HomeMy WebLinkAboutSigned Installation Certification - As-Built Plan / Installation Certificate Form - 562 BOXFORD STREET 11/15/2021 dim ♦ ���nA1
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PUBLIC HEALTH DEPARTMENT
(ommunily&Economic Development
TOWN OF NORTH ANDOVER
SEPTIC DISPOSAL SYSTEM—INSTALLATION CERTIFICATION
The undersigned hereby certify that the Sewage Disposal System(g)constructed;( )repaired;
By, Heider Building Associates
(Print Name)
Located at: 562 Boxford Street
(Installation Address)
Was installed in conformance with the North Andover Board of Health approved plan,originally dated
10/20/2017 and last revised on 1/13/2018 with a design flow of
330
_ 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: Jan. 2020+/— No longer employed by The Morin—Cameron
Engineer Representative(Signature) Group, Inc.
James Melvin
And—Print Name
Final Construction Inspection Date: Oct. 2021+/— �,�
Engineer Representative(Signature)
John M. Morin
And—Print Name
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Installer: (Signature) Date: �se�j G02�
James Heider, Heider Building Associates
And—Print Name
Engineer: ,N Mvv, (Signature) Date: 10/27/2021
John M. Morin, The Morin—Cameron Group, Inc.
And—Print Name
120 Main Street, North Andover, Massachusetts 01845
Phone 978.688.9540 Fax 978.688.9542 Web http://www.northandoverma.gov
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