HomeMy WebLinkAboutInstallation Certification - As-Built Plan / Installation Certificate Form - 1975 SALEM STREET 8/31/2020 Fz
PUBLIC HEALTH DEPARTMENT
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TOWN OF NORTH ANDOVER
SEPTIC DISPOSAL SYSTEM—INSTALLATION CERTIFICATION
The undersigned hereby certify that the Sewage Disposal System(constructed;( )repaired;
By:Dave Maynard
(Print Name)
Located at: Lot 3 Salem Street
(Installation Address)
Was installed in conformance with the North Andover Board of Health approved plan,originally dated
12/22/17 and last revised on 10/3/18
with a design flow of
550 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.
Bottom of Bed Inspection Date: 11/9/18 G�7�
gineer Representative(Signature)
James Melvin, P.E.
And—Print Name
Final Construction Inspection Date: 11/29/18
gineer Representative(Signature)
James Melvin, P.E.
And—Print Name
Install (Signature) Date
And—Print Name
Engineer:_ (, (Signature) Date:
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And—Print Name
120 Main Street,North Andover,Mauathuse is 41845
Phone 9.78.6188.9540 Fax '978.688.9S42 Web h11fr4 it aarlh=d*verma..gav