HomeMy WebLinkAboutAs-Built Plan / Installation Certificate Form - 415 BOXFORD STREET 11/20/2015 i
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PUBLICHEALTH DEPARTMENT
TOWN OF NORTH ANDOVER
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SEPTIC DISPOSAL SYSTEM—INSTALLATION LATION CERTIFICATION
The undersigned hereby certify that the Sewage Disposal System( )constructed;( }repaired;
(Print Nance)
Located at:
(Installation Address)
Was installed in conformance with the North Andover Board of Health approved plan,originally dated
and last revised oil AD ><r' -1. - ,with a design flow of,
1) c_ 'w.� gallons per clay. The materials used were in conformance with those specified on the
approved plan;the system was installed in accordance with the provisions of310.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 hoard of Health.
Bottom of"Bed Inspection Date:
j r 7 Engineer Representative(Signature)
And--Print Naane
Final Construction Inspection Date-
Engineer Representative(Signature)
And—Print Nance
Instaaller: G ..r (Signature) Date:
And—Print Name
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Engineer:jl ignature) Date:
CS
And—Print Name
1600 Osqaod Street, North Andover, lAussuchusetts 01845
Phone 978.688,95 40 Fax 978.688,,8476 Web h'itp //wviw"towtiofatoa°Ditatada,avei,,a:arn