HomeMy WebLinkAboutAs-Built Plan / Installation Certificate Form - 535 SALEM STREET 11/6/2017 PUBLIC HEALTH DEPARTMENT
(ommunity&Economic Development
TOWN OF NO RT11 ANDOVER
SEPTIC DISPOSAL SYSTEM—INSTALLATION CERTIFICATION
The undersigned lie eby ce:rt'fthat Sewage Disposal System GA constructed; repaired;
,By:_
(print Name)
T.,ocated at: 3J�l J-7
5 ("t'
(Installation Address)
Was installed in conformance with the North Andover Bard of Health approved plan, originally dated
lband last revised on with a design flow of
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.
Date:Bottom of Bed Inspection D, ......................
Engineer R re4//11t (Signature)
el
And--Print Name
Final Construction Inspection Date:
Engineer ep ntative(Signature)
Engineer
.............
And—Print Name
Installer:- ,, Date:—../-,-
And—Pidnt Name
Ei ngineer: Date:
(,Signature)
A
JITIZII
And Print Name
..........
120 Main Street, North Andover, Massachusetts 01845
Phone 978.688.9540 Fax 978.688.9542 Web http://www.northandoverma.gov