HomeMy WebLinkAbout- As-Built Plan / Installation Certificate Form - 116 OGUNQUIT ROAD 12/15/2021 PUBLIC HEALTH DEPARTMENT
Community&Economic Development
TOWN OF NORTH ANDOVExi
SEPTIC DISPOSAL SYSTEM—INSTALLATION CERTIFICATION
The undersigned hereby certify that the Sewage Disposal System(N constructed;( }repaired;
By: Robert Innis
(Print Name) .
Located at: 116 Ogunquit Road
(Installation Address)
Was installed in conformance with the North Andover Board of Health approved plan,originally dated
January 12,2021 ^and last revised on April 9,2021 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 o£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 Iced Inspection Date: 11/3/2021 v
Engineer Representative(Signature)
Benjamin C.Osgood,Jr.
And—PriintNarne
Final Construction Inspection Date: 11/18/21 �_
Engineer Representative(Signature)
Benjamin C.Osgood,Jr.
And—Print Name
Installer:�T&=X2 (Signature) Date:,
And—Print Name
Engineer:—� L C (Signature} Tate:
And—Print Name
120 Mnin Street,North Andover, Massachusetts 01845
Phone 978.688.9540 Fax 978.688.9542 Web http://wiiw.northandovernia.gov