HomeMy WebLinkAboutMiscellaneous - 45 WELLINGTON WAY 10/18/2017 (3) J
PUBLIC HEALTH DEPARTMENT
Contrnunity&Econoaric Developnrenl
WN OF NORTH ANDOVER
SEPTIC DISPOSAL SYSTEM--INSTALLA'T'ION CERTIFICATION
The undersigned hereby certify that the Sewage Disposal System( }constructed;( )repaired;
s
By:Dave Maynard
(Print Name)
Located at:45 Wellinrgtan Way(Lot 5 Wellington Woods)
— (Installation Address)
Was installed in conformance with the North Andover Board of Health approved plan,originally dated
2119/16 _ _ _and last revised on 3/24/17 _._. with a design flow of
_-_ g f I
-44G.--,.................__— gallons per day. The materials used were in conformance with those specified oil the
approved plan;the system was installed in accordance with the provisions of310.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. /
Bottom of Bed Inspection Date:9/11/17
Ln eer Representative(Signature)
Pfil Christiansen, P.E.
And—Print Name
Final Construction Inspection Date:_9/19/17
rrt 'Zcer Ti resentative(Signature)
t
f
Phil Christiansen, P.E.
And-Print Name
K 1
Installer: (Signature) Date:
And—Print Name
Engincers 4 ' mature) Date: fp' / //7
� f i
Phil Christiansen, P.E. f
And-Print Name
120 Main Street, North Andover, Massachusetts 01845
Phone 978,688,9540 Fax 978.688.9542 Welt Irttp://www.iiorthandoverma.gov j
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PUBLIC HEALTH DEPARTMENT
Community&Economic Development
TOWN OF NORTH ANDOVER
SEPTIC" DISPOSAL SYSTEM—INSTALLATION CERTIFICATION
The undersigned hereby certify that the Sewage Disposal System(constructed;( )repaired;
By: °,'-'_ _.__- �' `-' `<'
tot Name)
Located at: +! kii
�ddresss
Was installed in confortnance with the North Andover Board of Health approved plan, originally dated
and last revised on '� f': 201 ,with a design flow of
_....__._ _.�gallons per day. 'I"he 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.
Bo'ttOTTI of Bed Inspection Date:_ ..
Engineer Representative(Signature)
And—Print Name
Final Construction Inspection Date:
Engineer Representative(Signature)
Arid Print Name
InstallerG (Si
gnatut e) Date
,r
And Print Name
Engineer: (Signature) Date:
i
And—Print Nance
120 Main Street, North Andover, Massachusetts 01845
Phone 978.688.9540 Fax 978.688.9542 Web http://www.northandoverma.gov