HomeMy WebLinkAboutApp-Permit-Compliancetrffir-lrtr bL'-#
FEE c)
l-0\I\lt )N\\'1,,\l.l ll trf )1,\SS \l I lt'SlTlS
l3oartl t,l Httlth.,__. .\lI
Trlx' ol Btrilding
l)urllirrg ' No. of Bcrir-oorns 2
/d'rfiu
-oc "ltdx;':i AFp[.[c,4Tn0N FoR D[SPOSA[-/SYSTIM C0],tSTRuCTn0]'{ p{.t{MIT
-i' Applicariou for a Permit to Consrluc r ( ) Repair( t Upgr:rdr(\./ Abandori( ) - Qpomplete Slstem tr Individual Compon€nts
t
I ot Sizc rq.fi.
Garbage grinder ( )
Othcr' -'fype of Building No. ofpersorrr _ Showers ( ). Caletcria ( )
Othcr-Fixtllres
Ouner's Name
1 Acidr c..$r.ltr.^n-Jvi
l,a)l#
Installer"s Narrre dr\\Iit
Address I
ecl.rx rLtiort
Addr-ess aRr,o f
Tplephont#c 6't}5
Telephorre#
Telephone#6A>q(-
l)t sigrr Flow (min. requiIcd)
PIari [)rtc
4Ve cpd
Number of sheets
Calculated design fl"* 4S5 }-),ia"a 7SlDesign flow prov
Revisior) Date
8Pd
Tide
i otsr:zup.rtoN oF REpAIRs ()R AT.TERATIoNSd5 ,/
ar,,l!vl.1
'tr
f fn" ,-a"o4oud agrees to instalt the above describ€d Individuat Sewage Disposal System in accordance with the provisions of TITLE 5 and
further to place the operation until a Certificate of ce has been issued bv the Board of Health.
"DateSign
Inspeclions
CON4I,I0NWEA [-rTr 0F l,l *SS*ffi m(:,1c FE L {q:
rh{ 7>5uBoard of Health,t/.
ctRTIt-t{.,\Ttr 0f {.i))t l)Lt,\Nr_1,
Descriptiorr of Work: I Indhidual Component(s) J Complete SJstem
*--
Th
by'
at
e undersi ed hereby cerdry rhat rhe Sewage Disposal Systvsb u<em; Constructed ( ), Repaired ( ), Upgraded ( {Abandoned ( )t 'a
I !'\B \zr.'J\ tr-l Ars,^r,r.t-
has been
applicatio
irrrtallcd in accr>r'rl.rrrr
rr \o.
lr thr: plorisiorrs o{ lt
tcd
l0 CMR 15.00 (Tide 5) and tlrr,,rpproved delgn pl.urr,zavhrrilr pl.rns relating ro
. Appro\ed Design Flow -;I*€- (h?d / 5 5dir
ln sr.rllr.,
Desi
The
,l: I l
issuance of this permit shall not be construed
y&.ffi6;will function as designed.
(lONtrMON \\/ [,,\ ]l-llrt 0f It{,\SS,\n .l I t ] SIT it-S
/'t
at stsl(
ILL
Board oJ Health,\t.rtr-.oi$..-, MA,
, DISPOSAI SYSITM CONSIRUCTION PTRMII
IPermission fherebygranted to; Construct( ) Repair( ) Upgrade( u,f6lrandon ( ) an indiridual sewage disposal system
Disposal System Construction Permit No
Provided: Construction shall be completed within
as described in the application for
dated6th+eerpare of the date ol rhis,.it. All local conditions must be met
,rn5)? -OLtoard of Health
V^a A
Fom 1255 tuv 5/96 A.M.SulkinCo. Soslon. MA6o/ n l^/9,PFcZ *a/z- k v*A-
I
.I
trq\
{
q4
g'
Dcrcriptiorr of Soil (s)
SdilE\altlalorFormNo,-Namecl1'SoilE,ra1tlator-DateofE\'aItlJti.)ll-
,).,L
I
I
Designer's Name I'\er..^"!l* t- t)r.y\rt f, ,, ,
I
I
,". D +/1
MA.
\,, _