710 Title 5 Application/Permits 1997 lo.
FEE
COMMONWEALTI! OF MASSACHUSETTS
Board of Health, Nor I-ha nn pfoi
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT
.ppbr at ion for a Permitt to Con srrucr5 Repair( ) Upgrade( ) Abandon( ) - 'ajComplete System U Individual Components
Location North (Z1rnt, Read O or+ilenn Wards)
Owner's Name S1Cleil meadow 1+operhes LLC
blap/P:ucel#
2/i
Address 4/8 G-a(!-t 5 54PPb Woyfiawtpin1
Lott LI
Telephone# NM) .58t9 -£?za 7
installers Name
Designer's Name Herl+a(J . 3, rveyb, TC.
Address
Address a ( # • J E e ark S i1 "l0.3oX I
l� ( G
Telepbonett
Telephone#( t'�I5 7.- X60 s l
,3 ,�Lfharnplovlj
ype of Building
welling-No.of Bedroom s fi edreon i
House
Lot Size A/I ./t(J ' sq.ft.
Garage grin r( )
other-Type of Building No_nC persons Showers
O,Cafeteria ( )
other Fixtures
esign Flow (min.required) t9t,O gpd Calculated design flow Won Design flow provided C(oO gpd
Ian: Date Jt1fOOX 1-7, 2003 Number of sheets 1 Revision Date Maly In 'Z0 2003
iae Nc ctheri vMnds Plan of Proposed 5ew& e. Dir pe' J 5yslem Parcel 4
cscription of Soil(s) 5F('. PIo,yn -rev- Sni I Lo-95
ail Evaluator Earn, No. Name of Soil Evaluator mark Reed Date of Evaluation 4 i Zs/o?--
ReviSieJel p
ESCRIPTION OF REPAIRS OR ALTERATIONS CYIIaI'rcl Iona -Plc, Id per NafE<1Cur1
I5x larcyr Fiaily Plow rerit yore vneh+
he undersigned agrees to install the above described Individual Se
muter agrees to not to place the system in operation until a CeVi
gnerl /\
c
ispertiol
D osal System in accordance with the. roviii13 44b @$1 n
ompliance has been issued by the 9ea d of HEalth.
JEISSE
ith 9623
ISYER
are
and
No. s17.
THE COMMONWEALTH OF MASSACHUSETTS
BOARD/ O✓F� HEALTH
(i< OF VO(2-r t r i+o n,Oa
APPLICATION FOR IjISPOSAL SYSTEM CONSTRUCTION PERMIT
Application Cora Permit to Construct Repair ) Upemde ) Abandon ( ) - ❑Com Complete System ❑Individual Components
ype of Building
s/n)6
)welling-No.of Bedrooms 2
A_
Lot Size t ZS /YCR6jq,ft.
Garbage grinder (v)�
)ther-Type of Building No.of persons 6 Showers 0 4,,r' a. ,7O
h her Fixtures
)csign Flow (min. required) '3 3 0 gpd Calculated design flow 4C/5 Design flow provided (n) 3 3'-gpd
'lair Date /c)`OS` 4y Number of sheets / Revision Date
ide P(MA) OF Pk s&O 54.465c/P9 f p &u 4)/;JOt C_ Sy57`/�8/»I
)cs riprion of Soil(s Q L /O/R 3/T- (8J S/L /0 R '% CQI)(kwf) WC ( sy5 `in, J N//
oil Evaluator Form No. Name of Soil Evaluator/ /)iJ)O/AIN i3 Date of Evaluation
)ESCRIPTION OF REPAIRS OR ALTERATIONS
'he undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and
urdter agrees to not to place the system in operation until a Certificate of Compliance has been issued by the Board of Health.
Igucd Date
nspections
went:- "V
o „ is Fame
o . `lit LAT,.
//a9 Aid itril 964/2,416' 0091)
Location
Map/ParaN
a
( do 'eat '
f
I
es
NamclammpladA
1111
Lot
_ Inaallers Name
�`
tt moz VAGoe 4
@(s)Sal-saki
Address
TdcphoneM
Telepfonei
ype of Building
s/n)6
)welling-No.of Bedrooms 2
A_
Lot Size t ZS /YCR6jq,ft.
Garbage grinder (v)�
)ther-Type of Building No.of persons 6 Showers 0 4,,r' a. ,7O
h her Fixtures
)csign Flow (min. required) '3 3 0 gpd Calculated design flow 4C/5 Design flow provided (n) 3 3'-gpd
'lair Date /c)`OS` 4y Number of sheets / Revision Date
ide P(MA) OF Pk s&O 54.465c/P9 f p &u 4)/;JOt C_ Sy57`/�8/»I
)cs riprion of Soil(s Q L /O/R 3/T- (8J S/L /0 R '% CQI)(kwf) WC ( sy5 `in, J N//
oil Evaluator Form No. Name of Soil Evaluator/ /)iJ)O/AIN i3 Date of Evaluation
)ESCRIPTION OF REPAIRS OR ALTERATIONS
'he undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and
urdter agrees to not to place the system in operation until a Certificate of Compliance has been issued by the Board of Health.
Igucd Date
nspections
APR 2 3 ;g7F COMMONWEALTH OE MASSACHUSETTS
Board of Health,
CERTIFICATE OF COMPLIANCE
lescription of Work: ❑Individual Component(s) ❑Complete System
'he undersigned hereby certify that the Sewage Disposal System; Constructed ( ),Repaired ( ),Upgraded ( ),Abandoned ( )
FEE
as been installed in accordance with the provisions of 310 CMR 15.00 (Title 5) and the approved design plans/as-built plans relating to
pplicatiou No. dated . Approved Design Flow (gpd)
astaller
tesiguu. inspector: Date:
he issuance of this permit shall not be construed as a guarantee that the system will function as designed.
`( it y,7 r'tir. SC,(tl
COMNIONWEALTII (MASSACHUSETTS •
r(n a 1 (� �h1A.
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'a0 e O c. Bua < (Her(t n, vr'-t r ,
ro FC1 ° DISPOSAL SYSTEM CONSTRUCTION PERMIT
`' V," k
bhfis hereby r mu.. h; Consnt¢t( Repair( ) Upgrade( ) Abandon( ) an individual sewage disposal system
p
IDr� ft il,i,}iiiy iJ[cl`Gs ��chF �e�ibed in the application for
kp
'tsti ,pi )stun Construction Permit No -2-7 dated ///107a/
Prwads Giusti urnon shall be completed within three years of the date of this p mt All cal conditio nu{st be met.
��9wss stns nM Sunn Co.Be▪9109,inn Dace //��'���oard of Health i'` / % -.—__—