723 Septic Application Permit & Compliance 1999 No. ` -it THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
+y OF I V Or-�4,lwntp Ttl,
APPLICATION FOR/ DISPOSAL SYSTEM CONSTRUCTION PERMIT
Apphcation fora Permit ro(onetrt¢l t 1 Royal( IXI UpuriJc ( 1 Ahzndon f I - ❑Complete S■■mm VIndi■idual Components
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723 Florence lor
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Type of Building: 5i -ca/uvt IAoOSe
Dwelling—No.of Bedrooms
Other—Type of Buildine
Other fixtures
Lot Size 15, ODO Sq.feet
Garbage Grinder (OD)
No-of persons Showers ( ), Cafeteria ( )
Design Flow(min.re wre ) L H 8 gpd Calculated design flow 530 gpd Design flow provided gpd
Plan: Date 3L 5/ 9 Number of sheets Rev ton Dale
Title On 1 ¥e. /S�e�],�.�Jaje-/� 0 1>foy l 5 s-k-e,,.n cyL'
Description of Soils) RTIGekle.0
Soil Evaluator Form No. Name of Soil Evaluator tek +-- SiCYrr Date of Evaluation 114 i5/9e
DESCRIPTION OF REPAIRS OR ALTERATIONS //7,-I-Fa ti pump tit p..`0n�J Gl-ta wtla<r
n i-ev zK .S- .n� £ef t L -4-a%. ,K- aet40 .2. Qsach:nga P1.lc> in btc/c \Pava
cove poser:0 of I Zo e,vl4-ec. 33p pin....,bevs.
The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of
TITLES and further agrees not to place the system in operation until a Certificate of Compliance has been issued by the Board of Health.
Signed NA-�""rn/ CCor t }a 1"a.Ve0 Date '-3 I29I49
Inspections
FORM 1 - APPLICATION FOR DSCP DEP APPROVED FORM 5/96
No.
Description of Work:
THE COMMONWEALTH OF MASSACHUSETTS
QJer--hotN.QTW, BOARD OF HEALTH
CERTIFICATE OF COMPLIANCE
Individual Components) ❑Complete System
The undersigned hereby certify that the Sewage Disposal System:Cnnsvucted( ).Repaired 14.Upgraded
by: t a P0.-ki
at 7023 E1DC-Cnce
has been installed in accordance with the provisions of 310 CAR 15.00 (Title 5) and the approved design as
plans relating to application No.
Installer
dated . Approved Design Flow
Designer: Inspector
The issuance of this certificate shall not be construed as a guarantee that the system will function as designed.
FORM 3 - CERTIFICATE OF COMPLIANCE DEP APPROVED FORM 5/96
Date
(gpd)
No.
Description of Work:
THE COMMONWEALTH OF MASSACH USETTS
)sicr4410w suit ) BOARD OF HEALTH
CERTIFICATE OF COMPLIANCE
_Individual Components) ❑Complete System
FEE
The undersigned hereby certify that the Sewage Disposal System:Constructed( ).Repaired C$ .Upgraded( ).Abandoned( )
bv: R *a Pte- i
at 7023 F( CC-Ctn[c pC,tic',
has been installed in accordance with the provisions of 310 CMR 15.011 (B 5) and the approved design}stan9las- r
plans relating to application No. dated . Approved Design Flow (gpd)
Installer
Designer: Inspector Date
The issuance of this certificate shall not be construed as a guarantee that the system will function as designed.
FORM 3 - CERTIFICATE OF COMPLIANCE DEP APPROVED FORM 5/96
3)7-<,199
L
No. /- / THE COMMONWEALTH OF MASSACHUSETTS FEE r375/ELL'
KioY-4 Lin,4-,n BOARD OF HEALTH
DISPOSAL SYSTEM CONSTRUCTION PERMIT
Permission is hereby granted to Construct ( A Rppair Upgrade ( I Abandon ( ) an individual sewage
disposal system at /Z3 F�C I"'c x& rl,t, - as described
in the application for Disposal System Construction Permit No. /y-7
/g.
,dated .�%`a>� � .
Provided: Construction shall be completed within three years of the date of this permit. ATlocal-conditio ('be met.
Date -i%�, t" '� y Board of Health C'`.7 .t/� Z. / '
FORM 2 - DSCP DEP APPROVED FORM 5/96
FORM 1255 (REV 5/96)
HOVE; HOBas&WARREN
PUBLISHERS- BOSTON