HomeMy WebLinkAbout- As-Built Plan / Installation Certificate Form - 521 SALEM STREET 2 10/22/2018 p .
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RECEIVED
OCT 17 2018
TOWN OF NORTH ANDOV R
HEALTH DEPARTMENT
PUBLIC WEALTH DEPARTMENT
Community&Economic Development
TOWN OF NORTH ANDOVER
SEPTIC DISPOSAL SYSTEM-INSTALLATION CERTIFICATION
The undersigned hereby certify that the Sewage Disposal System ❑ constructed; ®repaired;
By: James Heider,Heider Building Associates
(Print Name)
Located at: 521 Salem Street
(Installation Address) —
Was installed in conformance with the North Andover Board of Health approved plan,originally dated
July 9,2018 and last revised on n/a with a design flow of
660 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 of310. 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: 9/12/2018
Engineer Representative(Signature)
Will Schkuta EIT
And—Print Name
Final Construction Inspection Date: 9/1.9/2018& 10/l/2018
— .,mom=-
Engineer RepresentatiV6Signature)
Will Schkuta EIT
And—Print Name
Installer: ✓ � (Signature) Date:
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And—Print Name
Engineer: "` (Signature) Date:
John M.Morin PE
— And—Print Name
120 Main Street, North Andover, Massachusetts 01.845 -
Phone 978.688.9540 Fax 978.688.8476 Web http://www.northandoverma.gov