52 Septic Upgrade Permit 2006 FEE
• COMMONWEALLTTH� OF MASSACHUSETTS
Board of Healh, ,r,�,an/AA%Pro�i, MA.
LICATION/FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT
min to Construct[' Repair lfpgrade(<Abandon( - )(Complete System O Individual Components
Location 6`u-�o gae_oOA
Owner's Name /aQ00A/
Map/Parcel/ 2 A/%TU�ki n p u-P
41,4
/EL[,EA/
Address 32 /W,D)W9 '0J� ��,
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,(/Oen1AM`�rov
Lot# pm, YS LOTOia
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Telephone# is-e6 LS/0
Installer's Name
Designer's Name/0/L ../f, s s/56t(271/
Address
Address 44,53 fr E0 FILIAL tsr I
Telephone# M 3 f 7 074/09 /z7- •�
Telephone#
Type of Building e s/(),Cailri4 t /10/4£ (�tE'r1srmiC Lot Size tx,'sr sq.ft
Dwelling-No.of Bedrooms 33i-0%n6'W AX l7'SPO SA6 - Garbage grinder(.46
Other-Type of Building cS/LJ LE //9/1!/GV No.of persons 4, Showers a Cafeteria g1id
Other Fixtures FULL-8,447
Design Flow (min..rqrequired)//O -e 9 gpd Calculated design flow 396 Design flow provid-d /S gpd
Plan: Date AOK-.i L /0 o%0/6 Number of sheets / Revision Date , ZLYJ
Title YEA17C SV(TTfd? £7. S/64/ ,=6/1— F//F•U ,tE4i206u 5-2 /1- 1-01€1,C1 6.
Description of Soil(s) �,/ ' f
Soil Evaluator Form No. rf Name of Soil Evaluator tT /'/0,S%/f/.O Date of Evaluation /2 -/3 'C)4
• 5-P64/IS 8- 30 -07
DESCRIPTION OF REPAIRS OR ALTERATIONS C nn/JG5 re" SEOr7C Sv5-r- 1 U,d /.441.E
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5E. .4YTAC_/7i/J
The dersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and
further agrees to t to place the system in operation until a Certificate of Co Iiance as been issued by the Board of Health.
Signed z r1 t« Date ,El i d
Inspections
Pere Test Witness Pa ent Record �}7 ,,�, /� �
Date: 02 / O, Amount: $�J . '�"-e-cei- 4
Property Owner
Property Address
New Construction Repair_
•cPURVES REARDON 3286
It LLEN D. REARDON
52 AUTUMN DRIVE 51)999 @t19
N' FLORENCE,MA 01062-9720 Y[✓. /3 DLO•., afuxcHI
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SAVINGS BANK N
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