HomeMy WebLinkAbout- As-Built Plan / Installation Certificate Form - 312 BOXFORD STREET 10/22/2018 /r0!
.A RECEIVED
2 2 7,018
TOWN 0R NORTH ANDOVER
HEALTH DEPARTMENT
PUBLIC HEALTH KPAUT CST
tan�rraur0iy t�Qtllpl'I'Ift De+rulaeam�n9
TOWN OF NORTH ANDOV E It
SEPTIC DISPOSAL SYSTEM--INSTALLATION CERTIFICATION
The undersigned hereby certify that the Sewage Disposal System(X)constructed;( )repaired;
--
(Print Name)
Located at; 312 Boxford Street
(Installation Address)
Was installed in conformance with the North Andover Board of Health approved plan,originally dated
6/26/1 f3 _... and last revised on 7/23/18 ----- _>with a design flow of
__..._gallons per day. 'fine materials used were in conformance with those specified on the
approved plan; the system was histalled in accordance with the provisions of 310.CMR 15.000,Title 5 and local
regulations,and(lie 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 I-Icalth.
f
Bottom of Bed Inspection Datr 10-9 2018
Engincer Re -eser t4AVC(Signature)
n
John D. Sullivan /
ay
And --Print Name "
Final Construction inspection Date: 10-17-2018 ���
Ellginceozel wC11tative(Signature)
John D. Sullivan
And Print Name
irnstaller : _ (Siguature) Date:
And --Print Name
Enghieer: (Signature) Date: 10-18-2018
. John D Sullivan III, PE
And--Print Name
1 0^Main Street, North Andover, Massachusetts 01045
Phone 978.68 .9540 Fax 978. 00.9 4 Web littp://www.tiortliatidovernia.gov