HomeMy WebLinkAboutAs-Built Plan / Installation Certificate Form - 31 JAY ROAD 8/30/2017 ,r;%/ /fir,,, •
RECEIVED
TOWN OF UII—H ANDOVM
I 1EAL111DE rel 1 MEET
PUBLIC HEALTH DEPARTMENT
(oniniunity R Imioitdc Develoluneo
TOWN OF NORTH ANDOVER
SEPTIC DISPOSAL SYSTEM--INSTALLATION CERTIFICATION
The undersigned hereby certify that the Sewage Disposal System(x )constructed;( )repaired,
By:_...___ )044°s 10 we 0 W _...w.._._.
(Print Name)
Located at: 31 Jay Rd. North.Andover,MA For Suzanne White
(Installation Address)
Was installed in conformance with the North Andover Board of Health approved plan, originally dated:
July 8,2014 and last revised on October 7,2016,with a design flow of—550 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 L-Iealth.
Bottom of Sed Inspection Date: Sept.21,2016
Engineer Representative(Signature)
Douglas J. Smith
And—Paint Name
pSept
Final Construction Inspection Date: Se t 23,2016
Engineer;Representative(Signature)
Douglas J Smith
And--Print Name
,.. ...... �
Installer: ._ (Signature) Date:— �2 / / A
i
� - And—Print Name
Engineer: 01r.1 'off( ignature) Date:12/14/2016
Douglas J. Smith
And_ Print Name
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120 Main Street, North n er, Massachusetts 01845
Phone 978.688.9540 Fax 978.688.9542 Web htti)://www.nor,thandoverina.gov