HomeMy WebLinkAboutSigned - As-Built Plan / Installation Certificate Form - 531 Boston Street 7/18/2024 IL ,
PUBLIC HEALTH DEPARTMENT
Community&Economic Development
TOWN OF NORTH ANDOVER
SEPTIC DISPOSAL SYSTEM—INSTALLATION CERTIFICATION
The undersigned hereby certify that the Sewage Disposal System constructed;( )repaired;
By: i ��1 k L��"9
(Print N t )
Located at: 53 ( 90 STDA) ST► j�&T_
(Installation Address)
Was installed in conformance with the North Andover Board of Health approved plan,originally dated
IW Ut—,AAF, (L. �� qgP�and last revised on JAWA" to,., 9(Yd Lf ,with a design flow of
y y 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: VV I Aa H 9j,tn.. i
Engineer Representative(Signature)
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And—Print Name
Final Construction Inspection Date: /���ay /��wv�✓� /
Engineer Representative(Signature)
1 N�iy1A� �L"mll uYc..6
And—Print Name
Installer: (Signature) f Date:?l/,q
And—Print Name
Engineer: (Signature) Date: -711?l a`f
And—Print Name
120 Main Street, North Andover, Massachusetts 01845
Phone 978.688.9540 Fax 978.688.9542 Web http://www.northandoverma.gov