HomeMy WebLinkAboutInstallation Certification - As-Built Plan / Installation Certificate Form - 288 STILES STREET 12/7/2020 PUBLIC HEALTH PiJP4 tTMW*
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;!�gPTIC DISPOSAL CC,RTMC—ATIOZ4
T ie urtcl i d1dreb c.. ._ P Y cexti£y!That the Sewag bpQSaf:Syteir�( } ostructed,:;( ) epatred,
g JamesBoraczek.
(Pruit Naiine)
.Lo at;:28B Stiles.Street, .
(Installation Address):
Was itistalIed in,cvnfbrmance w tli'tl#e NoiM AhdOVe BoaW dfrHealtI..approved'ptan arigi pally.dated;
4une;28 20"19 and last revised on jOY-2,2026 -;i�r#1 a.design flow-6f
30 galIons per day. The materials.used line in conforinance_with:tHose-specified oil"the
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approved plan;,the syste&:vias.Wtalled iu accordance With the grovisions:of310',CIMH IS:QQD,Title 5,agd local
regulations;-aiid.thefiinal grading agrees substantially with the approved plan.All woik is.:accuidtely rep&tented bfi
the As built,which bas-been submitted f6 the.Board of Health.:
7
Bottom of e:Bed,Inspectiou'Dat �.
Engineer presentative. Signature)
BenjdMIh C. Osgood,Jr_,
And--print Name
'146At(instruction Ins _ecijon,Date..91221202t}'
Rrigineer Regresertfafiv agnature)
Benjamirl-C..Osgood,.Jr ;
Arid--',1?riit 11ame.
;Installer:
Engineer: (S9gitetu Xe}° Date:
And.-PfidNaine
- 20 Main--'Sire tE for h Andovdr Mqs achvsOft 01845
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