HomeMy WebLinkAboutAs-Built Plan / Installation Certificate Form - 62 FARNUM STREET 11/28/2017 (2) e ^
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PUBLIC HEALTH DEPARTMENT
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tomniunily&Rononric pevelolinienl f
TOWN OF NORTH ANDOVER
SEPTIC DISPOSAL SYSTEM--INSTALLATION CERTIFICATION
The undersigned hereby certify that the Sewage Disposal System( )constructed;(' )repaired;
By _..... ..... ._. -...___ . --._._____.........
(Print Name)
Located at:02 Farnum Street
(Installation Address)
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Was installed in conformance with the North Andover Board of Health approved flan,originally dated.
S.eptemher 28,2017_.....and last revised on October 10, 2017 with a design flow of
gallons per day. 'Che 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.
Bottom of Bed Inspection Date:Nov. 172.2017 -,Y �r. e�QW.-, _, -""
� - — Engineer Represen ti've(Signatur-e)
Gordon Rogerson
And Print Name
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Final Construction Inspection Date;Nov. 27, 2017
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Engineer Representativ • ^gnature) 1
Gordon Rogerson
And-Print Name
ustaller^: (Signature)
And-Print Name
r N�neer^: __(Signatin^e) Date: Nov. 27, 2017
NO, 71i I Peter J. O ren RE,
And- Print Name
124 Mails Street, North ,Andover, Massachusetts 01845
Phone 978.688,9540 Fax 978.688.9542 Web http://www.northandoverma.gov