332 Title 5 Applications/Permits, 1996, 2008 •
No.
FEE SO�—
THE COMMONWEALTH OF MASSACHUSETTS
kO/C//TilA,41pro N MASSACHUSETTS
Ppplictttinn fur !ispnsal System @Innstruction Permit
Application is hereby made for a Permit to Construct()C) or Repair( )an On-site Sewage Dispo al System at:
Location Address or Lot No.
Odncrs Name,Address and lel.No.
TA-v. Ns Ap —I — It
GARY WA2uE2
ROAD
Nc2rN F42A4S Rc 4t>
37,2 ,vo2TN FARMf
NoQTNAaiPicu .MA
Installer's Name.Address,and Tel.No.
Designer's Name,Address and Tel.No.9.13_c(S. 7(/p
r
T C //TT
PAHA A'ETES
/uZ Recce& sr
34/Noe-at—Vie . MA of;j%
Type of Building:
Dwelling
Other
Design Flow
Plan Date
Title
No of Bedrooms
Type of Building
Other Fixtures
Y
Garbage Grinder(Nt
No per Persons Showers( ) Cafeteria
nib gallons per day.
Number of sheets 1 9 Revision Date,
Slav Pal?
Calculated daily flow
o It 4L
6-iv
Description of Soil
S
054E
gallons.
Nature of Repairs or Alterations(Answer when applicable)
H: .-at
WA fl% $
d
_ . 119�19P'S \
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
IO /2z/9h
/67a )-75‘
Permit No Date Issued
THE COMMONWEALTH OF MASSACHUSETTS
IJORT//A/t?PTO N MASSACHUSETTS
,Npplicution for Pispasul $gstrm Construction Permit
Application is hereby made for a Permit to Construct(K) or Repair( ) an On-site Sewage Disposal System at:
FEE
Cc<
Location Address or Lot No.
TAI rAAn n — it
NORrS FARMT RS AO
Ownm'i Name,Address and Tel. No.
6ARv wARA/ER
332 A/ORiH PA AMC ea"
A/00rw4++P70 ti/ MA
Installer's Name,Address,and Tel.No.
T- rf C';iI-'Ad-
Designer's Name,Address and Tel.No.vg_0 t5- 7i 76
DAvIp S KEAtES
/OZ Au SSG. Sr a
SoNDfaL ANG MA 0 Ii1S
Type of Building:
Dwelling No. of Bedrooms
Other Type of Building
Garbage Grinder hue)
No per Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow //Y6 gallons per day. Calculated daily flow
Plan Date toll.0'R l. Number of sheets t 9 Revision Date
Title $4w k/F )Is Pin Al S YST6 • F°R AAEY ssiAF USo
I
Description of Soil 5 ca p S 11 M S ! 1. AO 19
gallons
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 Date
Application Approved by 'A--e . - A Date /G/) a SSG-
Application Disapproved for the following reasons
Permit No.
Date Issued
THE COMMONWEALTH OF MASSACHUSETTS
MASSACHUSETTS
(igr'f{fia0P
untplizatte
THIS IS TO CERTIFY, that the On-site Sewage Disposal System installed( )or repaired/replaced ( )on
by for
has been constructed in
� sposal System Const a l "1 - I dated
fify ASR4the
se of this system is'conditioned on compliance With the proyjgipnssit forth below:
The issuance of this certificate shall not be construed as a guarantee that the system will function as designed. This
Certificate expires on
DATE i ;'7),/) Inspector
(r / /c7 '
THE OMMONWE LTH OF MASSACHUSETTS
`L
No. `3y-96 L i A,!:V rod.444ASSACHUSETTS FEE sSd
I
plops/II Sgstem iLunstructiun 1ermit
Permission is hereby granted to CAA f.1'�.- tt` ' (.�
to construct(�6r repair( )an On-site Sewage System located at 7/ °' II I4+(aa v`t° S ' ° «r'
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 construction must be completed within three years of the date below. - -
/ K
/ f ti-. -71 cr ;, A_
DATE �iC�.T � ) ��' �� Approved by /—�_. _ 7L—`---.
FORM 1255 Rev.315 A M SULKIN CO.-BOSTON.MA
No
1-A
COMMONWEALTH OF MASSACHUSETTS
Board of Health,13)orAlhovvf-tOti MA.
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION
S� PERMIT
Application for a Permit to Construct( 1 Repair()( Upgrade( ) Abandon( 1 - O Complete System I/Individual Components
FE
Type of Building Jlw9le '-4 wr ' ly id0L,Se Lot Size 36.4ciees sq.ft.
