840 Certificate of Compliance BOARD OF HEALTH OFFICE OF THE
MkMBERS
ROSEMARIE KARPARIS,R.N.,MPH
XANTHI SCRIMGEOUR,MHEd,CHES
JAY FLEITMAN,M.D.
STAFF
Ernest J.Mathieu,R.S.,M.S.,C.H.O.
Director of Public Health
chard Meczywor,R.S.,Sanitary Inspector
'atdcia Abbott,R.N.,Public Health Nurse
Madeline Heon,Clerk
BOARD OF HEALTH
CITY OF NORTHAMPTON
MASSACHUSETTS 01060
Board of Health, Northampton
212 MAIN STREET
NORTHAMPTON,MA 01060
MA.
(413)587-1214
FAX(413)587-1221
CERTIFICATE OF COMPLIANCE
Description of Work ❑ Individual Component(s) ® Complete System
The undersigned hereby certify that the Sewage Disposal System;
Constructed paired Q Upgraded O, Abandoned❑
by `5 . L4. CO 4711-
at I ' ,I��
O we ///IfT zi
J
has been installed in accordance with the provisions of 31 0 CMR 1 5.00(Title 5) and the
approved design plans/as-built plans relating to application No.
dated
Approved Des' ow
Installer LN r / ' - .l 106
Date(er Fa /
The issuance of this permit shall not be construed as a guarantee that the system will
function as designed.