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HomeMy WebLinkAboutBHDC-24-61d n Tl z t� �d��+dcce c x a � n� o 7 1 4 � � a C G q ell � i T � (V f h It oq D n Q S z rD ro r'o � 0 y- t p f� K1 y ry- r O r, C n r � � c vj a J a � rim v H � 7 � 3 H H s a � � o �o H m m O � r C FEE 1 COMMONWEALTH OF MASSAC14USETTS 06� Board of Health, \ l MA. APPLICATION FOR DISPOSAi SYSTEM CONSTRUCTION PERMIT Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) - O Complete System OIndividual Components Type of Building Lot Size sq. ft. Dwelling - No. of Bedrooms _ _ ) Gar ) Other Type of Building f{vuSQ No. of persons Showers — ,1 - _ p O, Cafeteria ( ) Other Fixtures f Design Flow (min. requir d) R Plan: Date TitleQ gpd Calculated design flow S �_ Design flow provided gpd Number of sheets Revision Date Description of Soil(s) Soil Evaluator Form No. Name of Soil E%ahtator AW Date of Evaluation DESCRIPT)ONOfREPAIRS ORALTERATIONSLA QU) JC�.-11 The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further agrees of to lace the system in operation until a Certificate of Cgatpliance as been issued by the Board of Health. Signed Date Inspections _ b I�- f l l No. ` I, <J` t FEE '7 COMMONWEALTH OF MASSAC14USETTS 45 Board of Health, 1 MA. CERTIFICATE OF COMPLIANCE Description of Work: Q Individual Component(s) O Complete System _ The LindZ-' geed hereb certify that the Sewage Disposal System; Construct edr epaired (graded (A!Abandoned ( ) by: 1 ItJ� at 4 )-rn ?%.tt0 - 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 application No. = dated `1,2/ 4/ Approved Design Flow 3-� ,7� (gpd) Installer Designer:_' Ile,L Inspector: IVA f6en i P,Date: The issuance of this permit shall not be construed as a guarantee that the system will function as designed. No. C' 2L �X1 COMMONWEALTH OF MASSAC14USETTS FEE�� Board of Health, NN I MA. DISPOSAL DISPOSAL SYSTEM (_CONSTRUCTION PERMIT Permission is hereby granted to; Construct( ) RepairUpgrade( ) Abandon( ) an individual sewage disposal system at as described in the application for Disposal System Construction Permit No. �/ , dated I Provided: Construction shall be completed withi¢�l f the date of this permit. All local conditions must be met. Form 1255 Rev 5/96 A.M. Sulkin Co. ChuWown MA Date 410 -- t Board of Health W W W W w w w w N N N N N N N w N N N .- N O — p — ?0 -1 Ot — ch AP �--• — N �-• ►-. — O pCl 0o J Ot cJti A w N �-- �n ch _�z�n�n�ncnv� Q R D rn14 S.F' .y � ".J' , �. � C RJO ..yy ,� tom? ,;,F• O v� � �* �' .-! � — C O r�ji ,O.r " `� ,� � "�' 3. � '"� � � O O O p� O ? �' (ID viIL O O p�5 �mi �• ��fpp• ppa� zr oO• O '+ O g g NHS y•(D ' R O 0. �,y.�.�.�-�'�. 34 pr�v, O p.. 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