HomeMy WebLinkAbout- As-Built Plan / Installation Certificate Form - 46 WHITE BIRCH LANE 7/29/2024 PUBLIC HEALTH DEPARTMENT
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TOWN OF NORTH ANDOVER
S1+TTIC.'01SI'C)SAL SYSTF11 +I—INSTALLATION ION C'E'R I II«IC;ATi
`fhe undersigned hereby certify that the Sewage e Dislrmd System( ceanstmeted; )repaired;
_. _
{ (Print Name)
(installation Address)
4ra!u,s installed in con@'brnrarnae with the North Andover hoard of Health approved plan,originally datcd
�" _.,.._... and last revised on _........ .... ...._... with as design flow of
° F gallons per day. 'l"he materials used were in conformance'with those specifxetI Barr tire;
aapproml plan;the systern was installed in accordance with the provisions of`310.CMR 15.000,"'t`'itle 5 and local
regulations,and the final grading agrees suhstantiady with the approved plan.All work is accurately represented on
this As-built which has been stulrmitted to the Board of Ilealtir.
Ituttrraaa¢at` laDate:
Itcri Inspection Tars�
Engincewr°Represtratzative(Signature)
Arid print Name
Final C"onstruction Inspection Date: m
Engineer lteprescntaaivoe(Signarture)
And.--Print Naarne
" "� (Signature(Sa
Iarstr►Ilcx _ g )
.mom -_ .._ ... ....w..
And--Print Nmae
I',n Iarcer: / ',ature)
And Print Name
120 Mafia Street, North Andover, Massachusetts OI 45
Phone 978.688.9540 Fax 978.688.9542 Web http-ll ww w.uarthrandovernia. ov