163 Applications & Permits THE COMMONWEALTH OF MASSACHUSETTS
•MASSACHUSETTS
■ plicatiort fur !iSpu%fh `, gztnm Construction Permit
pplication is hereby made for a Permit to Construct ( )or Repair( )an On-site Sewage Dispo al System at:
Owner's Name,Address and feed..No,
)r,t&L i- In v-5 T 6s/ L •
FEE
Location Address of No.
U,) �c�1ve5%t
yt)-PI 7-?Cot
Installer's Name.Address,and Tel No
Sw, e,
'ype of Building:
Dwelling No, of Bedrooms
Other Type of Building
Other Fixtures
Design Flow
Plan Date
Title —
Description of Soil
Designer's Name,Address and Tel.No
Garbage Grinder( )
No. per Persons
Showers( ) Cafeteria( )
gallons per day. Calculated daily flow
Number of sheets Revision Date
Nature of Repairs or Alterations(Answer when applicable)
RN - N i
Date last inspected:
Agreement:
The undersigned agrees to ensure
system in accordance with the p ovisions o
Certificate of Compliance s en issu
Signed
Application Approved by
Application Disapproved for the following reaso
gallons.
✓ c- L ;fC .
the construction and maintenance of the aforedescribed on-site sewage disposal
Title 5 of the Environmental Code and not to place the system in operation until a
ti's Board of Health.
As
Permit No.
Date
Date
Date Issued
�3 r-
3 r
l
THE CQ{AMONWEALTH$F MASSACHUSETTS
} MASSACHUSETTS
Certificate of Compliance
wa a Dis,osal System i L io r ra4redjreplaced(' ) on TT-WS TO CERT7FP, al the yr g for
"77 f- -
has been constructed in
�1 it br� a a 7 I
aat accordance with the provisions of Tale f Disposal re Construction Permit dated
Use of this system icond t oht n compliance h
the provisions set forth below:
not breconMaed as a guarantee that the system will function as designed. This
The issuance of this certitica
Certificate expiries on
DATE
No.
Inspector
WE CQ�MONW ALTH OF MASSACHUSETTS.
-47 iF ill (2'4"--1 MASSACHUSETTS
Co strnction ' ermit
Permission is hereby gran to' -
to construct( ) or rdppir( )an On-site Sewage System located at
^.
and as described in the above A placation for Disposal System Constmetion Permit. The applic4nt recognizes his/her
duty to comply with Title 5 and t e following local provisions o`s ecial c -- •.- i K r i -
� u
ed�vithin two years of the date bow.s V.� �' ✓/ ,
DATE Feiistruclian must p com�tj( Approved by
DATE
FORM 1255 Rea.&950.M.SULKIN CO BOSTON MA
FEE
FEE —✓
THE COMMONWEALTH OF MASSACHUSETTS ASSACFIUSE lS
ak.a..•
•ration for Pisposal ,flstem Construction Vienna
_ Sewage Disposal System
at
aj n I er «or Repair( )an On site S g
made for a Permit to Construct( Address and Tel
rs hereby tor
A L9 Bl3L
ti n Address or Lot No. RCInD
s_A 5ycv&s��
a ton
alleri Name, ddress.and Tel.No.
!avaif� 1s
No.
DwnerS Name.
rKnecES F Lls
/GJ sytv6S7l RD A
1- Mare sdnd Tel.No.
Designer's Name.A•
TMITV F 6 In R/DWI(
aim 1r .
Garbage Grin er( Showers( ) Cafeteria(
e of Building: ryW, No per Persons
Dwelling No. of Bedrooms
Other Type of Building gallons.
Other Fixtures Calculated daily Bow
gall s per day. Revision Date
/d$f tdi•
I /IL=V:
a�
�// 9g
sign Flow 5"--m Date /2"'7 .�R,Sa1.
Title �-
escriplion of Soil
on p
Number of sheets
iature of Repairs trans(Answer when applicable)
Date last inspected.
Agreement:
lace the system to operation ewagdi until a
The undersigned agrees to ensure the construction and maintenance of the aforedescribed on-sue sewage dispose
this Board of Health. Dale
system in accordance withthe provisions of Title 5 of the Environmental and not to
Certificate of Compliance has been issued by '
Signed ��f��� � Date
Or
Application Approved by
Application Disapproved for the following reasons
Date Issued
THE COMMONWEALTH OF MASSACHUSETTS
•MASSACHUSETTS
(Certificate of (Compliance
is osal System installed
that the n- for
by
Title 5 and the for ispo
Use of this system is conditioned on compliance with the
tolled( )or repaired replaced( ) on
THIS IS TO C h 0 site Sewage Disposal
p sal System Construction Permit No.
rdance with the provisions of Tit
The issuance of this certificate shall not be construed as a guarantee that the system will
tificate expires on
1TE
Inspector
THE COMMO WEALTH
n. isposal *Ste
eB4-c
construct(repair( )an On-site Sewage System located at
Permission is hereby granted to
F MASSACHUSETTS
ASSACHUSETTS
FEE
has been constructed in
dated
provisions set forth below:
function as designed. This
(Construction Permit
/35 E
:
and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his i her
duty to comply
with Title 5 and the following local provisions or special conditions.
ust be completed within three years of the date below.a< /c r Approved by
All construction
DATE
MUSS CO•BOSTON.MA