HomeMy WebLinkAbout- As-Built Plan / Installation Certificate Form - 240 FARNUM STREET 10/27/2022 O0,01
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PUBLIC HEALTH DEPARTMENT
(ommunity&Economic Development
TOWN OF NORTH ANDOVER
SEPTIC DISPOSAL SYSTEM—INSTALLATION CERTIFICATION
The undersigned hereby certify that the Sewage Disposal System(constructed;( )repaired;
(Print Name)
Located at: ZN O F A7A
(Installation Address)
Was installed in conformance with the North Andover Board of Health approved plan,originally dated
and last revised on 07— r7��/7 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: l b-1-7- sue-
Engineer Representative(Signature)
Ni LL' Purwi'*Ki C
And—Print Name n
Final Construction Inspection Date:nj
Engineer Representative(Signature)
And—Print Name
Installer: _(Signature) Date: b l 26 2 u 2
And—Print Name
Engineer: 9 ignature) Date:
And—Print Name
120 Main Street, North Andover,Massachusetts 0184S
Phone 978.688.9S40 Fox 978.688.9S42 Web http://www.northandoverma.gov