HomeMy WebLinkAboutAs-Built Plan / Installation Certificate Form - 1099 SALEM STREET 1/30/2018 A
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PUBLIC HEALTH DEPARTMENT
(ommunily 6lronamic Deralopment
TOWN OF NORTH ANDOVER
SEPTIC DISPOSAL SYSTEM--INSTALLATION CERTIFICATION
The undersigned hereby certify that the Sewage Disposal System 00 constructed;( )repaired;
BY j� �lt ?.► �ti r s
(Print Name)
Located at:1087 Salem Street
(Installation Address)
Was installed in conformance with the North Andover Board of Health approved plan,originally dated
05/1712Q17 and last revised on 07/17/2017 with a design flow of
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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:11/01/2017 C..�
Engineer Representative(Signature)
Craig Marchlonda,PE
And—Print Name
Final Construction Inspection Date:01/02/2018
Engineer Representative(Signature)
Cra12 Marchionda,PE
And—Print Name
Installer: ', 'Y, � (Signature) p Date: Am /b
And_Print Name �
Engineer: .. (Signature) Date:01/02/2018
Craig Marchionda,PE
And—Print Name
120 Main Street,North Andover,Massachusetts 01845
Phone 978.688.9540 Fax 978.688»9542 Web hitp://www.northandoverma.gov
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