HomeMy WebLinkAbout08-123 Certificate of Compliance 6/9/08No. � l�kerrn �✓��L/ /
THE COMMONWEALTH OF MASSACHUSETTS,>
�( 2 wVU^1 BOARD OF HEALTH
CERTIFICATE OF COMPLIANCE
Description of Work: ❑ Individual Component(s) ❑ Complete System
The undersigned hereby certify that the Sewage Disposal System, Constructed (f<Repaired ( ), Upgraded ( ), Abandoned { )
by: Q
at s,t C�vt l<
has been installed in accordance with the provisions of 310 CMR 15.01] (Title 5) and the approved desig lans/as-built
plans relating to application No. �dated / C% . Approved Design Flow (gpd)
Installer WCc `(', C_
Designer:��uR��✓L /-efL f) Inspector Date (0
The issuance of this certificate shall not be construed as a guardntee that the system will function as designed.
FORM 3 - CERTIFICATE OF COMPLIANCE DEP APPROVED FORM 5/96