244 Application & Permit 2002 —
FEE 31
COMMONWEALTH OF HASS I JIIJSSIJS
Board of Health.A(d( I A$�}DIOr.J . AL-1.
HY,V C ATLON FOR DISPOSAL SYSTEM CONSTRI!CIION I'LI?N1I
r fet
". a
: 1 na
• f R
o.,ner.Name jaA, Mr-KENNA
\rW-
Nap,
Adds,. 1 7 BLL1E 6001 4.44 - (n,C Dell /y�
Iot# -E' a4y
,i]ephoneh ( 99&) 5c1-4-- 6 3q 3
Insrllers Name
/l
- Y, ,
�L^-.LA , ��/�i�-6V
4 7
Deslgnvr's Namt 7 forI 43
(IN101r�� �s IiJ�11S
Addres. 9c MoNI ✓e/ s
�n
V'I t
Address
�
Telephonek
Telephone# ( +1� 5z 7- c2-W
\pe of Building 0 Qy ire% lot Silt .q.ft.
Dwelling-No.of Bedrooms ,D gapiiuonns f N clK--}I UN, 1 - DESIr I, A2. 3 Z g,l',set I I
Other-.Dye of Building No.of persons G Showers (fr(Serteeer t-T-1
other Fianres
Design Flow (min_required) 226 gpd Calodatedd sign flow 3 30 Design flow pt(Aided lin• Elf gpd
Plan: Date G-12 -Ce Number of sheets �
Title h - - - rA t 1 .S e-
Res non Date
Description of Soil(s) SEE pckki Ftiu,p tat_ i✓, ( , -ti(t_na�
Soil Evaluator Form No. Name of Soil Eraluatorlh 1 kE LftVI GNb Dam of Evaluati
DESCRIPTION OF REPAIRS ORALTERATIONS
AUOf <,>tttO i tttK 4&- a In ( tits . --LA/CIAO— uRt&' taC-4-1),ki
CkA,hbPTZ Si5 LW1 -Fo2 tN i 9Yr o iLy.
-r
7
•
I
6 -6 -c
e
The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and
further agrees to not to place the system in operation until a Certificate of Compliance has been issued by the Board of Health.
Signed Date
Inspections
COMYO\WLALIII Of );I 1SSACl .LSi IIS
FF F
CLRIIi1Cl1IP Oil COCA>Ll:AV'CL
Description of Work. J Individual Component(s) T Compl to System
The t ndsignjid hereby ifs'that the Selowf.,q Disposal l S tun CORP( 1 ( 1.Repaired ( ailed l I Abi a to i
at
has been tlled in accordance with the,prmidsirins of 310 CMR 15.00 (Tide.) and the app' nud le i plums/as-Inuit pla ns re ring t<i
appl rate No. /"i C �c�j-nted f �-- App t cd Design FDA.' T.7'772" tgPtl
g
Installer ?/Y ;L
Designer. -r 4A IliL,f0a 4 Date. t%
The issuance of this permit shall not be construed as a guarantee that the syst will function as designed.
( / r
✓
� ttM_3
CO 1MONWIALTI-I Of )1ASS,llrll l`SLTIS
Board of Health 4110i4Ae ittsi)f1-4/. .11d.
DISPOSAL SY TDI CON'STRI'CIION PL} S1]T
Permission is hereby granted to; Construct( ) Repairja Upgrade( ) Abandon( ) an individual sewage disposal system
as described in the application for
Disposal System Construction Permit No. / `i dated
Provided: Construction shall be completed within three Years of the date of this pfr ui II local r?t udi must he met.
oard of Health
Form 1255 Pee.5'96 &M.Sulkin Co.Boston.MA