Lot 5 Title 5 Application/Permits 1997 i0
THE COMMONWEALTH OF MASSACHUSETTS
FEE 5 V
NOR73l4fp727t% MASSACHUSETTS
pplication for PisY"pnsttl/$gstem Construction Permit
Application is hereby made for a Permit to Construct(tl or Repair( )an On-site Sewage Disposal System at:
Location Address or Lot No.
jar koRTy Fens RA
Owner's Name,Address and Tel.No. 689- /8'7/
Kwn..) t-nrei
/99 N• MAPLE 5/.. - FtoRE.t)CCE
Installer's Name Address,and Tel.No.
Designers Name.Address and Ted No. �r 666
FRl CIC; O
sltvefj 6DR
a 96 R)v61t RC - St./WE21Am° ✓hA
Type of Building:
Dwelling No, of Bedrooms
Other Type of Building S') 4Avol No per Persons Showers( ) Cafeteria( )
Other Fixtures
T Garbage Grinder(4
Design Flow 6a6 gallons per day. Calculated daily flow 64 D
Plan Date 6 - 'I-61 7 Number of sheets 3 Revision Date
Title SussuarAC& Di5)OeSR-L 49t;-wT7& - taT5 `
Description of Soil t/ r .5 — SU(jrSO) (- - 5EL/.-/ St//350Q. — J$NdD/
67tAuct_ i Rai/WET-4S
✓
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
Application Approved by Date
Application Disapproved for the following reasons
Date
Permit No
Date Issued
3
THE COMMONWEALTH OF MASSACHUSETTS
.MASSACHUSETTS
Certificate of Compliance
THIS IS TO CERTIFY, that the On-site Sewage Disposal System installed( )or repaired/replaced
by
at for P ( )on
accordance with the provisions of Title 5 and the for Disposal System Construction Permit No.
has been constructed in
. Use of this system is conditioned on compliance with the provisions set forth below:
dated
The issuance of this certificate shall not be construed as a guarantee that the system will tundion as designed.
Certificate expires on
DATE Y,ned. This
Inspector
' n
�q—r THE COMMONWEALTH OF MASSACHUSETTS 61// 7
No. 020 //
. MASSACHUSETTS D R'
!ISpuzal $notem Construction Fir ��
Permission is hereby granted to kISIrI;LtIOII a" eTmit
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 construction must be completed within three years of the date below.
DATE
Approved by
FORM 1.255 se. 3,95 AM SULMN CO-BOSTON.MA
No.' Or' / /
THE COMMONWEALTH OF MASSACHUSETTS
MASSACHUSETTS
FEE
cApp1icutiutt for Pigpen{ Construction Permit
Application is hereby made for a Permit to Construct Do tor or Repair( )an On-site Sewage Disposal System at:
Location Address or Lot No.
jar 5- hoRti-t FRems RID
Owner's Name.Address and Tel.No. tC /3-9/
k6wA,r th r&t JO (J 9/
/99 N. MAPLE 5� - FtogeNc. "
Installers Name,Address,and Tel.No.
Designer's Name,Address and Tel.No. / /`
srsvEA) FR R4ek, PC VVJ
JY8 Rl v6R go - Su•voQ2t ✓O AA
Type of Building:
Dwelling
Other
Design Flow
Plan Date
Title
No. of Bedrooms
Type of Building
Other Fixtures
60 6
.5..-,• (AM
Garbage Grinder ito<
No per Persons Showers( ) Cafeteria( )
gallons per day. Calculated daily flow
6 - f - 9
664
gallons -
Number of sheets J Revision Date
SveScRRF�ACC QLi3tPdSr-L •S — Lot- S
Description of Soil
arc 501� j51 Lfi1 Sti135ail 5trA..�/
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
Application Disapproved for the following reasons
Date
Permit No
Date Issued
73
THE COMMONWEALTH OF MASSACHUSETTS
MASSACHUSETTS
Certificate of Compliance
THIS IS TO CERTIFY, that the On-site Sewage Disposal System installed( )or repaired/replaced ( )on
by for
at has been constructed in
accordance with the provisions of Title 5 and the for Disposal System Construction Permit No dated
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 the system will function as designed. This
Certificate expires on
DATE Inspector
1271 fitre/2
THE COMMONWEALTH OF MASSACHUSETTS Z ��.
No <C - / ? MASSACHUSETTS Frr
S -
!isposut .*gstem Construction permit
Permission is hereby granted to
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 construction must be completed within three years of the date below.
DATE
FOAM 1255 Pee 3/95 AM.6ULNIN CO.-BOSTON.MA
Approved by