HomeMy WebLinkAboutSigned Installation Certification - As-Built Plan / Installation Certificate Form - 25 Beechwood Drive 12/27/2022 ��G�\v�o � ��.�LP,A 16p6' •
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PUBLIC HEALTH DEPARTMENT
(ommunily&Economic Development
TOWN OF NORTH ANDOVER
SEPTIC DISPOSAL SYSTEM—INSTALLATION CERTIFICATION
The undersigned hereby certify that the Sewage Disposal System*constructed;( }repaired;
By: Rocci DeLucia Jr. with Frank DeLucia&Son Inc.
(Print Name)
Located at: 25 13 G EC�-k w 0o
(Installation Address)
Was installed in conformance with the North Andover Board of Health approved plan,originally dated
I :Z 0.:2 and last revised on �j cT 1 2- 2—i ,with a design flow of
3 O 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 Heal(h,
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Bottom of Bed Inspection Date: eq
Engineer Represent lve(Signature)
c 19>z
And—Print Name
Final Construction Inspection Date: 0 2
Engineer Representativ Signature)
And—Prhnt Name
�¢ %�tG 11/16/22:u._, ,.�
Installer. Signature) Date:
Rocci DeLucia Jr.
And—Print Name
Engineer: C (Signature) Date: / / Z Z
And—Print Name
120 Main Street, North Andover,Massachusetts 01845
Phone 978.688.9540 Fax 978.688.9542 Web littll://www.northcmdovernna.gov