Lot 27 Title 5 Application/Permits 1995 (2) '..A o kulf illbSON UMW CI KV!J.
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THE COMMONWEALTH OF
rRJLLILILLL
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HUSE1co �l'�
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1/413plirtttion fur !ispusttl . gstem @lonstructiun Permit
Application is hereby made for a Permit to Construct k or Repair( )an On-site Sewage Disposal System at:
Location Address or Lot No. �` n _^ � n
LaFa7MApleP-"' /2t
Instal is Nam Na Address, Tel No
BUD' ' w
Oryners Name, dr ss Tey No
reel/r
Designer's Name,Addr ss and Tel No
Mae P� 4$50x. Mitt.
51��h r rue s MA 0i3 70
Type of Building: �y�
Dwelling No. of Bedrooms Garbage Grinder-fay-
Other Type of Building No per Persons Showers( ) Cafeteria( )
Design Flow
Plan Date
Title
Description of Soil
Other Fixtures
µyo
gallons per day. Calculated daily flow
Number of sheets
, may,—„-ee -
,,A56 +
Nature of Repairs or Alterations(Answer when applicable)-
(c7�-
Revision Date °N
fire !
t 0.
gallons.
,tom D w £A-,C
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
Application Approved by
Application Disapproved for the following reasons
Date
Date
a/f/ r
Permit No.
Date Issued
Ne.
3( 5` 9
THE COMMONWEALTH OF MASSACHUSETTS
MASSACHUSETTS
cAppliratiuu for plop-awl System Construction Permit
Application is hereby made for a Permit to Construct o Repair
Fee S
Location Address or Lot No.
1,04 v Mple
an On-site Sewage Disposal System at:
airLAi` '%�"�,CLNd fn/c5 C.-rY
JCU-c t% %IJL-ct
DoKiwni Aadpcs` awc.TeLT.v9-c
Shr-13J vn e -4'-a(l5 JPA C/i7C
Type of Building:
Dwelling No.of Bedrooms
Other Type of Building
Oth5 tures
4 )
Design Flow gallons per day. Calculated daily flow gallons
Plan Date
Title
Descriptiof
Garbage Grinder
No per Persons
Showers( ) Cafeteria( )
N ber etc e
sh� raC R ;°e"ftfp
ap_e
oil- Q c//li -it-r.-�.-.. 5;42- - i ice`
�.-4 r %e- .,c c ( /r; w(t
Nature of Repairs or Alterations(Answer when applicable)
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
Application Approved by
Date
Date ///0/ / �r
Application Disapproved for the following reasons
Permit No Date Issued
I COMyrytUNWEALT F MASSACHUSETTS
bAl ) N ."1— MASSACHUSETTS
Certificate of Compliance
/�H1� T RTIFY at e 6 age i sal S stem insta r re a
� - [" fi,', 1 1 it'1`. ... rTfPz.C,� Y for e P /i cedC ) on i.at ..�G't y . L_4t A-1r
his,heeg stmcted in
ae apcewle the pEevisions of Title 5 and the for Disposal System Construction Permit No r/Y / dated
' / .1---) Use of this system is conditioned on compliance with the provisions set forth below:
The issuance of this certifica(ysba dlas a guarantee that the system will function as /Oiled. This
Certificate expires o 1 e ° P
DATE �� _ o �� Inspector '��rdr^ Gr_ic
t
"4), f5'
TH COMh ONWEAL OF MASSACHUSETTS r504°.
No. I/ )I MASSACHUSETTS FEE
PISposa X18 m Construct n ermit
PermissL is hereby granted to
,c_Ar
to construct()or repair
( )an On-site Sewage System located at
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 conditions.
All constructionn/Q�ystt beC meted within two years of the date below.
DATE "/ � 7� / S j
Approved by
FORM 1255 Rev.Y95 AM SULFA CO.•BOSTON,MA