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HomeMy WebLinkAboutCertificate of Compliance - 268 RALEIGH TAVERN LANE 6/5/1998 MAY ' 2014 NORTH ANDOVER CONSERVATION COMMISSION TOWN OF NORTH ANDOVER BOARD OF HEALTH CERTIFICATE OF COMPLIANCE This is to certify that the individual subsurface disposal system constructed ( ) or repaired (x) by North Andover Licensed Installer Todd Bateson at 268 Raleigh Tavern Lane, North Andover, MA 01845 has been installed in accordance with the provisions of Title V of the State Sanitary Code and with the North Andover Board of Health regulations as described in the Design Approval Site System Permit# 1027 dated June 5, 1998. The Issuance of this certificate shall not be construed as a guarantee that the system will function satisfactorily. Board of Health Inspector E C MAY 2 2 2014 NORTH ANDOVER CONSERVATION COMMISSION TOWN OF NORTH ANDOVER SEWAGE DISPOSAL SYSTEM INSTALLATION CERTIFICATION The u dersigned hereby certify that the Sewage Disposal System( ) constructed; ( repaired; by 1BA 4 -EdAj Zn c . located at C:�6 Y P1A (.�� ✓�� �.��e was installed in conformance with the North Andover Board of Health approved plan, System Design Permit #j o5� dated with an approved design flow of 416 gallons per day. The materia s 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. Bed inspection date: f ( - f (-r ^^AUK Engineer Representative Final inspection date: Engineer Representative Installer: /© 0-yq-1Z3--14-,J Lie.#:JD -90-IDate: W -)j - �7 Design Engineer: DA BU kvr V"d 5 Date: WPA LlMassachusetts Department of Environmental protection DEP File Number: Bureau of Resource Protection - Wetlands Form Request for Certificate of Compliance Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Provided by DEP A. Project Information Important: MAA'Yv 21 0 1�' When filling out -- --- being �y: 1 This request is bei NORTH ANt7(�VEFi q g forms on the �/� computer, use "' I -- QNSERVAMON- MM -SJ - — Name only the tab Marlin Address.. _ �.-, key to move — i — - — -� � - dou not`use the �At L)0--a --_- ��—-------- — f return key. City/Town -W„ �w W State Zip Code w r� w - — - ----------- Q Phone Number 2. This request is in reference to work regulated by a final Order of Conditions issued to: A .C: 'p\_5 Applicant Dated DEP File Number Upon completion The project site is located at: of the work - ant Ordeer afn . t — "..f C .. ,... a t. .. .. tr � _ Street Address City/Town Conditions,the f property owner --- Q must request a Assessors Map/Plat Number Parcel/Lot Number Certificate of 4. The final Order f Conditions was recorded at the Registry of Deeds for: Compliance from the issuing authority that the work or Property�Owner° C f different)portion of the - - - _ -- - -- work has been County Book Page satisfactorily completed. Certificate(if registered land) 5. This request is for certification that(check one): the work regulated by the above-referenced Order of Conditions has been satisfactorily completed. ❑ the following portions of the work regulated by the above-referenced Order of Conditions have been satisfactorily completed (use additional paper if necessary). ❑ the above-referenced Order of Conditions has lapsed and is therefore no longer valid, and the work regulated by it was never started. wpaformBa.doc--rev.7113/04 Page 1 of 2 WPA LlMassachUsetts Department of Environmental Protection DEP File Number: Bureau of Resource Protection - Wetlands Form Request for Certificate of Compliance _ -- Massachusetts Wetlands Protection Act M.C .L. c. 131, §40 Provided by DEP A. Project Information (coat.) 6. Did the Order of Conditions for this project, or the portion of the project subject to this request, contain an approval of any plans stamped by a registered professional engineer, architect, landscape architect, or land surveyor? Yes If yes, attach a written statement by such a professional certifying substantial compliance with the plans and describing what deviation, if any, exists from the plans approved in the Order. ❑ No B. Submittal Requirements Requests for Certificates of Compliance should be directed to the issuing authority that issued the final Order of Conditions (OOC). If the project received an OOC from the Conservation Commission, submit this request to that Commission. If the project was issued a Superseding Order of Conditions or was the subject of an Adjudicatory Hearing Final Decision, submit this request to the appropriate DEP Regional Office (see h1tg:/h6L mass.qQy/deoLIVEggi ur on/findyo .P7trn). wpaform8a.doc••rev.7/13/04 Page 2 of 2