plan / Installation Certificate Form - 911 JOHNSON STREET 8/8/2024 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
2) J As-built plan has a suitable scale; (1 inch=40 feet or fewer for plot plans)
3) Tstreet Address,Assessoj's Map and Lot Number
4). TLot Lines and Location of Dwellings sezi*ed by the system
/
y Locations,Elevations and Dimensions of As-built system components,including reserve (if applicable)
6) J Ties to all tank openings,d box,and leach area from dwelling or Permanent Structure
7} ISetback distances are shown on the as-built plan from system components to:
ubsurface,interceptor&foundation drairLs
Catch basins
t
d operty lanes
y/ wellings or other structures
"4 ftivate water supply or irrigation wells
Watercourses or wetlands
&) Locations of Wells,Drains,Wetland Resource Areas within 160 feet of system
9) Y Location of water,gas,electric lines,cable,control panel (if applicable)
10 ELocatian of Structures within 6 Inches of Finished Grade
11) _L-Original stamp&signature
12) Location and holder of any easements which could impact the system
1.3) tlr Ipervious Areas;Driveways,etc
1-1) North Arrow
1 b Location&Elevation of Benchmark used
16) TSTAMMENT ON ELAN (NA 5.8)
a. "I certify the loeaffons,elevations,ties,covermatcrial;exposed component covers etc.,
shown on this as hudtsubtstantiallyagxw with the approvedplan andhave determined that the
bzrak out elevations,if applicable,have been met:"
Signature of Designer Date
b. "'If.a STf7C TIXAL WALL ISPREMT(NA 4.9)a LettP.xorstatem ant an the as-huff fn&ca
the wall was,or was not constructed in accordance with the intended design and any
manufacturer's speaiicaffons"
Signature of Designer Date)
As of:Tuesday,l'Aarch!7,2015