HomeMy WebLinkAboutInstallation Certification - As-Built Plan / Installation Certificate Form - 1499 SALEM STREET 8/11/2021 • RECEI��D
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PUBLIC HEALTH DEPARTMENT
Community&Economic Development
TOWN OF NORTH ANDOVER
SEPTIC DISPOSAL SYSTEM—INSTALLATION CERTIFICATION
The undersigned hereby certify that the Sewage Disposal System(x)constructed;( )repaired;
By. Peter M.Blaisdell,Jr.,P.E.,P.L.S.
(Print Name)
Located at: 1499 Salem Street
(Installation Address)
Was installed in conformance with the North Andover Board of Health approved plan,originally dated
May 14,2021 and last revised on June 1,2021 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.
Bottom of Bed Inspection Date: Jul} 15,2021
Engineer Representative(Signature)
Peter M.Blaisdell,Jr.,P.E..P.L.S.signing for Thor Akerley
And-Print Name
July 19,2021
Final Construction Inspection Date:
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(Note:July 26,2021 As Built Sun ey performed)
Engineer Representative(Signature)
Peter M.Blaisdell,Jr.,P.E.,P.L.S.
And-Print Name
Installer: a�'7 .1—ature) Date: " �'- Z
And-Print Name
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Engineer: ocs (Signature) Date: August 3,2021
Peter M.Blaisdell,Jr..P.E.,P.L.S.
And-Print Name
120 Main Street, North Andover, Massachusetts 01845
Phone 978.688.9540 fax 978.688.9542 Web http://www.northandoverma.gov