HomeMy WebLinkAboutinstallation certification - As-Built Plan / Installation Certificate Form - 37 WELLINGTON WAY 6/27/2017 0 �g • Sy.�irrn,ey� . I
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PUBLIC HEALTH DEPARTMENT
Community&honemic Developmeni
TOWN OF NORTH ANDOVER
SEPTIC DISPOSAL SYSTEM—INSTALLATION CERTIFICATION
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The undersigned hereby,certify that the Sewage Disposal System( )constructed;( )repaired; j
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By:Dave Maynard
(Print Name)
Located at:37 Wellington Way(Lot 6 Wellington Woods)
(Installation Address) j
Was installed in conformance with the North Andover Board of Health approved plan,originally dated i
1/8/16 and last revised on 12/22/16 with a design flow of
440 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,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.
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Bottom of Bed Inspection Date:
Engineer Representative(Signature)
And—Print Name
Final Construction Inspection Date: 6/1 6/1 t
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E neer Representative(Signature)
And—Print Name
Installer: (Signature) Date: U7
An —Print Name
Engineer: Signature) Date:
Phil Christiansen, P.E.
And—Print Name
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120 Main Street, North Andover,Massachusetts 01845
Phone 978.688.9540 Fax 978.688.9542 Web http://www.northan'doverma.gov
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