HomeMy WebLinkAbout- As-Built Plan / Installation Certificate Form - 1761 SALEM STREET 4/27/2023 PROJECT NUMBER
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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 y cunstructed
g Y �' P Y ( ,( )repaired;
(Print Name;
Located at: _ 17CoL ')a/�n S" �- -Y-'.0.r1� d(
(Installation Address)
Was installed in conformance with the North Andover Board of Health approved plan,originally dated
and last revised on l!- 24- 2a 2 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. C?vIR 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: /a-O h- QQZZ
Engineer Representative(Signature)
,r `l
And-Print Name `
Final Construction Inspection Date: 8-1'7 2-Z.2
Engineer Representative(Signature)
And-Print Name
Installer:
_ _� Signature) Date: �Z3)�pZ,3 _-
And-Print Name ih
Engineer: (Signature) Date:_
And-Print Name
120 Main Street, North Andover, Massachusetts 0184'5
Phone 978.688.9540 Fox 978.688.9542 Web http://www.northandoverme.gov