HomeMy WebLinkAboutSigned - As-Built Plan / Installation Certificate Form - 125 BOSTON STREET 8/1/2023 • TLED 16g6.
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PUBLIC HEALTH DEPARTMENT
Community&Economic Development
TOWN OF NORTH ANDOVER
SEPTIC DISPOSAL SYSTEM—INSTALLATION CERTIFICATION
The undersigned hereby certify that the Sewage Disposal System (constructed;( )repaired;
By: �b ► n s �-`
(Print Name)
I � C
Located at: f _>' �S�' S7`�%) J-7-l4e �t
(installation Address)
Was installed in conformance with the North Andover Board of Health approved plan,originally dated
. and last revised on with a design flow of
-7 �I 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.
7
7
Bottom of Bed Inspection Date:
Enginee epresentative(Signature)
z
And-Print Name
cf
Final Construction Inspection Date: 3 / Y _)
Engineer R esentative(Signature)
And-Print Name
Inst er: (Signature) ^r _Date:
` And-Print Name
Engine (Signature) Date: ��c'1 5,
And-Print Name
120 Main Street, North Andover, Massachusetts 01845
Phone 978.688.9540 Fax 978.688.9542 Web http://www.northandoverma.gov