HomeMy WebLinkAboutAs-Built Plan / Installation Certificate Form - 1099 SALEM STREET 1/10/2018 (2) m d �4ir e�r
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PUBLIC HEALTH DEPARTMENT
(ammunilp&t(onomlr Development
TOWN OF NORTH ANDOVER
SEPTIC DISPOSAL SYSTEM--INSTALLATION CERTIFICATION
The undersigned hereby certify that the Sewage Disposal System 00 constructed;( )repaired;
By:
(Print Name)
Located at:1099 Salem Street
(Installation Address)
Was installed in conformance with the North Andover Board of Health approved plan,originally dated
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115/17/7017 and last revised on 07/07/2017 with a design flow of
440 gallons per day. The 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:11/29/2017
Engineer Representative(Signature)
Craig Marchlonda,PE
And--Print Name
Final Construction Inspection Date:01/02/2018
Engineer Representative(Signature)
Craig Marchlonda,PE
And—Print Name
Installer: �?Jt ref` ,;�.� (Signature) Date:
And—Print Name
Engineer:Ll.. (Signature) Date:01/02/2018
Craig Marchlonda,PE
And--Print Name
120 Main Street,North Andover,Massachusetts 01845
Phone 978.688.9540 Fax 978.688.9542 Web http://www.northandoverma.gov
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1/10/2018 Town of North Andover Mail-1099 and 1087 Salem St
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% SER --. .....__ _ Michele Grant<mgrant@northandoverma.gov>
Massachu
n1099 and 1087 Salem St
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Robert loris.<robertinnis@yab=Gom�> �:--'
Tue, Jan 9, 2018 at 6:30 PM
Reply-To: Robert Innis <robertinnis@yahoo.com>
To: Mgrant@northandoverma.gov
To : North Andover Board of Health:
As both the owner and contractor of the above lots, I certify they are properly graded and take responsibility for the final
grades at and near the septic systems of each lot.
Robert Innis
LRC Builders LLC.
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