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Nu. FORM 3A CERTIFICATE OF COMPI.iANCE
' COMMONWEALTH
Board of Health, OF MASSACHUSETTS _
— . MA.
CERTIFICATE OF COMPLIANCE .�
Description of Work: El Individual Components) VC .
ornplete System
The undersigned hereby certify that the Sewage ®isle®sal System;
Constructed W, Repaired ( ), Upgraded ( ), Abandoned
by. �� C�LLv
at: _ LST3
has been installed in accordance with the provisions of 310 CMR
1 5.00 (Tale 5) and the
approved design plans/as-built plans relating to application No. /7—e5o
c.---�-` Approved Design Flow 962—(,Pd)
Installer Qpp -)-v�✓�
D,sibner.
Inspector
Date O3 30
fThe issuance of this permit shall not be construed as
unction as designed, a guarantee that the sysiem will
F R C� 52001
TNORTMMPTON,MA 01(160
DE•` PPROVED FORM 5/96