Construction-Debris-Affidavit-PDF (5)City of Northampton 212 Main Street, Northampton, MA 01060
Solid Waste Disposal Affidavit
In accordance of the provisions of MGL c 40, S54, I acknowledge that as
a condition of the building permit all debris resulting from the construction
activity governed by this Building Permit shall be disposed of in a properly
licensed solid waste disposal facility, as defined by MGL c 111, S 150A.
Address of the work: _______________________________
The debris will be transported by: ______________________________
The debris will be received by: ______________________________
Building permit number: ______________________________
Name of Permit Applicant ______________________________
__________________________________________
Date Signature of Permit Applicant
292 1/2 South Street
Valley Home Improvement
Valley Recycling
Kevin Yearsley
2/4/2022