HomeMy WebLinkAboutCertificate of Compliance - 1020 SALEM STREET 8/7/2014 µ
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PUBLIC HEALTH TIPPA12TIy[EW
Town of North Andover
Community Development Division
CERTIFICATE OF
COMPLIANCE
S of: 8/7/2014
This is to certify that the individual subsurface disposal system received a
SATISFACTORY INSPECTION of the:
By: Robert Daigle Jr.
At:
Andover,1020 Salem Street
Map 104D Lot 32
North MA 01845
The Issua of this certificate shall not be construed as a guarantee that the system will function satisfactorily.
S n Sawye
Public Health Agent
1600 Osgood Street,North Andover,Mossochusetts 01845
Phone 978.688.4540 Fax 978.688.8476 Web www.townofnorthandover.com
Commonwealth Of Massachusetts
City/Town of
�-
Certificate l i
_- Form 3
DEP has provided this form for use by local Boards of Health. Other forms may be used, but the
information must be substantially the same as that provided here. Before using this form, check with
the local Board of Health to determine the form they use.
This is to Certify that the following work on an On-Site Sewage Disposal System
Important:When
filling out forms Construction of anew system e;c f2'A,.J4/-0,
on the computer, ❑ Repair or replacement of an existing system
use only the tab El Repair or replacement of an existing system component
key to move your
cursor-do not
use the return Has been done in accordance with Title 5 and the Disposal System Construction Permit(DSCP):
key.
- -- — -- - — ----------....- -- - -----------
--
r�a DSCP Number DSCP Date
/9 2�2
Facility Owner(
Street Address or Lot# t
/AC)-i0¢ G��CI U C1 ly�4 erz/ '3t _4: —
City/Town State Zip Code
Designer Information: I
:w_- ... -- -- -- _ -- - - - -
Name-�j Name of Company
C
_ 1, 14/✓
_ --- —
Signature �" Date
Installer Information:
r
w
ame Name of Com any
g2rh' L_ 9✓' `, lr ° — 1 1 ....... --- -------
Signature Date
Use of this system is conditioned on compliance with the provisions set forth below:
The issuance of this certificate shall not be construed as a guarantee that the system will function as
designed.
Approving Authority
Signature Date
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