HomeMy WebLinkAboutSigned - As-Built Plan / Installation Certificate Form - 53 MARIAN DRIVE 2/13/2023 - DECEIVED
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PPA' fVc' 3 2023
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TOLE orH o' S MEN*T
PUBLIC HEALTH DEPARTMENT
(ommunity d Economic Development
TOWN OF NORTH ANDOVER
SEPTIC DISPOSAL SYSTEM—INSTALLATION CERTIFICATION
The undersigned hereby certify that the Sewage Disposal System( )constructed;(x)repaired;
By: Chad Jablonski
(Print Name)
Located at: 53 Marian Dr.
(Installation Address)
Was installed in conformance with the North Andover Board of Health approved plan,originally dated
2 ?! 2Z and last revised on /A 7-/Z:7 iZ ,with a design flow of
��K Q 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: I 1/Z 2 � c.
�J rn Engineer Represcutativc ignature)
And-Print Name �7
Final Construction Inspection Date: )
-� y�'�-�
r1 Engineer Representative ignature)
And-Print Name
Installer. - (Signature) Date: 12 ? L Z L
And-Print Name
Engineer: LrC/ _(Signature) Date: /
And-Print Name
120 Main Street, North Andover,Massachusetts 01845
Phone 978.688.9540 Fax 978.688.9542 Web http://www.nortliandoverma.gov