35-005 (35) No. �� � FEE
COMMONWEALTH OF MASSAC USLTTS
Board of Health, ' ✓ "
CERTIFICATE OF C®M IANCF
Description of Work: ❑Individual Component(s) omplete System
The under ' n hereby certify that a Sewa a Disposal Sys em; Co tructed ( ),Re air d ( ),Upgraded ( ),Abandoned ( )
by: �f' LA
at �^ �
has been installed in accor anc with the o ' ion of 31 CMR 15.00 (Title 5) and the roved design plans/as-built plans relating to
application No. 7" , dated Approved Design Flow gpd)
Installer- _
Designer: s Inspector: Date:
The issuance of this perrrut shall not be construed as a guarantee that the tern will function as designed.
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