HomeMy WebLinkAboutAs-Built Plan / Installation Certificate Form - 140 BRADFORD STREET 11/20/2017 (2) RECEIVED
�,JOV 14 7017
x TC)1 N OF NORTH ANDOVER
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PUBLIC IIEALT14 DEPAR'MIEUT
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TOWN OF NOW111 ANDOVE11
810)'11C I)NSlUSAL S Yea`['1i,M—INS'1'At.,1.,NUON C°I.,lt'11 CC.IA"FION
The undersigned I1creby certify 111111 the Sewage Disposal System( )constructed;( )repaired,
By Peter Breen
(Print Namc)
1
Located at 140 Bradford Street
(Installation Address)
Was installed in cola!"oranancc with Ihc'North Andover Board off-lealth approved plan,originally dated
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_81.11.1.7.._ _, _ ..._..__.._.and last revised oil 8/23/1.7 with a design flow or
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gallons per da The aaaterials used were in Collroramnce with those specified on the 1
.330_......._.�.. ...�...M.._ ' ' Y' �� i
approved plan;the sysicm was installed in accordance with 111c provisions or310,cmc 15.000,"I'itle 5 and local
regulations,and(lie final grading agrees substantially with(lie approved plan.All work,is accurately represcntcd on
tire As-built whicl►has been submitted to tire Board or I lcalth.
Bottom of Lied Inspection Dritc:.
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Ali([—Print Name
Final.Construction Inspection Date:
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And Print Name
Installer: ' .. _ (Sighs►lure) Date:
And—Print Name
Engines » (Signature) Date: /"14 /
..............�________ Phil Christiansen,P.E.
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And—Print Name
120 tVMoin Street,North Andover,Massachusetts 0,1845
Phone 978.688.9540 Fox 978.688.9S42 Web httpi//www.tforthundovet.gow