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HomeMy WebLinkAboutChecklist - As-Built Plan / Installation Certificate Form - 531 JOHNSON STREET 8/8/2024 Town of North Andover --- Septic System -- AS--BUILT CHECKLIST 1) I—All changes to the design plan have been reflected and noted on the as-built plan V As-built plain has a suitable scale; (1 inch=40 feet or fewer for plot plans) Street Address,Assessor's Map and Lot Number 4)- tl Lot Tines and Location of Dwellings sere=ed by the system TLocations7 Elevations and Dimensions of As-built system components,including reserve(if applicable) b) LTies to all tank openings,d-box,and leach area from dwelling or Permanent Structure 7) LSetback distances are shown on the as-built plan from system components to: Subsurface,interceptor&foundation drains Catch basins oPertY lines Dwellings or other structures Private water supply or irrigation wells Watercourses or wetlands 8) ,A—Locations of Wells,Drains,Wetland Resource Areas within 150 feet of system 9) _Location of water,gas,electric lines,cable,control panel(if applicable) q + Location.of Structures within 6 inches of l�inished Grade 11) Original Stamp&Signature 1 Y Location and holder of any easements which could impact the system l LImpervious Areas;Driveways,etc 1� J North Arrow 1� � Location&Elevation of Benchmark used lb) STATEMENT ON PLANT (NA 5.3) a. `4'certitythelocadons,elevations,ffas covermatarig exposedcomponentcoversetc., shown on tk&as-built substan dallyagm with the appm mdplan and have determined that the break out elevations,zf applicable,have been met n Signature of Designer Date b. "ITa 14AALL ISFREMVP(NA 4.9)a Leffer or sta temant on the as-builtln&cafztz� the wall-was.or teas not,cons&rueted in accordance with the intended design and an y manufacturer's speeificahons" Signature of Designer Date As of:Tuesday,March V,2015