HomeMy WebLinkAboutSigned Installation Certification - As-Built Plan / Installation Certificate Form - 125 BOSTON STREET 10/25/2021 • RECEIVED
OCT ?_ �
TOWN OF NORTH ANDOVER
HEALTH DEpARTMEK
PUBLIC HEALTH DEPARTMENT
Community&Economic Development
TOWN OF NORTH ANDOVER
SEPTIC DISPOSAL SYSTEM-INSTALLATION CE IFICATION
The undersigned hereby certify that the Sewage Disposal System constructed;( )repaired;
By: -, P DIES t4 0 2 t y1
(Print Name)
Located at: vas- S"T—
(Installation Address)
Was installed in conformance with the North Andover Board of Health approved plan,originally dated
"7 0 a. and last revised on '5&11a-� �—p�—(7 ,with a design flow of
3 S 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: 01 O .Zo a,
d Engineer presentative(Signature)
+�t�c �"`0 d--1►%
And—Print Name
Final Construction Inspection Date:
Engineer Re esentative(Signature)
MEN MU IA-61n
And—Print Name
Installer: (Signature) Date:_
And—Print Name
Engineer: (Signature) Date: a-1., b0
And—Print Name
120 Main Street, North Andover, Massachusetts 01845
Phone 978.688.9540 Fax 978.688.9542 Web http://www.northandoverma.gov