368 Septic Application 2007 No - r
THE COMMONWEALTH OF MASSACHUSETTS
NaCroil/1rri� IO MASSACHUSETTS
cApp1izntiun for !iSpusai $gztrm Construction Prrmis
Application is hereby made for a Permit to Construct( ) or Repair( )an On-site Sewage Dispo al System at:
Location Add less or Lot No
367 C f.es -,, /r/ !� RI
FEE
L«JS
installers me .and Address. No.
Svu7�>"yrs i .,ria - y ere f
,c7 90 4)vfy gd
So✓Tts( ^7)re.. ..1,-r aio >3
Owner's Name,Addr ss and Tel o
'n. ,w HRtf 6-0 it/ 6
sry
Designer's Na er Address and Tel.No.
/
Type of Building:
Dwelling No. of Bedrooms Garbage Grinder( )
Other Type of Building No per Persons Showers ( ) Cafeteria( )
Other Fixtures
Design Flow gallons per day. Calculated daily flow
gallons.
Plan Date s Number of sheets -
_ Revision Date
Title
Description of Soil \\ -
Nature of Ftepairs or Alterations(Answer when applicable)"' jfd/a c-e
<U C
"D,5- 7- Pox r
Date last inspected
Agreement:
The undersigned agrees to ensure the construction and maintenance of the aforedescribed on-site sewage disposal
system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a
Certificate of Compliance has been issued by this Board of Health.
Signed Date
Application Approved by Date
Application Disapproved for the following reasons
Permit No. Date Issued
V
TH�COMMONWELTH OF MASSACHUSETTS
AV) FF--</—"41, ' - -,-z MASSACHUSETTS
//ma�yy '�ll,, Certificate of Compliance rte,
Li/S-.TO CbER%?sruisttt ///,si??-s.nw ti s9 �`emfortalled,((Lt.-pc-
_..5 )pr replpd�e lap�d_-2.(._on
at �S �'�x" y'�� ' �✓t f�1 p,lb'ee2gjonstructed in
accord n t�f a provisions of Tit 5 and the for Disposal System Construction Permit No / dated
PP�L / Use of this system is conditioned on compliance with the provisions set forth below:
The issuance of this certificate shall not be construed as a guarantee that thrsyste will{nnctiwn as
Certificate expir on / .4
c-14-N V 2 JCG'% j� .i2_ G�
DATE Inspector
i
THE COMMONWEAL H OF MASSACHUSETTS
ed. This
No. - MASSACHUSETrS MASSACHUSETTS FEE
!tSpIISnt g#em Constructfon Permit
Permission is hereby Y{a�ted to Sa v7Ni9 h//3»n Sq v771,4"/ e.may
to construct( ) or repair an On-site Sewage System located at 36 L' NES7C./fir/ bG-ia /�O
and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his her
duty to comply with Title 5 and the following local provisions or special condition* - �/
7
All construction must be completed within bv�o,y,�aj of the date below. 7.,, 'r„ ' '�-�-�
/
DATE ✓A.-,t I 1 Approved by L .,C. L---
FORM'355 Rev.a 5 AM SULK'S CO-BOSTON.MA