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160 Applications & Permits No Zoe c-B.� THE COMMONWEALTH OF MASSACHUSETTS BOARD /OFy HEALTH n OF !t/ o /a't !f TT✓1 i" (V APPLICATION FO DISPOSAL SYSTEM CONSTRUCTION PERMIT R [ ) t peradc ( Alnandnn [ ) - omplete System ❑Individual Components FEE SO'at) PdC+40643, Application tor a rennin to LOnSINCI f 1 .-E"`• - . 442774- N rn-,Z/ tf siFrwro 4 c4 A/%4 �i,✓ �. Mp�a,✓ 9�£P� -mmor,d4a & l—Y .Tat..P X57 eP Pp pe 4,3-'SR'F- 0' Tr vnoaer Map:Parcel n w„< 29L Designers nem- /' N. wHti sr L, to//Gv�rca�.1, nianu�s yaaie 7 flares. ii/-Sir— 3 ezz— AU?, aadtiu Te crbolc 5/9.q _ iJepaooee _.In T Type of Building: T^/ uc7= `d' 12e74f(- Dwelling—No.of Bedrooms Other—Type of Building No.of persons Lot Size Sq.teet Garbage Grinder �/� Showers ( ), Cafeteria X�e Ole-55 Other fixtures Design Flow(min. required) ep � O X50 } '200 d Calculated design flow 350 gpd Design flow provided gpd Plan: Date.TA/s/ ZOOS- Number of sheets 2 Revision Date Tale SCPne- sy5>-&-r 1 PLAr.! Description of Soil(s) - f 1i/ raw 1 O/C CvAd_ca ! ^." Soil Evaluator Form No. Name of Soil Evaluator D4N•cc- ^et • Date of N r rbs c i-1c DESCRIPTION OF REP IRS OR ALTERATIONS U O9 -e_ s ysfee•-•- The under a ees to install the a scribed Disposal System accordance provisions n TIME 5 and rthe y not ro a the operation until a Certificate of Compliacee has been issued the Board of Health. 1J Date a A5 OS— Signed Inspecisans FORM 1 - APPLICATION FOR DSCP DEP APPROVED FORM 5/96 x- i —:? S Description of Work: THE COMMONWEALTH OF MASSACHUSETTS /Ui11777+Ami'a/✓ BOARD OF HEALTH CERTIFICATE OF COMPLIANCE ❑ Individual Component(s) ❑Complete System Fee The undersigned hereby certify that the Sewage Disposal System:Constructed( ).Repaired( ).Upgraded).Abandoned( ) by: at 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 No. r C L<' dated . Approved Design Flow (gpd) Installer Designer: Inspector Date The issuance of this certificate shall not be construed as a guarantee that the system will function as designed. FORM 3 - CERTIFICATE OF COMPLIANCE DEP APPROVED FORM 5/96 ' i. No. (-7 9 ' S C THE COMMONWEALTH OF MASSACHUSETTS FEE ...JJJ 41/412 4 714\ /.1✓' N T3 BOARD OF HEALTH fry ,%/rf a/;?/ DISPOSAL SYSTEM CONSTRUCTION PERMIT Permission is hereby granted to Construct ( ) Repair (/./0) Upgrade (�) Abandon ( ) an individual sewage disposal system at /(4/2i..4tri`NiA' 4-R P,,2T/ — rf f-Cy2/ Y 'e4' as described in the application for Disposal System Construction Permit No.2 GIN C - h S dated t/ tJ s..(-. T. 't"r-%r Provided: Construction shall be completed within three years of the date of this permit. All local cohditti&�t%s must be met. - Date l f'1>L� -�l:i" 5� Board of Health - - om h '��"� FORM 2 - DSCP DEP APPROVED FORM 5/96 FORM 1255 (REV 5/96) CH&W HOBBS&WARREN 1° PUBLISHERS- BOSTON 2©0, a ,O1 No. THE COMMONWEALTH OF MASSACHUSETTS FEE SSb BOARD OF HEALTH 0414631 e/TN of /VT?Tf ()TDB% J Ass ..kt ION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT A Gcetion Cur a Permil to Construct t 1 Repair ( ) Upgrade J Abandon ( ) Complete System ❑Individual Components PPA / t mTH.A-v°TTnJ A iaoLC Own N 140 otA , .Ry / �e �z ' rn wo i2-PC — —.B.v. . on1y 1 Locum -a..1:&7' taus.. MaNPara:la U. V 4P Address N%rA'n 1v,„, O 4/3 -5—g 7-980 � TJ- un�F G✓lG-4 hiYT��� _ Lelephone. rive 717-/Lie --EA•KW-r, P.E. Cbe i ors�enor:nnm� (i "fie AJdmar 0(0]0j 4/3 57-5--ate--2- TvlvpM1OOCn -S .i.nonnem= -•-, Addl. �� relcPM1Oncu Lot Size Sq.feet Garbage Grinder WO 4�4) Showers), Cafeteria (/•J+ Type of Buildi Dwelling—No Other—Type of Building No.of persons Other fixtures 4 (Sr Flow(min. required) g.&tap Calculated design flow gpd Desi n flow provided 600 gpd Plan: Date ?AN 'bC .Number of sheets .2— Revision Date 4 1110 /. Title SEPT?C cis-FEM PL4n1 Description of Soil(s) S6?.F .....4Th1r-1%n at, EVA.44.4-nvet/ Soil Evaluator Form No. Name of Soil Evaluator /1441/Et-M• Date of Evaluation DESCRIPTION 0 REPAI RS OR ALTERATIONS N,rL-SGHS S'yt' N2 St4Cirr--•.. / J The under. a -s to install the above described Individual Sewage Disposal System in accordance with the provisions of T11 TE 5 and hi a9. -s not to plat . ds'ssteminin operan a Certificate of Compliance has been issued by the Board of Health. / (//6L/ Date Signed Inspections Des FORM t - APPLICATION FOR DSCP DEP APPROVED FORM 5/96 .aos-&y ription of Work: THE COMMONWEALTH OF Mn. .a.HUSETTS w0Yct ^17601./ BOARD OF HEALTH CERTIFICATE OF COMPLIANCE ❑ Individual Component(s) ❑Complete System FEE G '6`637 andersigned hereby certify that the Sewage Disposal System;Constructed( ).Repaired( ).Upgraded( ),Abandoned( ) >een installed in accordance with the provisions of 310 CMR 15.00 (Title 5) and the approved design plans/as-built ;relating to application No. -"el dated . Approved Design Flow (gpd) Iler gncr: Inspector Date Cho issuance of this certificate shall not be construed as a guarantee that the system will function as designed. ,M 3 - CERTIFICATE OF COMPLIANCE DEP APPROVED FORM 5/96 z 0 7 THE COMMONWEALTH'YJF MASSACHUSETTS 1.17/QT/-0-A,-r9 M.✓ BOARD OF HEALTH DISPOSAL SYSTEM CONSTRUCTION PERMIT Permission is hereby granted to Construct ( ) Repair ( ) Upgrade Abandon ( ) an individual sewage osal system at i Ills 17 ' as described le application for Disposal System Construction Permit No. aLGD f ' (2 dated / 2 ," v - ,. .- ,-2-t ? c — s0'L. vided: Construction shall be completed within three years of the date of this permit.All local c'onditio'ns m'irstvbe me Board of Health / L.-2/7-- ;�/.;, .4----- f 1M 2- DSCP DEP APPROVED FORT $/96 M 1255 (REV 5/951 ( H&W) HOBBBB WARRENrm PUBLISHERS- BOSTON