21 Certificate of Compliance 1998 toK
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CERTIFICATE OF COMPLIANCE
This is to certify that the on-site sewage disposal system installed X or repaired
on 7//i9,9 at ,Lor* /7 SYtvw 1ANEy Mzr,sGYipr.ona
by FoB WspE XCAMt>i.Jc has been
constructed in accordance with the provisions of Title 5, the /)sS,2 24,091 j0r%t*)
Board of Health Regulations, and the Disposal Works Construction Permit No.
dated .
Use of this system is conditional on compliance with the provisions (if any) set forth
below:
The issuance of this certificate shall not be construed as a guarantee that the system will
function as designed.
SIGNATURES: /
Installer: (/I�/dlle-t�f10- 'C Date: % o P
Desig e
/James A. Gracia, PE
Date:
James A. Gracia, PE
99 Glendale Sheet
Easthampton,MA 01027