HomeMy WebLinkAboutSigned - As-Built Plan / Installation Certificate Form - 911 JOHNSON STREET 8/6/2024 8/6/24,8:17 AM IMG_8672.jpg
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PUBLIC HEALTH DEPARTMENT
Community t:Economic Development
TOWN OF NORTH ANDOVER
SEPTIC DISPOSAL SYSTEM—INSTALLATION CE TIFICATION
The undersigned hereby certify that the Sewage Disposal System constructed;( )repaired;
By:
(Print Name)
Located at: j_0�0///t� �_
(Installation Address)
Was installed in conformance with the North Andover Board of Health approved plan,originally dated
7+m and last revised on 6 ,with a design flow of
qqJ9 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.
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Bottom of Bed Inspection Date:_7— (F)7�
ingineer Representative( ignature)
And—Print Name
Final Construction Inspection Date:
Engineer Representative(Signature)
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And—Print Name
Installer: (Signature) Date:
And—Print Fame
Engineer: nature) Date:
And—Print Name
120 Main Street, North Andover, Massachusetts 01845
Phone 978.688.9540 Fax 978.688.9542 Web http:(iwww.northandoverma.gov