573 Applications & Permits IC
FEE
COMMONWEALTH Of MASSACIIUSTTS
Board of Health,yle7ratieu i7� L) MA.
TION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT
l/G �h�TZN.i �40
Owner's Name Pnuu BLaet4 Lap`p,�
ii913
ip/ParrVreel#
Address 5'73 U EST.[Yvs fro*) RL -p
,; �' ii„,,__L
tti ^
•
Telephone# /¢433 (4 y'i9
r
Name
Designer's Name^ *(�� E t LC
Ptaper's
ldress YYY�������^^'7�7°°°"'
Address le mila Le€� zoor4D.Atjaciv,phu
lephone#
Telephone# (4tt Stn St%1
Sill LE ?4 kt,ty Lot Size l AE4W T sq ft.
Ming-No.of Bedrooms
Ga.Lag �o..� v r
No.of persons Co Showers :fafnel a( )
rType of Building p
•of Building
r Fixtures
gn Flow (min.required) '330 gpd Calculated design flow 4qC
: Date G - ly -OS Number of sheets
:ription of Soil(s)
Evaluator Form No.
' L h _
Design flow provided
.
Rev on Date MfIa
l Ys.)
'[-.-
gpd
Name of Soil Evaluator ______ Date of Evaluation to-a'S-0
CRIPTION OF REPAIRS ORALTERATIONS
Rcpl„4c. NFU N U- %AS of )y
undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and
her agrees to not to place the system in operation until a Certificate of Compliance has been issued by the Board of Health.
ed Date
tons
CONMONIWLALTH OF ';'+IASS}AI UUSLIIS
Board of Health, N Yv�,/ , MA.
/ (-As unrb RTjflt iTI. Of O:�11�L1 iV'Ca:
pt o f Work; 2i ind viduai Comp e t(s) 7 Complete System
, d 'pgraded ( A red C
td< signed hereby certify that Sewage Disposal S stem: (d su uudd ).Re/pile
147.218-(i f ge .rsi /✓ . »r /n4ba 3 a CNR 15.00 (Title 5) and th j2p'ored design plans/as-built plans relating
Approved Dedgn Flow (g( 0 �1Ctl)
�.J L. C0 �
FEE J V•��
t atco d.ance with t
canon Noo/DDS 7 . dated
11c tC
N'icisit s of SIII
t,l� �
r °
01er7/1 1l'Jl :✓.vNi.S� inspector:
issuance of this permit shall not be construed as a guarantee that the sss
4a-ii fart
ti o <
.9/
Date.
in will function as designed.
CONI IONWLALfll OF N\SSAIL-HUS1�TIS
mum]of Health, /1/1 bLl-
DISPOSAL SYSIDI CONSIPLt:11O,N NOM
nssion is hereby grail yd to; (km struct( ) Repa
FLt ��' (-D
o2 �L;it, a6V3Z
i ) Upgrade ) Abandot, ) an individual sewage disposal system
�,„��-�, ".
lit /„��-vs� iv� �'y{ as described in the application for
Bosal System Construction Permit No) , if
vided: Construction shall be completed with'uthrc
1/�
255 Bev.596 AM.Swan Co.Boston.MA
DatcO /DS
.dated (,-)//7 os .
e veal s of the date of this permit tAIl local conditions must be met
Board of Hcallh `r/<-e;
COMMONIWFALIA OF MASS IIUSFTTS
FEE j5✓
Board of Health, s7d /'t MA
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT
cation for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) - O Complete System ❑Individual Components
■ -
_atirn �93 er u.,n�o
Owner's Name Z7 es 21-#4. 1/�GAie
'"
/Parcel#
Address — Sw�..r e —
p
Telephone# 4/3 5,--ta -..29
;taller's Name ' I (�n-'OS
Designer's Name
^�Q. nPS
dress (1„.„..0. ''_----����rrssss]]//''
Address
��(
lephone# q 17 — 6.75,1_ ;L(/�'e7
Telephone#
of Building — fvrivk 1A (Dbtj ULed Lot Size sq.ft
Garbage grinder ( )
Mingy of Bedrooms •
r Type of Building No.of persons Showers O,Cafeteria( )
er Fixtures
gn Flow (min.required)
: Date
gpd
Number of sheet
_dption of Soil(s)
Evaluator Form No.
ated design flow
Design flow provided gpd
Revision Date
Name of Soil Evaluator Date of Evaluation
iCRIPTION OF REPAIRS OR ALTERATIONS
undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and
titer agrees to not to place the system in operation until a Certificate of Compliance has been issued by the Board of Health.
ned Date
potion
r
CUMMONWFALTII OF MASSACHUSETTS
Board of Health, 4 i/1 i in//
CERTIFICATE OE CO4PLUANCE
ription of Work: ❑Individual Component(s) g3 Complete System
inder�hereby certify that the Sewage Disposal System; Constructed (),Repaired M.Upgraded (),Abandoned ( )
J ow,.c S ✓I IC..,er
S'73 hk kL.<✓-tic,.., 2 cf.
teen installed in accordance with the r is ns of 310 CMR 15.00 (Title 5) and the approved design plans/as-built plans relating to
catlo,.tio. Sol}-4 dated 6/6(1? . Approved Design Flow 3S6 (gpd)
Ilex '' - X .ea ". i '' .g
1. �Oim 3- o0"...., Il Inspector: Y 6 Date: i/ (//
issuance of this permit shall not be construed as a guarantee that the system will function as designed.
