HomeMy WebLinkAboutInstallation Certification - As-Built Plan / Installation Certificate Form - 24 FARNUM STREET 3/1/2023 PUBLIC HEALTH DEPARTMENT
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TOWN OF NORTH ANDOVER
SEPTIC DISPOSAL SYSTEM—INSTALLATION CERTIFICATION
The undersigned hereby certify that the Sewage Disposal System(constructed;( )repaired;
By 1 M V�)C Yt 7X/
(Print Name)
Located at: y'l �'•/'��'I,LI(,��L� ��
(Installation Address)
Was installed in conformance with the North Andover Board of Health approved plan,originally dated
:2 �i���-�� and last revised on with a design flow of
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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:
Engineer Representative(Signature)
And—Print Name
Installer: (Signature) Date:
(ZA L
And—Print Name
Engineer: rj ��j1�� j l� ��l(,�a _(Signature) Date: 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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