HomeMy WebLinkAbout- As-Built Plan / Installation Certificate Form - 459 SALEM STREET 11/3/2022 4PhoO
OF NpRTH TMENT R
ToHENuTH DEPAR
PUBLIC HEALTH DEPARTMENT
(ommunily&Economic Development
TOWN OF NORTH ANDOVER
SEPTIC DISPOSAL SYSTEM—INSTALLATION CERTIFICATION
The undersigned hereby certify that the Sewage Disposal System 4consh-ucted;( )repaired;
By: �Yr'r�i �ii'iL N
(Print Name)
Located at: 'A a"
(Instal ation Address)
Was installed in conformance with the North Andover Board of Health approved plan,originally dated
and last revised on_ G_ Z 7 7i"� with a design flow of
eA 40 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:
Engineer Representative(Signature)
And—Print Name
Final Construction Inspection Date: Li
Q, Engineer Representative(Signature)
And—Print Name
Installer: (Signature) Date: !�A.
And—Print Name
Engineer: / / /(Signature) Date: 10_1 2Z
VLa k'f
And—Print Name
120 Main Street, North Andover, Massachusetts 01845
Phone 978.688.9540 Fax 978.688.9542 Web http://www.northandoverma.gov
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