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Title 5INNOVATIVE/ALTERNATIVE SOIL ABSORPTION SYSTEM (SAS)
DESIGNER 8^OWNER CERTIFICATION
|naccordance with the Standard Conditions for Alternative So8AbsoopdonSystem with General Use
Certification andlor Approval for Remedial Use, modifed June 12, 2015, 1,
Designer name(Printed)
hereby certify tothe Local Approving Authority(LAA)the following:
* i have provided to the property owner copies of the Infiltrator Systems, Inc. approval and the
current Infiltrator Systems, Inc. Septic System Owner's Manual for the State of Massachusetts;
and
the system isdesigned i rdan with the Approval, any Company Design Guidance, and
310 CMR 15.00,
Signed: ��������N������
ueunoe/�V oam/e RECEIVED
,
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TODesigner's narne(Printed)
WN OF OFNDRTHANDOVER
HEALTH DEPARTMENT
Property Owner's name(Printed)
|,
hereby certify tothe Local Approving Authority(LAA)the following:
a I have been given copies of the Infiltrator Systems, Inc. approval and the current Infiltrator
Systems, Inc, 8epticGystem Owner's Manual for the State of Massachusetts; and
w the installer is locally certified.
w the design does riot provide for the use of garbage grinders, and this restriction is understood
and accepted.
* | understand the requirement to repair, replace, modify ortake action as required by the
Department or the LAA, if the Department or LAA determines the System to be failing to protect
finedin31OCK4R15305.
Signed:
ty c
Ir erty
.
Property Owner's name(Printed)
Property Address:
Enter property address
Enter town name
Date: , RECEIVED
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