35-041 (10) THE COMMONWEALTH OF MASSACHUSETTS ? ,
BOARD OF HEALTH 3'�
P 1 !
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...OF... .............................................................
Tatifiratr laf (11intphaurr (wor Repaired
THIS 1 (0 TIFY That the Individual. Sewage Disposal System constructed
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7 .....................................
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by---------- Installer
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- e Code as escribed in the
at-------- ........ ---------- -- -s Of ITLE 5 of The State Sanitary
accordance with has been installed in ac .ol the pr I ........•....•...........
----P;w
ovi - IS Of
application for Disposal Works Construction Permit No------ ------ .............. dated--
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARA/N E THAT THE
WILkFUNCTION SATISF Y.
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SYSTEM .. ............
.......... Inspector..... ....... .........................................
DATE. -------
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