Dwelling-No.of Bedrooms 3 - Garbage grinder( )
Other-Type of uilding No.of persons Showers( ),Cafeteria( )
Other Fixtures
Design Flow(min,required) 3 C gpd Calculated design flow Design flow provided 3 ` gpd
Plan: Date Number of sheets Revision Date
Title
Description ofSoil(s)
Soil Evaluator Form No.
Name of Soil Evaluator Date of Evaluation
DESCRIPTION OF REPAIRS OR ALTERATIONS
//t5fLa1( Neu-a Sepd-tL 444 it on (c/
The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and
further agree/{�a/o�not to place the system in operation until a Certificate of Compliance has been issued by the Board of Health.
Signed //— I �t a� Date 113 /sr
Inspections
Location 3aN4.Viess Md.FCOs'eyce a-0.4
Owner's Name 60. 1 tij&rs'te.✓
Map/Parcel# 7 - /p
Address y („sf CA( (Cq v.+. 5 Yee
Lot# Rae to//a/J' 007 0/8 00/
Telephone# ( (4 5-6 3 - 3F/S
Installer's Name Bob C..rgpl2
Designer's Name
Address N `BUY 445 ged Rite ace
Address
Telephone# 7f 3 5-24 a 1.1¶2
Telephone#
Type of Building Jlw9le '-4 wr ' ly id0L,Se Lot Size 36.4ciees sq.ft.
Dwelling-No.of Bedrooms 3 - Garbage grinder( )
Other-Type of uilding No.of persons Showers( ),Cafeteria( )
Other Fixtures
Design Flow(min,required) 3 C gpd Calculated design flow Design flow provided 3 ` gpd
Plan: Date Number of sheets Revision Date
Title
Description ofSoil(s)
Soil Evaluator Form No.
Name of Soil Evaluator Date of Evaluation
DESCRIPTION OF REPAIRS OR ALTERATIONS
//t5fLa1( Neu-a Sepd-tL 444 it on (c/
The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and
further agree/{�a/o�not to place the system in operation until a Certificate of Compliance has been issued by the Board of Health.
Signed //— I �t a� Date 113 /sr
Inspections
No. l - A
a1�DfS -/i-
COMMONWFALTLI OF MASSACHUSETTS
FEE
Bound u/HeaQly uaQ'\Wwi AL.
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT
Application for a Permit to Constr ua( ) Repair(Ns) Upgrade( ) Abandon( ) - ❑Complete System IIndividual Components
Location
Owner's Name
Map/Parcel# 7
-
Address
Lot#
';r
Telephone#
Installers Name
_
. . I C.
Designer's Name
Address
" -
Address
Telephone#
-,
Telephone#
Type of Building .. - Lot Size sq.ft.
Dwelling-No.of Bedrooms - Garbage grinder ( )
Other-Type of Building No.of persons Showers( ),Cafeteria ( )
Other Fixtures
Design Flow (min.required) gpd Calculated design flow Design flow provided 3 3G gpd
Plan: Date Number of.sheets
Title
Description of Soil(s)
Soil Evaluator Form No. Name of Soil Evaluator Date of Evaluation
Revision Daft
DESCRIPTION OF REPAIRS OR ALTERATIONS
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
No:-::Th7 C, t 1
COMMONWEALTH OF MASSACHUSETTS
Board of Heakh,/V 2-1/rVC44■//A7%/1/7 MA.
CERTIFICATE OF COMPLIANCE
Description of Work:)Individual Component(s) ❑Complete System
The unders4ned herby certify that the Sewage Disposal System; Constructed ( ),Repaired ( ).Upgraded ( ),Abandoned ( )
bv: .' <t Le ,/
at h
FEE C-
has been installed in accordance with the provisions of 310 CMR 15.00 (Title 5) and the approved design plans/as-built plans relating to
application - dated -7' 7,1/4- . . Approve. Design Flow '3 (gpd)
Installer V d V/(.'n-q---'
Designer: __AV/( Inspector: _ ,;1.. Date
/
The issuance of this permit shall not be construed as a guarantee that the system wi l function as designed
No. OW 7
FEE
COMMONWEALTH OF MASSACHUSETTS
Board of Health, Na / A5 3 "ICT pfflti n'
NcR', t1•l,v i7 J•�1 R.=Qvv 2 � Ci
DISPOSAL SYSTEM CONSTRUCTION PEPM
Permission is hereby granted to; Construct( ) Repaitt>) Upgrade( ) Abandon( ) an individual sewage disposal system
as described in the application for
t
Disposal System Construction Permit No. I A
dated % (j- /_.V\;;\
/�U k
ears o /the date of this et
Provided: Construction shall be completed within three y permit. All local conditions mast be met.
Poem 1255 Rev 5J 6 A M.Seiko Co Madam,MA Date
Board of Health--