13 Septic Permit THE COMMONWEALTH OF MASSACHUSETTS
el Ai
MASSACHUSETTS
f� inn for !ispimat `p� Sp em lLOnslructiun Permit
made for a Permit to Construct( ) r Repair an On-site Sewage Dispo.al System at:
Location Address or Lot No. /o7 3n
/3 .BAyBG-RIR G
1 / As
<r' Name.Address and Tel.No.
Oq.gv,,b Lsils/aVA/%
/V 0 " la At41• •h/ •
s.
. 44
Ins�allees Name,Address•and Tel No.
De_Sign ' Ma me.Address and Tel. o
W e s d M enelmJ: /M1,A
SLi-
z 9/
Type of Building:
Dwelling
Other
Design Flow
Plan Date
Title
No. of Bedrooms
Type of Building >nAK+ ittnil
Other Fixtures
35A•6S
9- '6
RAW PRI)
Description of Soil
Gweittetge-Cminelee+
Na per Persons In Showers( ) Cafeteria( )
gallons per day. Calculated daily flow
Number of sheets
338
Revision Date
gallons
3d1a5 s St A rr66 pI5p03S-L- s 1 RspAi-
!YT — ripe IJAUDt/1 5✓6Sent. •- 1116D 5/3.w2
MA/P
Nature of Repairs or Alterations(Answer when applicable)
Date last inspected'
Agreement:
The undersigned agrees to ensure the onstruction and maintenance of the aforedescribed on-site sewage disposal
system in accordance with the provisions of Tit 5 of the Environmental Code and not to place the system to operation until a
Certificate of Compliance fia been is ed b is Board of Health. / q /
gned V fart /IIP�'-^^ Date 9/.S ! fa
Application Approved by Date ///
Application Disapproved for the following easons
Permit No
Date Issued