HomeMy WebLinkAboutAs-Built Plan / Installation Certificate Form - 25 WELLINGTON WAY 11/21/2017 (2) �
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PUBLIC HEALTH DEPARTMENT
(ommiunifyxkonmwkuyvlopmon|
TOWN OF NORTH ANDOVER
SEPTIC DISPOSAL SYSTEM—INSTALLATION CERTIFICATION
The undersigned hereby certify that the Sewage Disposal System( )uunxh'oo\od;( )repaired;
By:_RvnK4a rd
(Print Name)
Located at:25Wellington Way(Lot 7 Wellington Woods)
(installation Address)
Was installed in confbi-niance with tile North Andover Board of Health approved plan,originally(fated
and Iasi revised oil 8/17/2017 with odesign flow or
gallons per doy. The materials used were iuconformance with those specified onthe
approved plan;the system was installed iunuco,Juooe with the provisions o[3\0.CMR l5.000,Title 5and local
regulations,and tile final grading agrees substantially with (fie approved plan.All work|saccurately represented on
the As-built which has been aubuoiVndmthe Board ofRoa)(
Bottom oKBedInspection Dmtc—q,
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Engineer Representative(Si8uxtn,c)
Pfi| ChrimUanaon PE
And—print Name
Final Coil mt,nodm1 Iowoxcdou Date:
f,,Ilgine�r,�ii'�p't-eseiitative(Signature)
Phil Christiansen, P.E.
And—Print Name
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Installici Date:
And—Print Name �
Eogixcm |goabxo) Date: �p
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Phil Christiansen, P .E.
And—Print Name
120 Main Street, North Andover,Massachusetts 01845
Phone 978.680.9540 Fox 978.688.9542 Web http,8w/ww.nnrthmndovarmm.gmv