COMMONWEALTH OF MASSACHUSETTS
Board of Health,,/;C. , >'J/C..,/ AM.
DISPOSAL SYSTEM CONSIRUCTION PERMIT
mission is hereby granted to Construct( ) RepairX Upgrade( ) Abandon( ) an individual sewage disposal system
L, / // . ���1�i as described in the application for
p
posal System Construction Permit N . /.. // dated t /r'9/'2
vided: Construction shall be completed within three years of the date of this permit. All local conditions must be met.
1255 Rev.sn AM.Suu'n Co.CharRgown,an Date 4 i?1,/ Board of Health r.-
/ i
4
anon to
y dT
FEE ✓�
COMMONWEALTH OF MASSACHUSETTS
Bomd of Health, Northamm p/on MA.
APPLICATION FOR DISPOS,AI. SII'STEM CONSTRUCTION PERMIT
-non 573 We5fh Qinp fan /2OOGI
Owner's Name JOtna5 d Nancy Fisckinie.r
✓Parcel# 42/99
l//
Address 573 kleshornpMri Road
/
Telephonc#(41 3) S84 . 7821
o
:tiler's Name Trueharf q 0✓ ]4 e O stnicho✓
Designers Name
gerl f4 e Survey:, roc.
re" 27 Cuder. Nighty" Soufhamalnn
Address
Coil ¢ Niyhway e ark Sf. P4.Box 1
-phone# (4/3) 5Z/-72410
Teiephoneit 413) 527-,3Cno0 ,50V/h4nnpfon
dBuilding
ug-No.of Bedrooms 3
-Iype of Bnildina No.of persons
F ir a res
l-Jo USE
Lot Size
sq.ft
Garbage g REder
Showers ( ),Cafeteria O)
I Flow (min. required) 330 gpd Calculated design flow 444
Date A4VCPRbtr ea) 2000 Number of sheets /
lieh of Proposed swag_ Disposed 5vs+U'n Up3retdt in
phon of Soil(s) 5ee Ptw- -for Soil LociS
ahtaror Form No. Name of Soil Evaluator Mark P Reed
Design llow provided
Res uion Date
Norfhaviipl-on / MR
444 gpd
Date ofEcaluanun /0/25/00
-ZIP DON OF REPAIRS OR.ALTERATIONS ,CXI5f1114 5eph G Tank fo be. I n30ec I-ed
ri In I t rho .e c 0 ac,e W Soo anon ' K 'The In fa
a ao x30 leap - Reid
( 0n
-dersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and
r�y{�,ees to not to lace a system in operation until a Certificate of Comp once has been issued by the Board of Health.
It v ws^'A_ Date /gee' e0
Lions
iJUNL][)INWLALLI LN ..M1\SS,11 IICSI ITS
Board of//milk.
1:L1R 111:AIL oL LONPJ !ANIIL
Lion of Work: $individual Component(s) J Complete System
Arilsigned hcrelm-certify that the Semige Disposal System: Comm m red ( ).lief Mired O.Ahandon<
�/ h :fit ityt r
r installud in a ocdance with it lei 1 r.inn or 310 ( \IR 15.00 (hide 5) and t1 tI Prored d plant/ash It plans reP.
Mon No. L�T dated -4111 I Approved Des Flow/it�R (gpd)
/// /RUN / )41%�f I. � y am!/-+-t
eiZet if Y1/4 / Inspector / � (^ ti _ .. Date:
.ounce of this permit shall not be construed as a guarantee that the system will function as designed.
CU PI0N\ 'I.ALIN O- M1SS.11_IIL'SLiiS
Board of Health, /4/2//4P ,)%17 ALA.
(DISPOSAL SYSTEM CDNSTi?i _LON PPk IJ
/2/16/do
9O"
ssion is herebypa d t u, Con stuct ) Repaukk)/Upgrade( ) abandon( ) an individual sewage disposal system
�� I �lli%LM � as described in the application for
sal Sstem Construction Perin N 41/4/- .dated ///?//z2
led: Construction shall he completed Ivithin tin
P 96 A N$Jlt'r C2.Bston.MA Date /r t</>
ee sears or the date of this it All local conditions must he met.
Boatd of Health ,(J-:/