HomeMy WebLinkAbout- As-Built Plan / Installation Certificate Form - 40 DUNCAN DRIVE 12/28/2023 w-
PUBLIC HEALTH DEPARTMENT
Crrrrrrrrrrmfay&l(rrmaOk Development
TOWN 01� NORTH ANDOVER
SEI'TIC I)ISH)SAL sys'I'I±.m — INSTALLA'.I' ON CERTIFICATION
IFIC.'"ATION
"I"'he undersigned hereby certify that the Sewage e Dispaosral System(.✓ 'const;ructed,p )repaaired
ley:_..._ . ._....� �.��� . .....�� ........
(Print Naraae)
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Was installed in coniorrnance with the North Andover Board ot'llealth approved plan, originally dated
and last revised on . .�... .:.��� .... .. �.. .. ...__,with at design flow of
" w�allons per day, I'lre materials used avert;in coral'irrrraance with those s acc�iliecl car)the
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approved plan; the systeraa was installed in accordance with the lmrc:rvisic:ns of'310, C'MIt I5.000,11fle 5 and local
regulations,altad the tonal grading, agrees substantially with the approved plan. All work is accurately rep;rresented on
the As-built,which has been suhnaitted to the Board of flealth.
Bottom of Bed Inspection gate: �..��� "° �� 2;*..._.........
Engineer Representative(Sig,rratur°e)
And .. l'rirrt:!'~~!'erase ,... ""
Final Construction Inspection Datc } : a�`��°�
gill pa ntative(Signature)
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And ...I"rint Narrie
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(Signature nature Date �
And , print Marne
And Print Nanre
120 Main_... ...._ .Street, Forth Andover, Massachusetts 01845
Phone 978.688.9540 Fox 978.688.9542 bleb http://www.nortitatidoverma.gov