HomeMy WebLinkAboutAs-Built Plan / Installation Certificate Form - 800 JOHNSON STREET 5/21/2018 e -
° � e
PUBLIC HEALTH DEPARTMENT
(wimunily&Eceueuric Uevelepineui
TOWN OF NORTH ANDOVER
SEPTIC DISPOSAL SYSTEM—INSTALLATION CERTIFICATION
'I'he undersigned hereby certify that the Sewage Disposal System 1 constructed;( )repaired;
By; -Tim Quinlan
(Print Name)
Located at: 800 Johnson Street
_.......,..._____.._...___ .___-_.......
.-._....._.....__
(Installation Address)
Was installed in conformance with the North Andover Board of Health approved plan, originally dated
June 21, 2017 and last revised on May 1, 2018µ ,with a design flow of
m_
440 ___.-..._......_..___gallons per day. 'rhe 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. wol'k ks accurately represented on
the As-built which has been submitted to the Board of l-Iealth.
Bottown of Bed Inspection Date:„May 4, 2018
I'jngiN��6�•12 pre ove(Signature)John D. Sullivan kll, PE
And—Print Name
Final Construction ]inspection Date: May 9, 2018.
Cngir v er R�a�i es ive(Signature)
John D. Sullivan III, PE
And—Print Name
Installer: (Signature) Date:
And---Print Name
Engineer: (Signature) Date: 5/16118
John D. Sullivan III, PE
And—--Print Name
120 Thain Street, North Andover, Massachusetts 01845
]hone 978.688.9540 Fax 978.688.9542 Web http://www.northandovernia.gov
PUBLIC HEALTH DEPARTMENT
Community&Economic Development
TOWN OF NORTH ANDOVER
SEPTIC DISPOSAL SYSTEM—INSTALLATION CERTIFICATION
The undersigned hereby certify that the Sewage Disposal System(4
constructed} repaired;
By: Apt 0 zH
.11r` ------- -_ _.._..
(I-Irint Name)
Located at: 6,00 C)W&)5
(Installation Address)
Was installed in conformance with the North Andover Board of 1-health approved plan, originally dated
and last revised on fyj J) Z 0 1 c with a design flow of
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. C3MR. 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 11calth.
Bottom of Bed Inspection Date:
Engineer Representative(Signature)
And---Print Name
Final Construction Inspection Date:.___
Engineer Representative(Signature)
................-
And-Print Name
(Signature) Date:
64
1
Irv%
Installer
And-Print Name
Engineer: Date-
-------—------ —-----
And--Print Name
---------- ------------------------
120 Main Street North Andover, Massachusetts 01845
Phone 978.688.9540 Fax 978.688.9542 Web http://www.northandoverma.gov