HomeMy WebLinkAbout- Certificate of Compliance - 2 BANNAN DRIVE 2/7/2019 • Ott �
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PUBLIC IC HEALTH [ SPAR rM CANT
Town of North Andover
Community and Economic Development Division
CERTIFICATE OF
COMPLIANCE
As cif® February 6, 2019
This is to certify that the individual subsurface disposal system received a
SATISFACTORY INSPECTION of the:
Construct a new on-site Sewage DisposalSystem.
By: James Kellett
At: 2 'Bannan Drive
Map 38 Lot 1.04
North Andover, MA 01.845
The Issace of this ti 'hot be construed as a guarantee that the system will function satisfactorily.
ce ficte shall''
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Br' n La 'irasse,
Yrector of Public Health
i
120 Main St.,North Andover,Massachusetts 01845
Phone 978.688.9540 Fax 978.688.9542 Wei) www.northandoverma.gov
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Commonwealth of Massachusetts _Ae)
City/Town of North Andover 1
Certificate of Compliance
0 Form 3
DEP has provided this form for use by local Boards of Health. Other forms may be used, but the
information must be substantially the same as that provided here. Before using this form, check with
the local Board of Health to determine the form they use.
This is to Certify that the following work on an On-Site Sewage Disposal System
Important:When
filling out forms ❑ Construction of a new system
on the computer, ® Repair or replacement of an existing system
use only the tab ❑ Repair or replacement of an existing system component
key to move your
cursor-do not
use the return Has been done in accordance with Title 5 and the Disposal System Construction Permit(DSCP):
key.
r DSCP Number DSCP Date
Michael s wosito
Facility Owner
2 Bannan Drive
Street Address or Lot#
North Andover MA........._ — 01845
City/Town State Zip Code
Designer Information:
Gregory J. Hochmuth Williams & Sparages LLC
Name Name of Company
Signature Date
Installer Information:
Jim Kellett Kellett Excavation LLC
Name Name of Company
Signature Date
Use of this system is conditioned on compliance with the provisions set forth below:
The issuance of this certificate shall not be construed as a guarantee that the system will function as
designed.
Approv .... _ rity
Signaturegt
Date
t5form3.doc•06/03 Certificate of Compliance-Page 1 of 1