377 COC 2000 lIf
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THE COM/ONWEALTH OF MASSACHUSETTS 76 �'
0_No. Fee
i //JL/�/.Lf/ BOARD OF HEALTH
'/ EM CONSTRUCTION PERMIT / U�S�
DISPOSAL SY ---
Permission is hereby oranted to Co struct ( ) Repair ( ) Up. . ( ) Abandon ( ) an individual sewage
Idisposal system at ��/. Ai as described
in the application for Disposal System Construction Permit No. ,i .dated i & / .
Provided: Const tion shall he completed within three years of the date of this permit. Ic co ti . mus f
Date Board of Health 1
FORM 2 - P DEP APPROVED FORM 5/96
FORM 1255 (REV 5/961 ,,.._I id, HOBBS&WARREN"' PUBLISHERS -BOSTON
Ili) @ L. U.),?� r P
alIN 8 2000fEJLi,
DEPT OF BUILDING INSPECTIONS
NORTHAMPTON,MA 01060
•
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FORM 3A - CERTIFICATE OF COMPLIANCE
No.. IP- � F«
•
COMMONWEALTH OF MASSACHUSETTS
g.- 1-/
Board of Health, Mr4 Ia4r"pnop, , MA•
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CERTIFICATE OF COMPLIANCE
Da
CV) T ascription of Work: Cl Individual Component(s) [li1"Complete System
5. ET:,..,1 e undersigned hereby certify that the Sewage Disposal System;
o,,,
eL Constructed t3, Repaired (), Upgraded (), Abandoned ( )
.. • by: CIff
ArkS gXCAV44ir1
•
• at: 377 Coles �eaclow React (Jerome C. p. seo)
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. q& -9
dated 6/5/o0 . Approved Design Flow Sol (gpd)
installer , ,. ✓, gli__
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Designer: Inspector Lift _ 4
Date 7/11 /00
The issuance of this permit shall not be construed as a guarantee that the system will
(unction as designed.
1500 6A{ •
SEPTI-'DWI(
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OVER
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pl . OLP APPROVED FORM 5146 00-1F : ACC.ESS GoV6QS ON LEACH -rANIKS
AR. . BEAM 1
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