HomeMy WebLinkAboutSeptic - As-Built Plan / Installation Certificate Form - 485 FOSTER STREET 4/23/2026 Torn of North Andover
MAY 1 2026
Health Department
PUBLIC HEALTH DEPARTMENT
Community&Ronomu Development
AM
TOWN OF NORTH ANDOVER _ . Jf'7
SEPTIC DISPOSAL SYSTEM—INSTALLATION CERTIFICATION Ci
The undersigned hereby certify that the Sewage Disposal System(constructed;( )repaired;
By: &T &-+J
(Print Name)
Located at: � ��� �rC
(Installation Address)
Was installed in conformance with the North Andover Board of Health approved plan,originally dated
-Z'"2(P and last revised on *-1 L-'z4-- ,with a design flow of
40 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. CMR 15.000,Title 5 and local
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 Health.
Bottom of Bed Inspection Date:
Engineer Representative(Signature)
And-Print Name f ---
Final Construction Inspection Date:_ "�� I la
� � ) afi""
Engineer Representative(Signature)
4 �
And-Print Name
Installer:_ _-,,,- Signature) Date: ..
��a
11��II And-Print Name
Engineer:-66 (z � � Signature) Date:_ 2?'�,—
� Vj A i — -%4
. ",- )z ,. And Print Name
. '°°� 120 I'VMain Street, North Andover, Massachusetts 01845
" Phone 970.688.9540 Fax 978.688.9542 Web ittp://www.uortliatidovernia.gov
Town of North Andover — Se tic System - AS-BUILT CHECKLIST
/ ,All changes to the design plan have been reflected and noted on the as-built plan
2) ��As-built plan has a suitable scale; (I inch =40 feet or fewer for plot plans)
3) Street Address,Assessor's Map and Lot Number
4) IV/Lot Lines and Location of Dwellings served by the system
5) y 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
7) Setback distances are shown on the as-built plan from system components to:
Subsurface,interceptor&foundation drains
Catch basins
Property lines
Dwellings or other structures
Private water supply or irrigation wells
-----Watercourses or wetlands
8) ✓ Locations 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) Z Original Stamp&Signature Town of Noah Andover
12) Location and holder of any easements which could impact the system
13) mpervious Areas;Driveways,etc MAY 18 2026
14) North Arrow
I Health Department
15) _zLocation&Elevation of Benchmark used
P,
16) � STATEMENT ON PLAN (NA 5.3)
k�2)
a. "I certify the locations, elevations, ties, cover material;exposed componencobv2
shown on this as-built substantially qaivc with the approved plan and have determined that the
break out elevations,if applicable,ha veheen met.
Signature of Designer Date
b. -"If a STUCTUXU WALL IS FFXSENT(NA 4.9)a Letter or statement on the as-built indicator
the wall- was or was not constructed in accordance with the intended design and any
manufacturer's st7ccifications.
Signature of Designer Date
AS of:Tuesday,March 17,2015
SUMMARY OF INVERTS BUILDING TIES
SEWER 0 FDTN. 134.96 5' OFF BLDG. CORNER A B C D NOTE: THIS PLAN & CERTIFICATION IS NOT
SEPTIC TANK IN 134.79 SEPTIC TANK IN 12.4 21.0 - - A WARRANTY OF THE SUBSURFACE DISPOSAL
SEPTIC TANK OUT 134.51 SEPTIC TANK OUT 18.8 28.4 - - SYSTEM. IT IS A RECORD OF THE LOCATION
DIST. BOX IN 134.03 1 DIST. BOX 47.0 54.3 - - AND ELEVATION OF THE EXISTING SYSTEM
DIST. BOX OUT 133.85 COMPONENTS.
LEACH FIELD BEG 133.80
LEACH FIELD END 133.60 1 "1 HEREBY 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 ELEVATIONS, IF APPLICABLE, HAVE BEEN MET."
SIGNATURE OF DESIGNER DATE
Town of North Andover
MAY 181026
Health Department
164.02'
92
i
40'
INSP. PORT
26'
DIST. BOX
0 00
P
1500 GAL
SEPTIC TANK LEACH FIELD
(800 S,F,)
1�
PORCH'E
RM. 1T.F.=137. EXIST. j
DWELLI, G #4851 EXIST. ---BIT.—CONC. DRIVE t
GARAGE
0
LOT 2—A
(43,582 SF) EXIST.
WELLWET/
:�
ND AUGE BY N A,�CONSER AT ION
WETLAND FROM PLAN ADMINISTRATOR
OF RECORD
0 Y _ . $
41 49
a �
AS BUILT PLAN
OF
SUBSURFACE DISPOSAL SYSTEM
LOCATED IN
NORTH ANDOVER, MASS./485 FOSTER STREET
a �N OF ass AS PREPARED FOR
NATE BOYNTON VLADIMIR TM: 104B
Q L. G�
NEMCHENOK �, DATE: 4-23-26
H )')O SCALE: 1"=40' TL: 175
z -o � � 0 20 40 80
E! FSFCISTER����v
v' sro"/AL MERRIMACK ENGINEERING SERVICES
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ca 66 PARK STREET
ANDOVER, MASSACHUSETTS 01810