HomeMy WebLinkAbout- As-Built Plan / Installation Certificate Form - 1015 FOREST STREET 2/13/2019 •
40) 4
� r
PUULIC HEALTH DEPARTMENT
(ornirrunliy&Economic Develolrrnerri
TOWN O NOIVfII ANIDOVEIt
SEPTIC DISPOSAL SYSTEM—INSTALLATION CERTIFICATION
The undersigned hereby certify that the Sewage Disposal System( )constructed;( )repaired;
By: Jim Kellett
(Print Narne-)
Located at: 1015 Forest Street, North Andover
(Installation Address)
Was installed in conformance with the North Andover Board of Health approved plan,originally dated
12/11/201$ _ and last revised on n/a with a design flow of
Ire materials used were in conformance with those s ecified orr the
. ....._ .... . .__..—._.___._._gallons per clay, I p
approved plan; the system was installed in accordance with the provisions of 310. C',MR'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: 1-25-2019
En er I eserrtartive(Signature)
John D. Sullivan III, PE
And—Print Name
Final Construction Inspection Date: 2-8-2019
I ngh sentative(Signature)
John D. Sullivan III, PE
And—Print Name
Installer v � r (Signature) Date:_
And—Print Name
Engineer: __(Signature) Date: 2-8-2019
John D. Sullivan III, PE
And--Print Name
120 Main Streot, North Andover, Massachusetts 01845
hono 978.688.9540 Fox 978.688.9542 Web littp://www.nortliandovert,via.gov