48 Septic Application & Permit 2005 00 eCi-61E7
CONMoN'wIKA14)f �i \SS;\i 11L'SFIfS
Boardvim/Ii •osTnpneTotU
LION 1:011 DISPOSAL SYSII_I\1 IIONS1P,11C1101N
p-,,al
Are. DtNpwy PRtvE
40vnersN. ne vICC.k )°yGC
Addres. 45l C /v)o CI-CP U1/4„)1 . L
1eIeplone# (4l-J) 3{yrt--.98t C CGL tit j
i},ue 'N nntelr„r yl E. v\ACs1NN,5
Y ci
Map/Pant-l#
LoI Ar e
Installers Name Ma52C L.A.� VA L/.'G e11
�4
Adh � aVCS�,L RVAD- .Cuok_,Ct- Alhe• 70 NAON-T• v/ r..- �1 k a .4 •
Telepltne# 4 3) C _ 3�� 9 t ref �'
J
/Trlr piton ur (4-v 52.7=Si 9 J
Type of Building
Dwelling-No of Bedrooms
Other-Type of Building
other Frain es
I
Lot Size e, a o G — sq-ft.
No. of penmis El Shower s (L):Cafeteria (
Design Flow (not it quiied) 4 40
Plan: Dare 01 — I t- O S
Tide PRtIIpOaD
Des(riptiou of Soil(s) Y'I CAL
Soil Et alumni Form No.
gpd Cal( la
Number of sherd c Rrtoot Dare
5, D5✓2-EAC% S2WPs6 015Po5AL
1.-/f%
I desigf now (0fcs0 Design How provided74-Cs gpd
NIP(
Name of Soil Evaluator lOhl r M-1<( •
DESCRIPTION OF R P IRS ORALIERAI IONS BLC Al NU
New Pl ■RtIovt R-D aNin) 4 Et CHES
Dale of Et-aluation OI-Of1 -05-
X 3`w x 2' p
LC.
ck
The undersigned agrees to install the above described Individual Sewage Disposal System in .with the provisions of TITLE 5 and
Further a• ees to not to place the,system in operation until a Certificate of Cxrnpli e has been issue y the Board of Health.
Signet I 1C1C. �.S'-'-� 1�.. _ Date /� g o
a
Inspections
No. 17[(15 -G
CO I IO '1\'E \LTIT OI N \SSAI:11L`SEIIS
Board 4 Health //1/./lit J mit
/Pro/ 5,A,5
OF C(Th1PLIANCE
Description of Work 0 Individual Component(s) 7 Complete System
The undersigned hen thy cernf that the Sewage ge Disposa l S I u n; Clunntrin ted ( ).Rep cd O.Upgraded ( ).Abandoned ( )
h}, ��},ZL L4VALLEy rim-7 .....
FFF '
*z-
rine-222
at
has been installed in accordance with the' p 'abs of 310 CA1R 15.00 (Title and the 11 oced dg plans/as-hii It plans relating to
application No.:,o -Cn dated a
/5— Apptor d Design Flow 7e (gpol
Installer k e. a
Designer: a . 'Ya. / Inspects 7 .„17/t /..2%[ A a:rate) Date:
The issuance of this perrhit.shall not be construed as a guarantee that the system Will function as designed.
3
COMMONWEALTH Of MASSACHUSETTS
Board of Health. �a,.a M7lL �%l'7J V.L ii
DISPOSAL SYSTEM ONSIiUC_FIDN PERMIT
Permission is hereby granted to; Construct( ) RepairO Upgrade( ) Abandon(
et Lit { if/ i1) 6au — (.Lbrpa 7 LA s l i?a'.F
Disposal System Comp Itejtion Permit No. 2ATr”— . dated a a 7i " 1/-5
an individual sewage disposal system
as described in the application for
Provided: Construction shall be completed within three rears of the date of this permit. AIJ local conditions must be met.
Form 1255 Rev 5re6 A.M.SWAM aP Boson.MA Date 1 —"n Tho a rd of Health
•
<:)-2 (i/ _01_