HomeMy WebLinkAboutCertificate of Compliance - 915 JOHNSON STREET 7/20/1998 Town of North Andover, Massachusetts
BOARD OF HEALTH
Date: July 20, 1998
CERTIFICATE OF COMPLIANCE
This is to certify that
the Individual Soil Absorption Sewage Disposal System constructed ( ) or repaired ( x )
by-John Soucy, Installer, at 915 Johnson Street, North Andover, MA 01845
has been installed in accordance with Board of Health Regulations as described in the
Design Approval Site System Permit # 1010 dated June 5, 1998.
The issuance of this certificate shall not be construed as a guarantee that the system will
function satisfactory.
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Board of Health
SS/cjp
Revised: 7/20/98
TOWN OF NORTH ANDOVER
SEWAGE DISPOSAL SYSTEM
INSTALLATION CERTIFICATION
The undersigned hereby certify that the,Sewage Disposal System{ )consaucted; { )repaired;
by 12' OU41
was installed in conformance with the Oorth Andover Board of Health approved plan,,System
Design Permit# dated , ,with an.approved design flow of AD
gaAams per day, Ile materials us ere 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, the final grading agrees substantially with the approved plan, All work is
-accurately repro d on the Asw milt which has been submitted to the Board of Health.
Installer: Lic, #: - Date: r7
Design Engin Date' �7
K
No.9162
9 O
1T
FORM U - LOT RELEASE FORM
INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from
Boards and Departments having jurisdiction have been obtained. This does not relieve`
the applicant and/or landowner from compliance with any applicable or requirements.
*****************************APPLICANT FILLS OUT THIS SECTION
APPLICANTS/LAG!} / (� J�( PHONE
LOCATION: Assessor's Map Number PARCEL
SUBDIVISION LOT (S) /-7 tZ_
STREET � �n�` � (>7 ST. NUMBER/
*** *********** *******************OFF 1C IAL USE ONLY***********************************
RECOMMENDATIONS OF TOWN AGENTS:
R�f�Hr.UJ a l
X0/1 S
CONSERVATION ADMINISTRATOR DATE APPROVED
/ DATE REJECTED
COMMENTS
TOWN PLANNER DATE APPROVED
DATE REJECTED
COMMENTS
FOOD INSPECTOR-HEALTH DATE APPROVED
--r DATE REJECTED
SEPTIC INSPECTOR-HEALTH DATE APPROVED
DATE REJECTED
COMMENTS
PUBLIC WORKS - SEWER/WATER CONNECTIONS
DRIVEWAY PERMIT
FIRE DEPARTMENT
RECEIVED BY BUILDING INSPECTOR DATE
Revised 9\97 jm