HomeMy WebLinkAboutApp-Permit-Compliancea
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No.V
THE COMMONWEALTH OF MASSACHUSETTS
FEE
, MASSACHUSETTSPd
�Nyyfirativn for (fous#rurtion 1hrratit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an On-site Sewage Disposal System at:
Location Address or Lot No. 'AJ
Owner's Name, Address and Tel. No.
45 SiC1t �G2 ��9a7�=�� ZoT�
2o�F�er ��E17
Installer's Name, Address, and Tel.No.
Designer's Name, Address and Tel. No.
P. K. 97- GOi-17X' C70_ A(
TADCO CONSULTANTS
3A5 -5993
Perc. Tests & Flans
Type of Building: 7X131 COD 02"3441
Dwelling No. of Bedrooms 3 Garbage Grinder (No
Other Type of Building No. per Persons Showers( )
Other Fixtures
Design Flow 3v3O gallons per day. Calculated daily flow 340 4 -
Plan Date 11 / 14 I9lo Number of sheets (3NF_ Revision Date
Title
Cafeteria ( )
gallons.
Description of Soil SF t f 4)4
Nature of Repairs or Alterations (Answer when applicable) G _ _ Od 59 /
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 Prov' 'Eonsof Title 5 of the Environ ental Code and not to place the system in operation until a
Certificate of Complianc has b e d b this B o He
Signed Date
Application Approved by Date Y/
11/Y ons
Date Issued
C ONWWE/ALTH OF MASSACHUSETTS
MASSACHUSETTS
_Z_ e, C, ifirate of Toullatialtre
ilAt Sewage Disposal System installed( ) or repaired/ replace on
0 z�/F�-7??e-•.S for 496&W= 7.
�•4��i4
as bee constructed in
�wj �nz� to for Disposal System Construction Permit No. dated
r aai Q is 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 ; r't �� Inspector