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HomeMy WebLinkAboutApp-Permit-ComplianceN q r'41 / O o No. 60 --154? FEE ®• _ THE COMMONWEALTH OF MASSACHUSETTS MASSACHUSETTS t!1ArI� Z �yylirativn for Visposal Sgstem Guetrurttun lJormit Application is hereby made for a Permit to Construct (V�or Repair ( ) an On-site Sewage Disposal System at: Locati n Address or Lot No. S y Owner's Name, Address and Tel. No. C��L �, �--3 ..249e 4Zd!X �R.^y /�-�u� rrdr�>' aG/i�Aa'3�Ti� !�/vaPS ®v7!•f WR_,vWuTff/ /I' ©�.F,6 ®f4/cw�® ��•rb, /V AP 2-6 4,V7-30 - B3 nstaller's Name, Address, and Tel.No., _Designer's Name, Address and Tel. No. ek-mow�q.V C o Donald W. Moncevicz �'¢'" �9-S© 4024, -"7-3 �'� a� Civil Engineer 40 Pond Street Type of Buildin: West Dennis, MA 02670 �wellin_No. of Bedrooms 75,ris_ 2— Garbage Grinder ( )1 0 Type of Building No. per Persons Showers ( ) Cafeteria ( ) Other Fixtures »M fir n Design Flow ��,,,_4-W gallons per. . Calculated dail, Plan Date,,��,�I•L . ;2 m®® Number of sheets Title JAxe�'R.%i _.54 jL7TRY Description of Nature of Repairs or Alterations (Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensue the system in accordance with the provisio s Tit: Certificate of Compliance has been Nslieki Ay t Signed Application Approved by Application Disapproved for the following reasons ion and mainte Environmental Permit No. a Dat flow 336 gallons. Revision Date ..„ua t � 7,0 �Z_ �, (Z - A, A -t 1 VU m Nom✓!g r ! L% -- THE vTHE COMMONWEALTH OF MASSACHUSETTS --- -� rV MASSACHUSETTS M (,�-- C�erttttxttte ut fl�uxn�CYttnxe . f THIS IS TO CERTIFY, t t the On-site Sewage Disposal System install d (i/�or repaired/ replaced ) on by �" for at as been constructed in accordant . with. the movisions 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 THE COMMONWEALTH OF MASSACHUSETTS 00 No. eo — � ��MeCJr , MASSACHUSETTS FEE to. JBt6yustt1 '116gstexn Cfunstrnrttun Flerxntt Permission is he5reby granted to �� itJCG to construct (V, or repair ( ) an On-site Sewage System located at and as described in thelabove 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. 0 -noo7 h All construction must be completed withinAtree-yeurs of fhe date below. DATE `.� _ g ~ Approved by 7 FORM 1255 Rev. 3/95 A.M. SULKIN CO. - BOSTON, MA /