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521 Septic Permit 2005 o. Sz- COMMONWLALTI1 OF MASSACHUS£IIS Board of Health. Vii. DISPOSAL SYSTEM CONSTRUCTION PERMIT Permission is hereby granted to' Construct( ) Repair( Upgrade( Abandon( ) an individual sewage disposal system as described in the application for FE{ 00.-'4) �4a/ 4 0Att&B at 5)! (AAta-in /WC',o��p t� Disposal System Construction Permit No.O"35---32 dated Provided: Construction shall be completed within rye years of the date of this-(ppee/rrmmii�tyc�'�•�Vl local conditions must be met. Form 1255 Rev 5/96 AM Sulkin Co Boston.MA Date D 5 Board of Health V ''" ° a llit W1 \1 i COMMON'W'E:\ITII OF MASSAC/ITUSETTS Board of Health, 4/0%2<17/4rij /Galt. FEE 5 .W acz iih• 115B PLICATION POR DISPL)SAL SYSTEM CONSTRUCTION PERMIT m Tto Construct 7 Repay tipgra(IX) el6rndonO - Complete System 7lvdividual Components Ioat / p Locet on � / �%) 0 Owner's Name /204 4,US // a - b�ap/Parcel#�r�i /J 0/3&tu.o R Address ,5a/ 0 / -4 / �,._•" Telephone# �7 or�T Lot# Installer's Name --F.,. or /� \1,� / / itin) Designers Name /tLG1 i�� C.//��-'ll Address %( yil.f} 0`I()�� address `t((/{,�!/ r /[.� JH-i /-rA u Telephone# e!!3 -yG 7- 9 e a S . Telephone hie,-Y•!0 _ Type of Building 14 S//'JJ4.-N 77/1-6_ /Jt Lot Size %D nom-ell.ft. �� Dwelling-No.of Bedrooms (7/-/7./f"//700k/'��� 4/�% visoof x6 Garbage grinder(4,6 Other-Type of Building l� ,c - % No.of persons 4, Showers a Cafeteria/$ Other Fixtures /%(.l_ g/14r w Alt ear Design Flow (min.required) /10 tS X l Silated design flow 4 25- Design flow provided �� gpd Plan: Date) .P.T//% 9__ JC Number of sheets ,./Reviisiion Date Title (ifrA77L SV 7X-re "-Pilo/C/ et /7"/`�S 0 ..521 4OOL p Description of Soil(s) fee, At r7-' ' `''� Re Soil Evaluator Form No. /7 Name of Soil Evaluator Date of Evaluation /l///G i DESCRIPTION OF REPAIRS OR ALTERATIONS The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further a eGg to n9t to plac th em in operation until a Certificate of Compliance has been issued by the Board of Health. ' Signed! ail-h CX% t1 t Date /o(i ?l'a ' / lnspecio' I/O/ s - °4 eS fir- ka 4 FJ yq[ ` )