HomeMy WebLinkAboutAs-Built Plan / Installation Certificate Form - 394 BOSTON STREET 5/12/2208 � 4,lpRYy'4
MAY 0 pQ
PUBLIC HEALTH DEPARTMENT j
Community Development Division 0
TOWN OF NORTH ANDOVER
SEPTIC DISPOSAL SYSTEM—INSTALLATION CERTIFICATION
The undersigned hereby certify that the Sewage Disposal System(constructed;( )repaired;
By: tr "j°rh
(Print Name)
Located at F/0-- `� 7 i�
(Installation Address)
Was installed in conformance with the North Andover Board of Health approved plan,originally dated
"" 7 and last revised on
with a design flow of
.��.4 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: °
Engineer Representative(Signature)
>11 r
And—Print Name
ry
Installer• w .
� � �I5ignature) Date:
/ d J(d(;tIriJIIEC
t
idG7t And—Print Name
Enginer °" e, � .IA ! . (Signature) Date: O. o-of
And—Print Name
1600 Osgood Street, North Andover, Massachusetts 01845
Phone 978.6889540 Fax 978.688.8476 Web http://www.townofnorthandover.com
v�ob� ww z2
vi
b
In
x o xcn GTyw
NOCn Ci �g
w° xvx,gwn°, d-
C7 �o _`o?oa ads CIO
�v>i'I°
m w n
coo
0
x
Q N N ^
w
L Oco
m vwis 8 �QP4 6 ut
Pa wc, � x
vi
pq
E 6 W P
s�
M.�-fi]M N•~-- �p qS�'2 O -1 asw ';C Q U1
w ww Ua of W o .....
O u i ii
�vwiv,v�ao?m