HomeMy WebLinkAboutCertificate of Compliance - 100 RALEIGH TAVERN LANE 11/15/2004 Town of Forth Andover „ORTN 1
Office of the Health Department
Community Development and Services Division
400 OSGOOD STREET ^o, , s`
North Andover, Massachusetts 01845 0111
Susan Y. Sawyer, REHS/RS 978.688.9540-Phone
Public Health Director 978.688.9542-Fax
CIFRIIFIC3T(F O F C0_141'0 T 11 XCE
As of:
5Vovember 15, 2004
,This is to certify that
the individuafsufisurface disposal system
repaired Full System
by
,john Soucy
at
100Raleigh Tavern .cane
-Arorth Andover, 94,4 01845
has been installed in accordance with the provisions of Title v of the State Sanitary Code and
with the Yorth Andover 0oard of Y(ealth regulations.
The Issuance of this certificate shall not be construed as a guarantee that the system will
function satisfactorily.
✓ . ''Sus��T Sawyer
(Public Ylealth Director
BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535
TOWN'OF NORTH ANDOVER SEWAGE DISPOSAL SYSTEM
INSTALLATION CERTIFICATION
The undersigned hereby certify that the Sewage Disposal System O constructed;
(y)repaired;
b'
a�Cy
located at / e7 fz A C 614-Y i
was-installed in conformance with the North Andover Board of Health approved plan,
System Design Permit.# ,plan dated with a design flow
of gallons per day. The material s.used were in conformance with those specified
on die approved plan;the system was=installed in aeeorcianee with.te provisions of 3l0
C1VYR.15.000,Tithe 5 and local regulations,.and the filial grading agrees substantially with
the approved approved plan. All work is..accurately-represented on the As built which has been
submitted to the Board of Health..
Bed inspection date:
- Engineer Representative
Final inspection date:
Engineer Representative
Install�er.' Lic.#• Date:
Ift Engin B j MIN
- Date:
CIVI
Pao.4989