HomeMy WebLinkAbout2001 Jan 27 - Certificate of Compliance f
FORM 3A - CERTIFICATE OF COMPL,. � L.."
. • ' �� . . . Fee
' � No. .
COMMONWEALTH OF MASSACHUSETTS
Board of Healtfi,
�_ � �/ , �a , MA.
CERTIFICATE OF COMPLIANCE
pescription of Work: O Individual Component(s) (t� Complete System
The undersigned hereby certify that the Sewage Disposal System; �
Construded ( ), Repaired (�p, Upgraded ( ), Abandoned ( )
I �S U .�-�. �,,,� .
by: �
at:
p �
has been installed in accordance with the provisions of 310 CMR 15.00 Cfitle S) and the
a{iproved design plans/as-built plans relating to application No.__.
Approved Design FIow5�5D. (8Pd) �
dated .
hstaE;er
� '�h �g�' �nspedor
. . Designer. ,�
� AP1TN0(S'! i,
Date � DELGA FAi,
Civ:L . ot be construed a5 a guarantee that the system will
The issuanc f isq�er
function as d . .�g4+ .
� � (� [E.c� [� Om [€•�
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. FEB 0 1 2�i _ .
HEALTH DEPT.
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i � DEP APPROVED FORM S196