HomeMy WebLinkAboutSigned - As-Built Plan / Installation Certificate Form - 851 JOHNSON STREET 9/26/2022 • �EGEtVED
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SOWN OF NOEP PA MENT
HEp,�TH
PUBLIC HEALTH DEPARTMENT
(ommunity&Economic Development
TOWN OF NORTH ANDOVER
SEPTIC DISPOSAL SYSTEM—INSTALLATION CERTIFICATION
The undersigned hereby certify that the Sewage Disposal System I)o constructed;( )repaired;
By: YY1't tC 1 t t4 tJ
(Print N e)
Located at: OKNC2,��
(Installation Address) '� SEPTIC TANK
Q-E�-Oi�TL�N S�;r,TC
Was installed in conformance with the North Andover Board of Health approved plan,originally dated 'C:qp,�Bt At.,t3'"L�Z
to�2t Zo'Ll and last revised on ►l�t S(2021 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: -4 1 1 `Zy27' /
Engineer Representative(Signature)
And-Print Name
Final Construction Inspection Date:
Engineer Representative(Signature)
W tit, SCHKIX -i+ Pc=
And-Print Name
Installer: d ignature) Date: cz�
rn CYi[ +7�ln
And-Print Name
Engineer: (Signature) Date: 4�z31 Z Z
J o V-1 r, M o r-�M
And-Print Name
120 Main Street, North Andover, Massachusetts 01845
Phone 978.688.9540 Fax 978.688.9542 Web http://www.northandoverma.gov