HomeMy WebLinkAboutTitle V Inspection Report - 20 BRIDGES LANE 11/6/1997 Form No.4
Town of North Andover, Massachusetts
BOARD OF HEALTH
November 6 19 97
CERTIFICATE OF COMPLIANCE
This is to certify that
the Individual Soil Absorption Sewage Disposal System constructed ( ) or repaired (X )
D— Box Only
by John Soucy
INSTALLER
at 20 Bridges Lane
SITE LOCATION
has been installed in accordance with Board of Health Regulations as described in the Design
Approval Site System Permit No NSA dated 19 .
The issuance of this certificate shall not be construed as a guarantee that the system will
function satisfactorily.
BOARD OF HEALTH
Town of North Andover, Massachusetts Form No. a
BOARD OF HEALTH
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DISPOSAL WORKS CONSTRUCTION PERMIT
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Applicant AME ADDRESS TELEPHONE
Site Location
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Permission is hereby granted to Construct ( ) or Repair Individual Soil Absorption
Sewage Disposal System as shown on the Design Approval S.S. No.
CHAIRMAN, BOARD OF HEALTH
Fee D.W.C. No. 9�
APPLICATION FOR DISPOSAL WORKS CONSTRUCTION PERMIT
DATE: k) ,'�'``` )z'I/� CURRENT INSTALLER'S LICENSE#
LOCATION:
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LICENSED INSTALL,,,
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SIGNATURE: P[ON:E#
CHECK ONE:
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EPAI>E�:� ,, ° NEW CO STRUCTION:
IF NEW CONSTRUCTION, PLEASE ATTACH FOUNDATION AS-BUILT.
Administrative Use Only
$75.00 Fee Attached? Yes No
Foundation As-built? Yes No
Floor plans on file? Yes No
Approval Date: IdZ
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