106 Application & Permit 1998'p
FEE
COMMON\i.TALTII Of MASSACHUSETTS
Board of Health /e01a/4n. /GI.51q
PLICATION E®R DISPOSAL SYSTI I CONSTRUCTION PERMIT
Location,e0.64AtE ,C't
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Owner's Namenalvezre Occo nl.
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Address /O LC/a`r/�. /p - T
Map/Parcel# ep , �/ a /
I at# al0 et/ /
/ r77.f� ST
Telephone# 5-496. 30� G
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lusmller's Name , Cep �j ff
2 Se7t)1•6
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Designer's Name 1...e./L.7-5./..g y(�(/J�'W "Oa
Address s si. _ : _
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Address 1.1-41 O/C/O&G/ /ia"
Telephone# Et ?
w
Telephone# -
pc of Building /Lee /�/7e2///'es- /, n-C
telling-No.of Bedrooms ;3.LLe..O//6Om £tierr/ 12/SSOOS/JG Garbage grinder (54/1,5
then-Type of Building / .00s, C P4.2 /% /tS No.of persons // Showers a Cafeteria pC/U
ther Fixtures
Lot Size -
ti
%f7
ussigu Flow (min. required) /10 v3 e/C9 Calculated design flow ,69.-5- Design flow provided w579 to gpd
Date �1//! /797 Number of sheets / Revision Date 4PO4-0?4PO4-0?am e (.52/0117 0-7fre-927 /49z170t1 , a a 600,0am4..) /00 Cu,,-- Zee
rscnpt on of Soils) Q.0 /77777CAde 577
ail Evaluator Form No. // Name of Soil Evaluator//.Ut%-if/��'.C/ re of Evaluation B�O'7 9 7
ESCRIPTION OF RERJ S OR ALTERATIONS ir�/S!/.1%J9 /C�//L *Co Zirt& /7
`/ ezJc.&zr /t ',c/ncea Gu/7-i 2r°4 -' LP/dcA ,4/£G.t2
ie undersigned agrees to install the abo de d dividual Sewage Disposal System in accordance with the provisions of TITLE 5 and
rther agrees to t to place the syste o. on tit a Certifca : C.mpliance has been issued by the Board of Health.
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COMMONWEALTH OF MASSA ]TUSFTIS
Board of Health, Al / i1' k' MA'
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CERTIFICATE OF COI PLIANCF
Description of Work: dividual Component(s) ❑Complete System
She undersigned hereby certify that the Sewage Disposal System: Constructed () Repaired (( Upgraded () Abandoned ( )
be —e P f M � 4 � V V r Cac-
at / C(/' tl Ca t-E-I f
has been installed2ra?ceoFdaticc with the pro isi n s o f 310 CMR 15.00 (Title S) and the approved desidesign plans/ -built plans relatin
application No.
dated it / . Approaed Design Flow S� (bpd)
Installer t o" �[ r�erP .w ,i iC ,� 1 /— �—�d
p (^"? a"_ Date:Designer: �i H4 See Ic L� Inspecmn `�
The issuance of this permit shall not be construed as a guarantee that the system will function as designed.
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CV N v 5 • COMMONWEALTH OF NASSA' IIIISFTTS
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T]'2 Board ofHeaGh act 4(
g L G s 92 DISPOSAL SYSTEM CONSTR. JCTION PERMIT
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E 64144 is hereby grante to; construct( ) Repair 0.- Jpgrade( ) Abandon( ) an individual sewage disposal sr
Ha, ar/d&/_ It) �+ • as described in the applicatior
m U/ ���III�MM�"'111 ��� /'�J yam/
.ti tnu to 49r4--71, dated M1.9/61/
l> agl stem Construction Permit No.
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� o�a�r�Construction shall be completed within three years of the date of this rill lo con s must be m
C] p /(i ( Board of Health C
f on IFee 596 F ad A91tiCOiBS� MP � Date