HomeMy WebLinkAboutAs-Built Plan / Installation Certificate Form - 130 WINDKIST FARM ROAD 6/20/2018 PUBLIC HEALTH DEPARTMENT
(011110unily&Economic Development
TOWN OF NORTII A ND 0 V ER
SEPTIC DISPOSAL SYSTEM-INSTALLATION CERTWICATION
The undersigned hereby certify(list the Sewage Disposal System(,v)Consh-ucted', repaired;
(Print Name)
Located at:130 Windkist Farm Road
(installation Address)
Was installed in conformance with the North Andover Board of Health approved plan,originally dated
6/30/17 and last revised on 4/12/18 with a design flow of
550 gallons per day. The materials used were in conformance with those specified on the
approved plan;the system was installed in accordance with lite provisions of 310,CMR MOO,Title 5 and local
regulations,and the final grading agrees substantially with(fie approved plan.All work is accurately represented on
the As-built which has been submitted to the Board or Health.
Bottom of Bed Inspection
Lengineer Itepresenta
4q! I' 10(gli, tire
And-Print Name
Final Construction Inspection Date:5/15/18
-----------
rn neer Representative(Signature)
Philip Christiansen
And-Print Name
4a 1 7-
Installer: gnature) Date:
9
Dean Dyne
And-Print Name
Kngincer,4je (Signature) Date;617!18
Philip Christiansen-Christiansen and Sergi
And-Print Name
120 Main Street,North Andover,Massachusetts 01845
Phone 978.688.9540 Fax 978.688.9542 Web litili://www.nottliajidaveritio.gov