HomeMy WebLinkAboutChecklist - As-Built Plan / Installation Certificate Form - 531 Boston Street 7/19/2024 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) ✓As-built plan has a suitable scale; (1 inch = 40 feet or fewer for plot plans)
3) ✓Street Address,Assessor's Map and Lot Number
4) Lot Lines and Location of Dwellings served by the system
5) `&/Locations,Elevations and Dimensions of As-built system components,including reserve (if applicable)
6) ` Ties 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:
Subsurface,interceptor&foundation drains
N/fir Catch basins
✓Property lines
✓ Dwellings or other structures
N/A Private water supply or irrigation wells
Watercourses or wetlands
8) "cations of Wells,Drains,Wetland Resource Areas within 150 feet of system
9) Location of water,gas,electric lines,cable,control panel (if applicable)
10) ✓Location of Structures within 6 Inches of Finished Grade
11) ✓Original Stamp&Signature
12) Location and holder of any easements which could impact the system
13) '' Impervious Areas;Driveways,etc
14) `: North Arrow
15) ✓ Location&Elevation of Benchmark used
16) ✓STATEMENT ON PLAN (NA 5.3)
a. ✓ "I certify the locations, elevations, ties, cover material;exposed component covers etc.,
shown on this as-built substantially agree with the approved plan and have determined that the
break out elevati s,if applicable,have been met."
Signature of Desig er Date
b. "If a SIUCTURAL WALL IS PRESENT W 4.9I a Letter or statement on the as-built indicatinst
the wall- was. 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