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808 Septic Application & Permit 2008 COMMON1 IAITI OF MASSACITI'SRTTS I{)N FOR IDISPOSAL SYSTEM CONSTRUCTION PERMIT cs' Location /a" /Z Fa I Map/Pareel# Og /3 /J//S //F/ )//D Lot# 027 /4 2/1/OU 44/LS /. a/• (10/ /0,t/ S 6t srsr ////77/-(g Owner's Name I Installer's Name I Address Telephone# Type of Building Dwelling-No.of Bedrooms OtherType of Building led design P Uisgn flow provided A4. Sf d Other Fixtures //(2/-5- U .04' L ,Design Flow (min lei-mired) Numhr of sheets Revision Date Address oaf' o/275F / rt.� j3 89' Bsi- Designer's Name /661 / /C /1„/ Address 5/33 P--()/7./ ,57- Telephone# --- — — - O /0/72Z I of Size sq.ft. /10//6t}7 76 /L F/O.2__ Garbage grinder yrs No.of persons_8_Showersde.Cafeteria (Aj(/ k- 2E/G//C Plan: Date Title s-"IC/177( Description of Soils) Soil Esaluator Form No. Date of Evaluation Name of Soil Evaluarur_ DESCRIPTION OF RF//RO / LT IONS 772 7( 7//.0/6/2"/ TL�F� 107- /k /u The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further agrees to,ot to place the systetn in operation until a Certificate of Compliance issued by the Board of Health. Signed F - Inspections No. C7 CQM\IQNtWL\LIII OF 'MASSACHUSETTS Bonrd of Health, , MA. CERTIFICATE OF COMPLIANCE FEE Description oT worx: �u•W�-- -°--r--- - The undersigned hereby certify that the Sewage Disposal System; Constructed ( ),Repaired.(e),Upgraded ( ),Abandoned ( ) / he: has do l 1 d plans/as-built ilt plans relating to has bee installed��i,u,,a��.. oda� with the provisions ot 310 CMR15.00 (Title 5) p No dated J /L -C j A proted Design Flow 66 1 (gpd) application Instant-1 .l�l fYr I - � Designer Lai/ _ Inspector_ • l Date: The issrunce of this permit shall not be construed as a guarantee that the system will function as designed. No.;Gee-- % COMMONWEALTH OF MASSACIIITSI✓TTS Board of Health l/g 11 frti -2471 • MA. DISPOSAL SYSTEM CONSTRUCTION PERMIT Repair pe L rade( ) Abandon( )an individual sewage disposal system Permission is hereby granted to; Goosvti t( ) a PK f— J C as described in the application for at ,�57: Y I s/< -i til Disposal System Construction Permit No. ,±Lrldateed b -/C- b' Provided. Construction shall be completed within three years of the date of this pp-mi MI local condidt s must be met. Form 1255 sec sss am AAA Co eosins.MA Date (P P(c Board of Health -n/f/C FEE cr