HomeMy WebLinkAboutSeptic - Installation Report - 191 GRANVILLE LANE 8/25/2025 Town of No�h Andover
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Health Department
PUBLIC HEALTH DEPARTMENT
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SOWN OF NORTH ANDOVER
SEPTIC DISPOSAL SYSTEM—INSTALLATION CERTIFICATION
The undersigned hereby certify that the Sewage Disposal System( constructed;( }repaired;
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Located at: � � � �,' LIP,
(Installation Address)
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Was installed in conformance with the North Andover Board of Health approved plan,originally dated
and last revised on ,with a design flow of
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. gallons per day. The materials used were in conformance with those specified on the
approved plan;the system was installed in accordance with the provisions of 310.C MR 15.000,Title 5 and local h
regulations,and the final grading agrees substantially with the approved plan.All work is accurately represented on
the As-built which has been submitted to the Board of Hearth.
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Bottom of Bed Inspection Date: b
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, Engineer-Repr-esentative(Signature)
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And--Print Name 4
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Firral Carrfi-uctiorr Irrspectiorr Date:
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Engineer-Repr-eserrtative( ignatur-e)
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And—Print Name r
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Irrtaller•: � �� Ya;,�n������� ( ignatur•e) Drrte: yam y _u
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And—:Print Name
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Engineer': (Signature) Date; ~
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And--Print Name
120 Main Street, North Andover,Massachusetts 0 18454
Phone . . 978.688.9542 e littp-,//www.northandoverma.gov
Tow. of North Andover-- Sepgq-�ystem - AS-BUILT CHECKLIST
�V�.�cha ages to the design plan have bcen raflected and noted.on the as-built pla-�-�
2) _7vLAs-buff plan has a suftable scale; (I Inch=40 feet or fewer for plot plans)
3 Street Adux css,A.ssessoes A/lap azd Lot Nvxiber
4) Loi.Unes rind Location of Dwellings served"by the system
'L/ Locations,Elevations a d Dimensions of As-buhi system components,includhng rose).-uc(if applicable)
6 Ties to ah fank openings,d boas and leach area fi-,om dNkreuing or perxnanent S-b.'a cture
i Setback list—ices are shovni on the as--bWlt plan from syste'nt components to: .
interce-ota, foUnci ff'on drains
Catch basins
_ ftopel-fy homes
Dweltings or other structures
_ Private water Supply or irrigation wells
Watercovxses or wetlands
8 :V1 of cllfi Drains Welt and Resource seas w-lthhi IS 0 feet of s stell1
9) Location of water,gas,electric lhies,cable,control.panel(if applicable)
10) Location of Stmct=es witbin G hiches of shed Grade
1I —Izorigimo Siamp&signatvxe
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12) -ocation a:adholder of axLy easanenfs which could impact'me system
13) hnpervxoUs Areas;Driveways,etc ��eo
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_L/Locatio i&Flevatlon of Benclunarl�Yised
16) L/STATEA/S-EN7, ON-10LAN W-5.3)
106166r cjoaflhlalls,e war Zo?s, tiff cover11.7ate iY-1 exposed coml-a unt cclre 15 etc.,
shomr-ii on tlus sw arzi sus a f al.I awe vdfh Mo approved plan andhaye deiamzned Mat Lie
hirak-out d--cyaiYbn.,iTappEcabUc,hame,been.rnet"
Slgnahu re of Designar _ Datc. J .
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`%Ta STUCTURAL 147ALL BaUUVT rA-ef,9 -a 1x P,2,,or statenic-Ti car
7c�-,g,dj-F,w,Or was 1704 consh-acted ili accorl.wicc TirrM the bitended 6�g �arx
Signal-u.r e of Desig ter _ - Date
As tit:Tucsd22 f,N 3arch:#7,70,15