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249 Lot 5 Cert of Compliance 2017 Feb 23 17 03:35p Ken Bousquet Excavating (413)547-6514 p.1 FEB-23-2017 12:29 FROM:WRGINNIS 14135275291 70:14135476514 P.1/1 5Z, Commonwealth of Massachusetts ,, ,- .f. City/Town of No irr4.,tc.,"A Thr.J ( FL ) ( 4? � Certificate of Compliance .^ FOI>TII 3 DEP has provided Htfe Form for use by local'Goards of P eeith.Other forme may be used.but the -information must tie aubstsniailythe earner Sy the provided'here.$siert using thblcrm,Cheek With the local Board of Health to determine the farm they use. Ilitolvitor.CeirtItylnet ttne4011 aringivora on en Oeste Sewage Colica ear SYstem wow,, ins out Construction of a new system forme on Me Repair or replacement of an existing system computer,too D Repair or replacement of an sedating system component only W IDA INT to move your cursor-do-not .1-las boon done is with Tate S and the Disposal Symon Pandit(OSCP) Woert eAliu�+ D/��� 6 3o .�zo/5- kpy t - - SYl.0& Z. Book p -1‘'. 14111-1ASow Adders,or Lot ft . r15-74-) (Ft Nc : P 0 v aaar" ► a sta,. Ey cgsa Designer Information: :• "c a-4hy rv. - _, ItIOTHY " trematil of C,ompnnp Installer information: \_'r4rnr. ' ' : KYlL OUV 5QUF_j... . `'=..' (P id �!_.)pc).3 cJ` .Exc 4 la�u Mune 0—, Nems do�o oasr _ - a 3 --I re Dara Use of this system it mullioned an contptance with cite provisions set tom wow. N CS GA f (36)_G.rE 0t SDrt5.ed— Ptl.l.QW _. . v Arkp Teter- Kr iripgra- pop.ay 3 YPIPtizaS . . ... _ 70-11.1 krii t The i6ovanoer o.Pei t:eftir tts - -, riot be con ed as a guars^ tj ,s)< L t"II f n as des".sed. — //!� %%PFf .:veep Authority Z.__?44/ 7 Sipneture Ds Siorm3.aoc 12640 Cr ,uttketo o{Caraptawg-Pape I of 1 FILE COPY