44-052 (13) THE COMMONWEALTH OF MASSACHUSETTS It Li afq
BOARD OF HEALTH 6
C JI OF.NQRT.H.h "F.i.QJ\
Qprtiftratr of Tuntplianre
THIS Is,TO RT , That the Individual Sewage Disposal System constructed (X) or Repaired ( )
by =
..... st filer
at A
...... did (7c;01 A2e)
has been installed in accordance with the provisions of TITLE 5 of T e State Sanitary Code/as/geed in the
application for Disposal Works Construction Permit No . o?• dated ,q//
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE S A GUARAN THAT THE
SYSTEM WILL I�FUNCTION SATISFACTORY.
DATE . ?i/f.13 /9 g7` Inspector