HomeMy WebLinkAboutInstallation Certification - As-Built Plan / Installation Certificate Form - 544 JOHNSON STREET 7/27/2021 PUBLIC HEALTH DEPARTMENT
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TOWN OF NORTH ANDOVER
SEPTIC DISPOSAL SYSTEM-INSTALLATION CERTIFICATION
The undersigned hereby certify that the Sewage Disposal System( constructed;( )repaired;
By: I AmgS m o c'kvJ
(Print Name)
Located at: Je-�-t�j J D�A S (LVA s A e o- -
(Installation Address)
Was installed in conformance with the North Andover Board of Health approved plan,originally dated
2 2020 and last revised on -] /ot-0 a-co with a design flow of
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: a 0
I Engineer presentative(Signature)
cJ v"l y"i o`(L\Vi
And-Print Name
Final Construction Inspection Date:
Engineer R •esentative(Signature)
And-Print Name
Iustaller: (Signature) Dater �1 0
f2�
And-Print Name
Engineer: (Signature) ` Date:
JAF� �� %V-\
And-Print Name
120 Main Street, North Andover,Massachusetts 01845
Phone 978.688.9540 Fax 978.688.9542 Web http://www.northandoverma.gov