HomeMy WebLinkAbout- As-Built Plan / Installation Certificate Form - 50 HAY MEADOW ROAD 9/11/2024 a
PUBLIC HEALTH DEPARTMENT
(ommunity&Economic Development
TOWN OF NORTH ANDOVER
SEPTIC DISPOSAL SYSTEM—INSTALLATION CERTIFICATION
The undersigned hereby certify that the Sewage Disposal System 6/constructed;( )repaired;
By: dE l �� ►�
( rmt Name)
Located at: r-,L k y N"r;K)k_I- '
(Installation Address)
Was installed in conformance with the North Andover Board of Health approved plan,originally dated
1L4 and last revised on L I I- -Z ,with a design flow of
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:A—F/'7i LL/ UU ryT
Engineer Representative(Signature)
And—Print Name
Final Construction Inspection Date:
Engineer Representative(Signature)
And—Print Name
Installer: (Signature) Date:
.4
And—Print Name
Engineer: � /�)�,��f� re) Date:
And—Print Name
120 Main Street, North Andover, Massachusetts 01845
Phone 978.688.9540 Fax 978.688.9542 Web http://www.northandoverma.gov
..
�1,`4.:
' - t �
� � I .._
-�:.
.. a ...
�...
i.
t
i