Loading...
HomeMy WebLinkAboutApp-Permit-ComplianceNo. FEE#_5s'6® 'B0*DC-r(,o-j 0829 COMMONWEALTH OF MASSACHUSETTS 4 —//P Board of Health, %,,&007% , MA. APPLICATION FOR DISPOSAL SYSTEM[ CONSTRUCTION PERMIT C. 6562 Application for a Permit to Construct( ) Repair( ) Upgradego Abandon( ) --U-e6mplete, System ❑ Individual Components Location 15 WER STIMET Owner's Name :TOYCE CW4IE Map/Parcel# so /1(03 Address 1 S QI V U STAT' Lot# IS Telephone# 508, 3i$. 6$30 Installer's Name C.C. CONSTR U(,TtOt4, t NC. Designer's Name JA. DKOt,(.4 i A-5 .A-V AddressVS DIAMN05 PAIW � Dt�INtj 14 • Address 1`573 kMO Sr 31f.0V5 M�', �LG�31 Telephone# (G*6% 116t1 Telephone# 570--scjt ,GGQ1 Type of Building 9G:S t 0"tAL RttlSe, Lot Size Dwelling - No. of Bedrooms Other -Type of Building N jh No. of persons Other Fixtures 2%'720 sq. ft. Garbage grinder( ) Showers ( ), Cafeteria ( ) Design Flow (min. required) APto gpd Calculated design flow q44- Design flow provided gpd Plan: Date 51vi I Lo at Number of sheets Revision Date l Title SITE 5EWA(E OS1OS L SVSTcfA Description of Soil(s) FINE towi voJo Go mebtum $kr6 Soil Evaluator Form No. SC- 1714- Name of Soil Evaluator AMY V014C N01W Date of Evaluation DESCRIPTION OF REPAIRS OR ALTERATIONS REMob6 Two I4 txis-riya- GESSPOOtS 4WA "PL41" wt7i!- tS00Gat. SEPTic_0WK wq- - 10'X30' SrodEAW Pt faQ•1Tr7D PtOE t of j'z� The undersigned ees install the ab a scribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further agrees t not to lace the -tion until a Certificate of Compliance has been issued by the Board of Health. SignedDate lI ,E r I e I6 Inspections No. 0#DC- G 44669 " a Description J,�.E� ®N LTH OF MASSACHU J l of Health, Y1�7�.1i�©(� , MA. :RTIEICATE Of COMPLIANCE t(s) -a-complete System The undersigned hereby cer`I that the Sewage Disposal System; Constructed ( ), Repaired ( ), Upgraded Abandoned( ) by: (; , C • C - N _rV U C' ?7 dA,) 1, l ti C . F � at /r5 R-1 Ver - has been installed in accordance with the protZsions of ,10 CMR 15.00 (Title 5) and the a oved design plans/as-built plans relating to application No. A//,P , dated � i/' A.. Approved Design Flow ` (gpd) Installer E - LA ` ''ip f, U,° . C Oh 0 Designer: , 1, Q'P_aU-y 4 AS,50C, Inspector: ! I` %' Date: The issuance of this permit shall not be construed as aguaratitee that the system will function as deKigned. No. mac y FQ`°,PJ � f C &NS%-%l.o jaJU FEE NVQ COMMONWEALTH Of M SSACIIUSETTS C 651 22 Board of Health, DISPOSAL Permission is hereby granted to; Construct( at /. %211lr✓7L_ SiP2tT MA. UCTI®N ,PERMIT Abandon( ) an individual sewage disposal system as described in the application for Disposal System Construction Permit No. "/,' , dated Provided: Construction shall be completed within thf _cAta s.of the date eof this permit. Al local conditions rust be met. Form 1255 Rev. 5/96 A.M. Sulkin Co. Charlestown, MA Date (7 ' �)/ �f+�Board of Health' (1l /