HomeMy WebLinkAboutAs-Built Plan / Installation Certificate Form - 42 FOSTER STREET 10/30/2017 r rn
•
RECEIVED
0 CT 2 } 7 0 17
TOWN F NORTH ANDOVER
14EALTH DEpARTMENT
PUBLIC HEALTH DEPARTMENT
Comnronnity&Economic Development
TOWN Or NORTH ANDOVER
m.PTIC DISPOSAL SYSTEM—INSTALLATION CERTIFICATION
The undersigned hereby certify that the Sewage Disposal System( )constructed;( )repaired;
By:Todd Bateson
(Print Name)
L.ocated at:42 Foster Street
(Installation Address)
Was installed in conformance with the North Andover Board of Health approved plan,originally dated
and last revised on 7/21/17 with a design flow of
p 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 of310.CMR 15.000,Title S 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 ofHealth.
Bottom of Bed Inspection Date: 10/10/17
,n ineer Representative(Signature)
James Melvin, P.E.
And—Print Name
Final COIISfI'netion Inspection Date: 10/17/17
igineer Representative(Signature)
James Melvin, P.E.
And—Print Name
Installer: t� (Signature) Date: r
--- r)
. � � . a __.....�....._ And—Print Name
Engineer - v(:► natare) Date: f r
Phil Christiansen, P.E.
And- Print Nance
T-- _ — 120 Main Street, Norte Andover,Massachusetts 01845
Phone 978.688.9540 Fox 978.688.9542 Web http://www.northantlovernta.gov