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HomeMy WebLinkAboutBHDC-24-79ao s� �°0 �L rn N m rn � C ' c. rn tD 1I� O � O S o• w � n n � rry CJ Ot.�, p S� 2 rrkx w N o fit+ v NAB o' x' 0 �r to o• v n C O N il � s N � n y O� � O C 5 � r� G C 2 0 t a N N a ti W 4 J Q �s � � s � rror v � r A W E� O n c b F • �7 O 11 r" i� EL T zy 76, No FFE okiCOMMONWLALT14 OF MASSACHUSETTS Board r f Health, _ t /1 % it ,� l } Am APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to Construct(} Repair* Upgrade Abandon( ) - O Complete SystemIndividual Components Location 603 wt115j" v' �! Owner's Name MapiParcel# 310 _ Address l a 5 L/�lt/151wa) 6rcayp Eel Lot# Telephone# Installer's Name Address 3(,3 w� ,4,cl Telephone# Designer's Name _\( GYq murtnrr Inc - Address 2i �tAP12-4, r iltu' �h a)arcila,vt (lS Y 3-. Telephone# =�pq - 9 An Type of Building �e.rHo ( Lot Size _1 1 y ) t.1 __ sq. ft. Dwelling - No. of Bedrooms _.- -3 Garbage grinder ( ) Other -Type of Building No. of persons Showers ( ), Cafeteria ( ) Other Fixtures' Design Flow (min, required) 33o -gpd Calculated design flow Design flow pro%ided % 7 _ gpd Plan: Date S/t 1 zov/ Number of sheets Re%ision Date Title Ala, Gulrt- eel yell-.10-44 iY1A Description ofSoil(s) F-t+lL -,peal yZ" Soil Evalttatoi Form No. Name of Soil Evaluator W , _I f w1 e',, -c Date of Evaluation �!1 1 Z v DESCRIPTION OF REPAIRS OR Al TERATIONS _ (t1 Sfb l vl /i 1 -:�% SGU a.,f U LI !Le I The undersigned -agrees toinstall the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further agrees `�/not,t4laee e system in operation until a Certificate of Compliance has been issued by the Board of Health. Signed Date - Inspections COMMONWEALTH OF MASSACHUSETTS FEE Board of Health, . '. ';.... --IMA. 4 S ��f I CERTIFICATE OF COMPLIANCE ewl le {*,/- Description of Work: A Individual Component(s) O Complete System The undersigned hereby certify that the Sewage Disposal System; Constructed ( ), Repaired (0, Upgraded ( ), Abandoned ( } by. jL r w 4 P, L" Cy has been installed in accor ance with the proxisions of 310 CMR 15.00 (Title 5) and the approved design plans/as-built plans relating to application No ` - C ` I dated '. `i Approved Design Flow L/ _(gpd) Installer byjlJ ( ,) Designer: _ �,( ry;18r.,g 'u YV Inspector: (� , t , Date: �2 J7 The issuance of this permit shah not be construed as a guarantee that the system will function as designed. No 66h . :7.`c; COMMONWEALTH OF �LXSSACHUSETTS Board of Health, ji h%A.? i' MA. DISPOSAL SYSTEM CONSTRUCTION PERMIT FEE. Permission is hereby granted to; Construct( ) Repair(v) Upgrade( ) Abandon( ) an individual sewage disposal system rl..- , , n ., . .i at as described in the application for Disposal System Construction Permit No (I- dated +-• /c is 't Provided: Construction shall be completed within 4Uee_e.ai-s'bf the date of this permit, AL11 local conditions must be met. Form 1255 Rev 5/96 A.M. Sulkin Co. Ctereslo RMA Date -- 1 ) I Board of Health W �1 W C+ W In W A W W w N W --• w O N �O N OD N �1 N O� N In N A N W N N N •--• N O -- �O �0 �! C� to A w N — O �O 00 �I O+ t� A w N -- m m W -v m_ � � � v� z cn to cn cn v r� r C W -e r r c" cp -rI 1 x ram± CD iD N a 1 C C ACa C O (D y •�AOa lD co y� y ifSi) CD 7 SD WS W c^nD ?AS Cd Vl .AO+7 cC�D pr O. 0, Oon CD ( O CD C 7 f �O(, CD (D ff S n S 00 . AW•y - N X WL1 n O m CD 7• cD =' �' 7• ^ ,�.. „O,ti ".ry [D p' q. O �' O O no n N cD 0. N cD a G " C cQ'i �_ �_ �_ F ^ X• G O —• O ._+ p n• 7 f) c9 O Oj C ccDD y O A " 0 A y 3'7' O N ,�� � O O cD L<O y m o y C, c ^' C O O a Ej O lD N.= Ch N f1 A C !. CCD C, E3 O n 0 O R cr o m .r. �,' o cD m o o- o O c o cD �, ¢ CD LA 0 O < '� rL zJ N y A S CD G' C .T cD �' C C CD ^' O C 1 O a O O C a, y f�D " .n. O CD Cn `\, c9 O O G A cD d N �_ O O ,� 7r W n -, O Z tD G y r. P1 VOi o y• V N S Al y a p m 7 N y Ci C G. cD ncD S T O �? O O Vi tD _ O 3 CL eD fl.. n "3 y -1 (cDD cD G. cD 'O�! �y cD Vf y CD C u CL w m CD-M. =-, o ( C B w p p cCDD ,y» y' _ Na7 C < A7 fOrDa two fD rb (A X � C y 3J fD CND Q I a� a F O � 0 � � 1 d' Q z a e z 0 < ° o rLO o °'a� CD n w CD i CD rn2 -• _, O 11 m � Uo o = CD CD O C az zo `D ~' oCD !V C) c 1 J it (D O y CD :. ac n J RECEIVED �imov� `+ I MAY o 3 2024 q0t C1'�� t 1 HEALTH DFPT -Al ^ i Yam+ „No A d co x x x x x x x x x x x x x O W W\ a W N W O -N om VWi O N N Oa0 � W �N•• rp N N§ Q n h 1'� cn G CA ELCD a ZZ •� o N ¢ r, o r C cCD �, �, m o N _ a "' a. crPi �G o �,•°. o o�,`` rn n � ^ ^ O Q 1..' fry V1 `+ t� < ii• CA OF++ 1+ A cn _l' �OM W CA ry CD W' < CD •--r b O n ��QoZ y w ` v mg zs- l r 1 (IQ n MLrI Xh w N N Z qD n m "C 3 W N 07 m c W �© z x n m O.. D � N N Q m c K %* l•� QQ m QQ w O m 3 cra rf • C O m rT fII rn � (b N al Q cr � nnl rrul m m _ Fill � N P r�'� L'J a