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HomeMy WebLinkAboutDisposal System Permitb a � G v r � � N l S R -� r rD ua' a n -o y C- r° O n z O eb -- G � 1 r G Nu. � FEE dy- COMMONWEAL OF MASSACI4USETTS POBoard r f Health, t, ,MA. APPLICATION FOP, DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) - O Complete System 0 Individual Components Location 1Vxtoad Owner's Name 11X% 1-1 -111A 0 I Map/Parcel# 73Z► Address • 1'I( N tAm NkA Lot# Telephone# Installer's Name y + Designer's Name Wetter K Address 6 ays�w QA VrAddress v7b& 4t-1 Cenk(vA > PA Telephone# U' 1 Telephone# ►96 . J 2 (oq � Type of Building Lot Size sq. ft n Dwelling - No. of Bedrooms _ Garbage grinder ( ) Other -Type of Building No, of persons Showers ( ), Cafeteria ( } Other Fixtures_ — Design Flow (min. required) gpd gpd Calculated design flow Design flow provided gpd Plan: Date �' 31 •2 "[ Number of sheets _ —1� _ Revision Date Title Description of Soil(s) Soil Evaluator Form No. Name of Soil Evaluator Date of Evaluation DESCRIPTjON OF REPAIRS OR iALTERATIONS �11n� aiii �/� �f {�(� LPL. ( l�( ♦ � ' t J yN E i t t7E `)2 �L.A ! ^� �. t C n -s r vl 74r hi LAP� C - I (t ►•11 r A 01 t rt-I t rl . \1 4t, "1" 4 � iltY1?1 � C7 V1 � Vni 1111A ! J i I(IA kd i n Q �1 ` t'+11� . -A n t The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further agrees not to pl a the system in operation until a Certificate of Compliance has been issued by the Board of Health. Signed --- Date Inspections No. �2-H 183 W TT ' / a FEE 11 COMMONWEALTH OF MASSACHUSE 5� Board of Health, um'%— MA.� CERTIFICATE OF COMPLIANCE Description of Work: Q Individual Component(s) ❑ Complete System The undersigned hereby certify that the Sewage Disposal System; Constructed ), Repaired ( ), Upgraded ( ), Abandoned ( ) by: L 11a�e. 1' I f lrl 1", LIJ— -- -- at 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 applicationlINo. , dated .�. Approved Design Flow (gpd) Installer' l.! p l _ Designer- P t It, _ Inspector: Date: `! _ The issuance of this permit shall not be construed as a guarantee that the system will function as designed. No. 2T'� Z53 COMMONWEALTH Of MASSACHUSETTS Board of Health, �tl r INA C lOA', , MA. DISPOSAL SYSTEM CONSTRUCTION PERMIT FEE Permission is herebygrantedto; Construct( ) Repair( ) Upgrade( ) Abandon( ) an individual sewage disposal system ( at __ �1 �� t � ► x �- d as described in the application for Disposal System Construction Permit Ndated Provided: Construction shall be completed within IhESLyea of the date of this mit. All local conditions must be tnet. Form 1255 Rev 5196 A.M Sutkin Co. Charle0a, MA Date /i �1�_ Board of Health __ _ RECEIVED NOV 16 2024 ©o or 3 7C' m 3 Q n c '^ L w x T 1 A � M 3 oD to r d Q m m IA w 3 Q 04 c M T (D 1 5 f y M 3 t ti z a z m m w a Q � N J 3 z T � a A j 'M v b m w 1 n w � W x m 0 _m C m a � - a i �■2 \ � / � 2 / n § \ � �E« � � 7 � ( � } � \ k � { W W W OS CA W A W W W W N W N N N N N N N ?o J vA A W N N N.- O oo .1 CN — A W' N= � �* G $ .... y n �E i � � cD �.p,y y � p � �� � _ �•R �•a'ON�� 2 [' .6 CD CD co e °Lco -s co R• o �; c J� _ ,ate o Of CD o o ►D pp O < (gyp C' G. "" �' CD LA v, �<« ;<xf a b Y C^ e° _ m CD f �O 0 m ate' a z Lei < < z 0 vl '� � •J _o y CrJ O ,ti R •� a • �g n0 KI w' c O c T �I �a 8 m� f c� r RECEIVED HEALTH DEPT C 0 ,bL• ! b o o Z r � o r ZOp — J I O Z u O -4Eppp C ' I D to -0CD CD + rn O - t ,r p�rn6lLp i u,v70�o rn r�O c zmrnz Z rn ..fir •:.: CD— r" x 1 N O � � rn ; rn cn I r O no + OD rQ ` t , a ` 1 + !9 \ ' C) i cn 991 �1I�` Ag ad o LOT 74 - LCP # 14 1 14-A2 Z A55E550R5 MAP 34 PARCEL 2 • st, �`� ����... ' ode' °"Od � '• s N ' I > 2 V o rn o D�� � p � rn -ti r O O 4 N cn R C�p ?s—! N^ rn -i Z 70 rn �rn <orn p� rn �O O Sot O rnrnrn N r I� —i Ln A n ! Cl p°o oy�u01 -00 1 nz � V' g(noF� rn tp o �g g 4 N y Q1�nW� SN w rnD zz Q O �0 z00 r,� r0 "� N 1 N rnN )> c z _O{ _ N 0 ,� a N 70 J 2 n9-9 ; Z l J O Zi u < N cDLn a� r�u C A ? T = U y ? O 3 Zrn Ot� rn m 20 z zN� v < co Ln rn = (A Cl�n F- n v , < ICi c re p 0 ;t z rnA a 1 vim' rn . U) 7-1 rn orn CJi W N — Lp � l � --4 0z0oaoo=J �m CnCNO 0 _� I OO n <>zNz�U>CD t➢l�rrnnrnF ~!1 iV� o� N O�'cz�0�°��°cn�,n � rn��_ rn � Czx rn rn��i0 DO�<�ZiO CDrO r- O�l�7z7a O�rn0Zz0<7rnr rn Z z�,;>�pLZ yWw � An crn O0� c➢ co OrnOO za 'ti = �, � OgZ° � r rn rn n 70 � N (p x O U Z O c I" i q rn r - x Z LD C) 7�10-�<— Cn OO =ntDnNx rn z Ir:n O a<—�1 Z o� rnrnD O— C O o D rn D O rnrn 0 0 0 IO 70rnCAD O rn II z-�rTlrn G� 70 n 0 -u rn rn gym `' N�(3cRf6ya Q / O C70z7o O D� Z: D ZO z ( O N z -+ -a �rnp t7 = -o 70 >rn O c� 11GGS5 G� c� o Z �-pp w r- �r�O 70o fl�� 70O 0 D N rn rn O O� -a I o0 �>0� rn c Z pZ 0 (A OCC7 Q O O rn O %� D l Fnco �rn Q Z z rn N 3 I O r=rn ➢ � ODD rn I O N rn rn D � O / D Z rn O 70 Q Z 03 o � o0rzsi rn