HomeMy WebLinkAbout- As-Built Plan / Installation Certificate Form - 805 JOHNSON STREET 9/6/2022 �\��O
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PUBLIC HEALTH DEPARTMENT
(ammumly&Economic Development
TOWN OF NORTH ANDOVER
SEPTIC DISPOSAL SYSTEM—INSTALLATION CERTIFICATION
The undersigned hereby certify that the Sewage Disposal System Oo constructed;( )repaired;
By:_J�en C,.5;
(Print Name)
Located at:_ E O,S"
(Installation Address)
Was installed in conformance with the North Andover Board rof Health approved plan,originally dated
G//f�!2 v 2-9— and last revised on 6,12'7/ 2 a Z Z. ,with a design flow of
-; F, C-�> 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: Z022 C/ �
22 Engineer Representative(Signature)
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And—Print Name
Final Construction Inspection Date: t4z, .� Z.�ZL � Dom—
Engineer Representative(Signature)
—/Y'i'r%G],�c � � U�5 per../ ✓r�. .
And—Print Name
Installer: ,f Signature) Date:_
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And—Print Name
Engineer: (� (Signature) Date: IgD 2 2Z-
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And—Print Name
120 Main Street, North Andover,Massachusetts 01845
Phone 978.688.9540 Fax 978.688.9542 Web http://www.northandovernia.gov