HomeMy WebLinkAboutInstallation Certification - As-Built Plan / Installation Certificate Form - 62 BANNAN DRIVE 10/10/2023 PUBLIC HEALTH DEPARTMENT
Community B Economic Development
TOWN OF NORTH ANDOVER
SEPTIC DISPOSAL SYSTEM—INSTALLATION CERTIFICATION
The undersigned hereby certify that the Sewage Disposal System(constructed;( )repaired;
By:
(Print Name)
Located at:�?f DAo&
(Installation Address)
Was installed in conformance with the North Andover Board of Health approved plan,originally dated
(2'2j-' and last revised on 10 -7,1- ,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: �'�� ��7 �'(�`�' f� n
Engineer Representative(Signature)
�11.t, FYL ,k%.
And—Print Name
��Final Construction Inspection Date: —�-2- ,
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Engineer Representative(Signature)
And—Print Name
Installer: (Signature) Date: �v 0 120-1 3
And—Print Name
Engineer:
� y nature) Date: q-��t�
AR-21 i y-
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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