HomeMy WebLinkAboutAs-Built Plan / Installation Certificate Form - 60 DEER MEADOW ROAD 6/20/2018 (3) r, V,
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PUBLIC HEALTH DEPARTMENT `
Community&Economic development
TOWN OF NORTH
TH NDOVER `
SEPTIC DISPOSAL SYSTEM—INSTALLATION CERTIFICATION
The undersigned hereby certify that the Sewage Disposal System M/Constructed;( )repaired;
By:_ ,_.. e-c 113 f z)
(Print Name)
/A
:Located at:
(Installation Address) --....._.
Was installed in conformance with the North Andover Board of Health approved plan, originally dated
and last revised on ,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.CMR 15.000,'I'itle 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:
Engineer Representative(Signature)
Print Name
Final Can p w.
Construction Inspection Date: T, z k'
Engineer Representative(Signature)
And—Print Name
Installer: � � (Signature) e Date:
And--Print Name
I+angineer: � ' ,rw "" - (Signature) .Date: �-A 114 0 t'
And—Print Name
120 Main Street, North Andover,Massachusetts 01845
Phone 978.+588.9540 Fax 978.688.9542 Web http://wwwr.northandoverma.gov