11 COC COMMONWEALTH OF MASSACITUSFTTS
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Board of Health. ���7+;/o4) MA.
� //,�- CERTIFICATE OE'COMPLIANCE
Description of Work: 2flndtvi�ual�Component(s) 7 Complete System �
The undc s g ed hereby certify that the Sewage Disposal System: Constructed (),Repaired 1/Upgraded ("j,Abandoned ()
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has been installed in accord
ic with the pros son 'of 310iCSIR 15.00 (Tide 5) and the approved design plans/asbuilt plans relating to
application Np ,! dated 7 /.'o 7 App oved Design Flow ji (gpd)
Installer Jf[ (A [�
142716/0 tit// "7.1C !/V 71/4/1: I-Zt- Y- /? /�_/ l
Designs 41-1. 'j 1/11/55,5- Inspector ,ti 11.x' - Date: .{;f
The issuance of this permit shall not be construed as a guarantee that the system will function as designed. 1
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, MA.
CL] [I lC.tiTL QI CO11111.1AN'i_1:
Description of Work: Individual Component(s) CI Complete System ,4'& Fez 6 OiJ L
The unclersig uedherebycertifytha ttheS ewage Disposal Systen:1 Coo•truied ( Repaired ( Upgrade ( .net ( )
by Ap r bR/e iri et szti
_ _ y=a-
has been instal in aaccer an e with the to sini 'of 310 CMR 15.00 (Gtr 5) and the approved design plans/as-built plans relating to
applicauou o. da -.
Approved:Design Flow L(_(gpd)
Inscalleel
Designer: Inspector //(. �� Date S2
The issuance of mks permit sba i no:u
ree J.nt the system will function as designed.