35-025 (4) THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF H LTH
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8199T U
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rfifiratj� ]a
....��TQ CERTJ Y.-That the individual Sewage Disposal System constructed (,�k) or Repaired
C ................................................................................................
by ........ . ................................
Installer
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at......... .. .......
has been installed in accordance with the provisiow-, of TITLE 5 of The State Sanitary Code as escribed in the
application for Disposal Works Construction Permit No.........
........• dated
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WI L FUNCTION SkTISFACTORY.
........ Inspector_......--_.-
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DATE....._... ...F-UN.-KEF ................