HomeMy WebLinkAboutCertificate of Compliance - 114 STONECLEAVE ROAD 10/6/2010 tAORT11
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� VO4'greo Pea�y,�9
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PUBLIC HEALTH DEPARTMENT
Community Development Division
C TI�I ./ T �' Aj CE rV
As of:
etober 6, 2010
This is to certify that the individuaCsu6sur.face d�sposafsystem received a
SATISTACToRTIMTECTIOXof the:
Tuff ftair1ft&cement Of an
On-Site Sewage osa[Syste
�y�
ToddBateson'
At:
Stonecfeave Wo
Wap-1 arre -13 8
er 9WA 01845
The Issuance of this certificate shall not 6e construed as a guarantee that the system will
function satisfactorily.
/ --
us n Sawyer E�fS/
P u C'c Aealt�lnirector
1600 Osgood Street,North Andover,Massachusetts 01845
Phone 978.688.9540 Fax 918.688.8476 Web www.townofnorthandover.com
TOWN OF NORTH ANDOVER RT11
Office ofCO'*Dv1UNITV DEVELOPMENT AND SERVICES
HEALTH DEPARTMENT
4M OSGOOD STREET °
NORTH ,1NDOVER, ;'vIASSACHUSETTS 01845 �"s3 CHUS�ga
978.688.9540—Phone
Susan Y.Sawyer, REHS/RS 978.688.8476—FAX
Public Health Director E-MAIL: hcaltlideoti,atownofnortlhandover.com
W EBSI T'E:http:',www.townofiiorthandover,com
TOWN OF NORTH ANDOVER
SEPTIC DISPOSAL SYSTEM ® INSTALLATION CERTIFICA'T"ION
The undersigned� e hereby that
the,7
Sewage Disposal System constructed; repaired;
by
(Print Name)
located at pq ( llatian" p t c )
.a �,.
Insta Address
was installed in conformance with the North Andover Board of Health approved plan, originally
dated and last Revised on , with a design flow of
gallons per day. The materials 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:
Engineer RepresentatTGe(Signature)
I
And- Peint Name Pea µ"
r
Final inspection date:
Engi
Weer Represep ive(Signature)J",And- Prinf Name
a
g,
Instal ler: ,n (Signature) Dater _
�yyyI p)
And- Print Name
Engineer: . �.. (Signature) Date ^ � )
9 ! d-
And-Print Name