HomeMy WebLinkAboutSigned Installation Certification - As-Built Plan / Installation Certificate Form - 0 BOXFORD STREET 2/8/2022 PUBLIC HEALTH DEPARTMENT
(ommunity&Economic Development
TOWN Or NORTH ANDOVVER
SEPTIC DISPOSAL SYSTEM—INSTALLATION CERTIFICATION
The undersigned hereby certify that the Sewage Disposal System C4 constructed;( }re)ired;
By: Torn Sawyer (.�ia/'� 77sa+—w e-
(Print Name)
Located at: 734 Boxford Street
(Installation Address)
Was installed in conformance with the North Andover Board of Health approved plan,originally dated
January 12,2021 and last revised on March 22,2021 ,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 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: 11/9/2021 R C
EngiRepresentative(Signature)
Benjamin C. Osgood,Jr.
And—Print Name
Final Construction Inspection Date: 11/18/21
Engh eer Representative(Signature)
Benjamin C. Osgood,Jr.
And—Print Name
Installer: (Signature) Date:
And—Print Name
tngineer: ` (Signature) Date: 1:�1912I
n-
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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PUBLIC HEALTH DEPARTMENT
Ccaw.mily&Eccncmi(Development
'GOWN OF NORTH ANDOVER
SEPTIC DISPOSAL SYSTL+M—INSTALLATION CERTIFICATION
The undersigned hereby certify that the Sewage Disposal System constructed;( )repaired;
By: 1L(111U1 -&%w."eC4. � d y/Q0 C.
(Pj&t Name)
Located
(Installation Address)
Was installed in confonuance with the North Andover Board of Health approved plan,originally dated
L/1 Z and last revised on �Z� ,with a design flow of
536 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 Red Inspection Date:__ (L /Z
Engineer Representative(Signature)
And-Print Name / J
Final Construction Inspection Mite:
Engineer Representative(Signature)
And'-Print Name
(Signature) Date: /AZ/��o�1
GIUba,92 T 5adwu _
And-Print Name
Engineer: _(Signature) Date: w
And-Print Name
120 Main Street, North Andover, Massachusetts 01845
Phone 978.688.9540 Fax 978.688.9542 Web http://www,northcindoverma.gov