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PUBLIC HEALTH DEPARTMENT
Community&Economic Development
TOWN OF NORTH ANDOVER
.SEPTIC DISPOSAL SYSTEM—INSTALLATION 7toATIFICATION
The undersigned hereby certify that the Sewage Disposal System( nstrucd;( )repaired;
(Print Nam /
Located at: r*/ O '/ y'"'� ../"1 A
(Installation Address)
Was installed in conformance with the North Andover Board of Health approved plan,originally dated
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+ and last revised on .� �" ' � ^• ,with a design flow of
QQ 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.
Bottom of Bed Inspection Date: Al. , "201'
Engineer Representative(Signature)
And—Print Name "
Final Construction Inspection Date: le �� �C` " a'z ..�� .
Engineer Representative( gnature)
And—Print Name
Installer. '�''' (Signature) Date:
And_Print Name
Engineer: (Signature) Date: --
And—Print Name
120 Main Street,North Andover,Massachusetts 01845
Phone 978.688.9540 Fax 978.688.9542 Web http://www.northandoverina.gov t f
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