HomeMy WebLinkAbout- As-Built Plan / Installation Certificate Form - 1469 SALEM STREET 7/11/2022 o'4,
PUBLIC HEALTH DEPARTMENT
Caurrarrmraf9y&(cmnorrrir Development
SIA I"IC I)ISP aAL SYS'11EM —IN I LLA'1 IO CEIRTIF1CATION
1 he undersigned hereby certify that the Sewage Disposal laystern(.juonstructed;( }repaired;
BY:. L ..Q . .. "P �a_ >.t ?_......
(Print Name)
14
l..c:acatecl at _..1. .UL-I.......
(Installation Address)
Was installed in confornmauce with the North Andover Board of 1-lealth approved plan,originally dated
and last revised on _._...___.._� �. � �..__. with a design flow of
��E- '_...... gallon, per day. "1"lre materialsused were in conformance with thosesl:rccifieafi on the
approved plan;the system was installed in accordance with the provisions oi'd 10.tti.MR 15.000„Title S 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 Beat lnsla+ Aion Date:
En ineer Representative(Signature)
�j
And- print Name
Final(;oaastracticmra Inspection Date:
P ngineer Representative(Signature)
And Print Name
Installer. '- � . 4i nature) Date
wnr
And._print Name
`
14�aa�rraeer: Signature) Mato
And.-.Print Narrne
120 Main Street, North Andover, Massachusetts 81845
Phone 978.688.9540 fax 978.688.9542 Web littp://wvwwv.nortlaatidoverraaa.gov