HomeMy WebLinkAboutAs-Built Plan / Installation Certificate Form - 127 VEST WAY 11/22/2017 (2) � • � RECEIVED
wiwuuwn-
TOWN OF NORTH ANDOVEER,
HEALDi DEPARTMENT
i
PUBLIC HEALTH DEPARTMENT
Community&Economic Development
TOWN OF NORTH ANDOVER
SEPTIC DISPOSAL, SYSTEM—INSTALLATION CERTIFICA'IJON
The undersigned hereby certify that the Sewage Disposal System( )constructed;( )repaired;
(Print Name)
Located at:—Z._ _
(Installation Address)
Was installed in conformance with the North Andover Board of Health approved plan,originally dated
and last revised on -!:�14 �,tit 6' ,with a design flow of
gallons per day. The materials used were in conformance with those specified on the
approved plan;the system was uestalled 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:_._67 `� l
Engine z' epres ative(Signature)
c "
And—Print Name --
I+ina)Construction Inspection Date:_
Engineer reser ' e(Signature)
tw,.., � ✓ C'r
And—Print Name
Installer: —: 04ov% `�G.c, J.fI l (Signature) Date:_(
And—Print Name
t+ngineer:_ (Signature) Date: k t cl %
And—Print Name
120 Main Street, North Andover, Massachusetts 01845
Phone 978.688.9540 Fax 978.688.9542 Web http://www.northandovernia.gov