35-005 (27) No. ��� FEE
COMMONWEALTH OF MASSAC14USETTS
Board of Health, , MA.
CFRTIFICA F OF C® RLIANCF
Description of Work: ❑Individual Component(s) a omplete System
The undersigned hereby certify th t the Sewage Disposal System; Constructed(aired ( ),Upgraded ( ),Abandoned( }
by:
at ;t U Q
has been installed in accordan with the provisions of 310 MR 15.00 (Title 5) and th a proved design plans/as-built plans relating to
application No. z) d t d — 7Y Approved Design Flow S _(gpd)
Installer V,Q—
Designer: /U l ej Inspector:
The issuance of this pert t shall not be construed as a guarantee that the system will function as designed.
[Fri) 15.
1 ` DEC 7 1998