HomeMy WebLinkAboutCertificate of Compliance 1/14/09�CLLc! • 1. /YS - br/l/ - , :1(_ i -'-.z -e I
No. � _1
COMMONW�AUH OF MASSACIILISeTT
Board of Health,
CERTII IC Ir OF COMPLIANCE
Description of Work: ❑ Individual Component(s) Complete System
The uudersned hereby certify that the Sewage Disposal System; Constructed ( ),Repaired ( ), Upgraded (t/f`Abandoned ( )
by:61
—
at
has been installed in accordance with the rovisions of 3 0 CMR 15.00 (Title 5) an t e ap ed design plans, as -built plans relaying to
application No. S , dated 2 Approved Design Flow � (gpd)
Installer
Designer: Inspector: k Date:
The issuance of this permit shaKot be construed as a guarantee at the system will function as d-signed.