HomeMy WebLinkAboutInstallation Certifi - As-Built Plan / Installation Certificate Form - 137 FOREST STREET 8/14/2019 Ym.
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PUBLIC HEALTH DEPARTMENT
(ommunity&Economic Development
TOWN OF NORTH ANDOVER
SEPTIC DISPOSAL SYSTEM—INSTALLATION CERTIFICATION
The undersigned hereby certify that the Sewage Disposal System constructed;( repaired;
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(Print Name)
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Located at:
(Installation Address)
Was installed in conformance with the North Andover Board of Health approved plan,originally dated
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t with a design flow of
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I � 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: Z j J- , f
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Enginyer Re ative(Signature)
And—Print Name )
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Final Construction Inspection Date: ) 1
Engines Wntal
ive(Signature)
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And—Print Name
Installer• lw� G (Signature) Date:,(-f -1 —
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Engineer: (Signature) Date:
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And—Print Name
120 Main Street, North Andover,Massachusetts 01845
Phone 978.688.9540 Fax 978.688.9542 Web http://www.northandoverma.gov