HomeMy WebLinkAboutSeptic Installation Certification - 280 Gray St - As-Built Plan / Installation Certificate Form - 280 GRAY STREET 9/26/2024 +mr
PUBLIC HEALTH DEPARTMENT
tommunily&Economic Development
TOWN OF NORTH ANDOV r'R
SEPTIC DISPOSAL, SYSTEM INSTALLATION CERTIFICATION
The undersigned Ih-erelay certify that the Sewage Disposal System(4,onstructed;( )repaired;"
By:__
(Print Name) —
Located at: % _—A
(Installation Address)
Was installed in conformance with the North Andover Board of Health approved plan,originally elated
and last revised on I ? ,with a design flow of
,gallons per day. The materials used were in conformance with those specified on lire
approved plan; the system was installed in accordance with the provisions of310. CMR 15.000,'title S 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.
T#otfonl of lied Inspection Date: Gc __ c
Engineer Representative(Signature)
And—Print Name c
Final Construction Inspection Date:G•� CIE
�lrgineer Representative( ignature)
And—Pant Name
P
Installer: (Signature) Date:
And—Print Name
Engineer: /„'/f� �f^�` � �/ � nature) Date: I-Ul j
And—Print Name
— 12) Main Street, North Andover, liViassachutsetts 01845
Phone 978.688.9540 Fox 978.688.9542 Web iltti)://www.iiortll(411(lovernia.gov