HomeMy WebLinkAboutChecklist - As-Built Plan / Installation Certificate Form - 46 WHITE BIRCH LANE 9/24/2024 Town of North Andover,---- s_tqM -.,AS-BUILT CHECKLIST
1) ".-All(;IuuVes to the design plan have been reflected as noted on tlie as-built plan
plan has it suitable scale; (I inch ;7 40 feet or fewer f6i plot plans)
3) Address,Asscssoi s.Map and Lot Number
4) Lot Lin es an d f.Amition of I)Wellings served,by tI'Le System
5) —.1.0caliolls,Elevations and Dimensions of As-built syStem.cxmipozients,including resea-va(if al7plicable)
6) Ties to all fan k openings,d-box,and leach,area honi.dwelling or Permanent Str,ucture
eistances are shown on the as--L't�iift plan from systent components to'.
hflerceptor k-foundation drains
Cak'la ms
" �" �i) bms
)TO er� lixtes
Dwellings or offier structures
water supply or irrigation wells
raterecaur Or Nvetlands
of WeEs,Drains,Wetland Resource Areas within 1,50 feelt of systun
LLocaEnn of watar,gas,electric lines,cable,control pand (if al)plicab.la)
of Structures within 6 Inches,of Finished (:trade
I[) a
--original sflunp&Sigi:ianxrc
12) Location and holder of my userrients whicii could hripact lJle,,y tnn,
I --juipervious Arms; Driveways,et(;
14) Nortli Arrm
I fi) t Location &Elevai'm of Benelunark 11SUI
SrATEMEINFON IFLAN (INA 5.,'�3)
16)
"I'carli tr fbe locv,1661"I's", alevaliors, lia'�'cover lindetild;C�Tt '711 n I Co mrs dc
(town on th&as-huilt mibstmithally a,"!"rvc Wifil t1loaliywo Ila ve,defelmined Mat Ole
btr vzk-Old t c to vatiom" dall ve IrIct.
Signature of Dmg
"Ylc:r
or slatemiclif('.ul
dm ,r,rL mras.,( '11 1'elanco Ivill,1'hq inkneled dc avrr,ra7da ly
Ni,g nal ure of Dcsigvev