HomeMy WebLinkAboutInstallation Certification - 4.8.2002 - As-Built Plan / Installation Certificate Form - 0 BRADFORD STREET 8/13/2019 F
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TOWN OF NORTH ANDOVER SEWAGE DISPOSAL SYSTEM
INSTALLATION CERTIFICATION
The undersigned hereby certify that the Sewage Disposal System( ) constructed;
(repaired;
by
located at —Z �-d
was installed in conformance with the North Andover Board of Health approved plan,
System Design Permit # , dated with an approved design
flow of 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.
Bed inspection date:
Engineer Representative
Final inspection date:
Engineer Representative
Installer: i _ Lic.#°n FL Date: 0
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Design Engineer: Date:
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TOW14OF N 0 h
BOARD OF
`MAY-
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TOWN OF NOR,'rH ANDOV R SEA AGE DISPOSAL SI STENI
i\STALLA-rioi`t CERTIFI(:ATION
The uncer sivned here: certiiv that the _S ewa2e Disposal System C. ! cor:su,ictcd;
(X) re^^aiirz�d: J
b.— :a U on curse
located at 2-7 a&Q FoiL,?_ 5,r&e 7 _-----
was installed in coniermance with the I,o th Andover Board of He-a ith approved plan,
Svstem Desium Pec:rit = dated _. :pith an accroved desi-n
tlow of gallons per day The mate a:s usec were in conlormarce %%,ith those
specined oh the approved plan; the system was installed in accordance ,,pith the previsions
of 310 CMR 15.000, Title 5 and local reL-ilations, and the final Qradipg agrees
substantially Vvith the approved plan. .-ail work; is accurateiv represented ;)r. the As-built
.which has been submitted to the Board e:`iealth.
Bed inspection date: —
.�__.
Engineer R �rese :drive
Final inspect:on care C� _ _ _D
E-nCiretr Represz-aat::e
Installer: L.c T. Date:
Desi<Tn Engineer: C '/ _ Date: /�Z_ _
RICHARD tiG�
C.
TANGARD y
fss�ONAL ��6