HomeMy WebLinkAboutHealth Permit # 11/15/1999 MIMES
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TOWN OF NORTH ANDOVER SEWAGE DISPOSAL SYSTEM
INSTALLATION CERTIF'ICATIO
The undersigned hereby certify that the Sewage Disposal System (. constructed;
( ) repaired;
17r 15
by . ,
located at
was installed in conformance with the North Andover Board of Health approved plan,
System Design Permit # dated with an approved design
flow of gallons per day. The materials used were in confarmance with those
specified on the approved plan; the system was installed in accordance with the provisions
of 310 CNIR 15.0001 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.
Bed inspection date: IZ/I / 9 YA-
Engineer Representative
Final inspection date: °7�l 1 a ,, , l w -M
Engineer Representative
t
Installer: � ' �° - °� ..,� Lic.#: Date:
Design Engineer: �c� y1i1 Date: -71:E!4/oo
APPLICATION FOR DISPOSAL WORKS CONSTRUCTION PER1NJJT
DATE: ////
� '',), C U RR E NT INSTALLER'S LICENSE-'_
LOCATION:
LICENSED INSTALLER:
Tr'
SIGNATURE: TELEPHONE
CHECK ONE:
REPAIR: NE W CONSTRUCTION:
IF NEW CONSTUCTION, PLEASE ATTACH FOUNDATION AS-BUILT.
Administrative Use Only
I575,00 Fee Attached? Yes 1,111", No
Foundation As-Built? Yes No
Floor Plans? Ye s No
Approval
Date: