35-258 (7) THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEA TH
,�11 i al
0 F. IV ...........
..............C( ..............
atifiratr laf n
constructed or Repaired
THIS IS TO CERTIFY, That tJjejn&vidual Sewage Disposal System constrt
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by.......... hA& . . I .. ...... . ...........talle
6 ibed in the
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at..... ........ 17 T:7 nitary
roviSiOns Of 5 of The State S,1 ------------
has been installed ted......
alled in accordance with th Permit NO..---- ---C..... ---------------- d,,i 7,
application for Disposal \Vorks Construction SHALL NOT BE CONSTRUED AS A GUVRAANTEE THAT THE
THE ISSUANCE OF THIS CERTIFICATE
SYSTEM WILL F"CTION SATISFACTORY. Inspector....
..........
DATE.............