HomeMy WebLinkAboutSigned - As-Built Plan / Installation Certificate Form - 250 ABBOTT STREET 9/28/2022 • LED l •
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PUBLIC HEALTH DEPARTMENT 10" tJv y\
Community S Economic Daaelapmen!
TOWN OF NORTH ANDOVER
SEPTIC DISPOSAL SYSTEM—INSTALLATION CERTIFICATION
The undersigned hereby certify that the Sewage Disposal System( )constructed;( )repaired;
BY IVA
(Print Name)
Located at: ZSO 44?9 6o' T ST
(Installation Address)
Was installed in conformance with the North Andover Board of Health approved plan,originally dated
O aZl and last revised on 30`Lc�2; with a design flow of
aalions 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 3'.0.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:
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Engineer Representative(Signature)
And—Print Name
Final Construction Inspection Date: of Z�I ZaZZ'
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Engineer Representative(Signature)
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And—Print Name
Installer: ' (Signature) Date: Sy��J 1oZZ,
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And—Print Name
Engineer: ytitM (Signature) Date:—3! ZoL2—
And—Print Name
120 Main Street, North Andover,Massachusetts 01845
i Phone 978.688.9540 Fox 978.688.9542 web http://www.northandoverma.gov