HomeMy WebLinkAbout- As-Built Plan / Installation Certificate Form - 531 JOHNSON STREET 7/29/2024 i
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JUL 2 9 2024
PUBLIC HEALTH DEPARTMENT �ea
Community&Economic development
TOWN OF NORTH ANDOVER
SEPTIC DISPOSAL SYSTEM—INSTALLATION CERTIFICATION
The undersigned hereby certify that the Sewage Disposal System( )constructed;( )repaired;
(Print Name)
Located at:o?3 _ .-r ,��a,� �-,,• V.�j -t�^s,� •e
(Installation Address)
Was installed in conformance with the North Andover Board of Health approved plan,originally dated
6g-,A 11 a y and last revised on f� a ?o / ,with a design flow of
130 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:---,-,-,-
-
Engineer Representative(Signature)
And-Print Name
Final Construction Inspection Date:&j'� ' CIOE21 i.L, afluftit _
Engineer Representative(Signature)
And-Print Name
Installer (Signature)(Signature) Date: 6
JrAO�4&AJ
And-Print Name
Engineer:( � (Signature) Dater
VLAVIKItZ _ Hel-kki
And- Print Name
120 Main Street, North Andover, Massachusetts 01845
Phone 978.688.9540 Fax 978.688.9542 Web http:/'/www.northandovernia.gov