Habitat-Northampton 785 Burts Pit-Debris AffidavitDEBRIS DISPOSAL AFFIDAVIT
In accordance with the provisions of M.G.L. c. 40, s. 54, Building Permit
# ____________ was issued with the condition that all debris resulting
from this work shall be disposed of in a properly licensed solid waste
disposal facility as defined by M.G.L c. 111, s. 150A.
The debris will be disposed of in:
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Name of Waste Facility
_____________________________________________
Address of Waste Facility
111.5 Debris: As a condition of issuing a permit for the demolition, renovation,
rehabilitation or other alteration of a building or structure, M.G.L. c. 40 s. 54 requires
that the debris resulting therefrom shall be disposed of in a properly licensed solid waste
disposal facility as defined by M.G.L. c. 111 s. 150 A. Signature of the permit applicant,
date and number of the building permit to be issued shall be indicated on a form provided
by the Building Department and attached to the office copy of the building permit
retained by the Building Department. If the debris will not be disposed of as indicated,
the holder of the permit shall notify the building official, in writing, as to the location
where the debris will be disposed.
780 CMR – 6th Edition
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Signature of Permit Applicant
_______________________________________
Date