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HomeMy WebLinkAboutBHDC-24-101 septic permit/planE ;n Y z z o G „• C C k.� o• cam, G.. _ x� ►3 C-1 n I�Q Q O v. • r n c � Y Vi z � r 5 � z W i -Vol 21 c 9 X� to k � sr G i n n � 1 4 L)� No, Z�,V,4� � _ v �.FEE COMMONWEALTI4 OF MASSACHUSETTS l Board of Health, _V G! M o u \*',� `}IA. l j APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to Construct(vf Repair( ) Upgrade( ) Abandon( - 0*Complete System © Individual Components Location �4. p u; Owner's Name Y,Ps G 6s — Map/Parcel# 6k4 Address 3rpL yNt S C� 9c.,k Lot# Telephone* Installer's Name Sc—(A `Cr%`/ Designer's Name (ISC rOV Cn Address t (M Address C` Telephone#-�^� ' d �� Telephone# �S (� X i'l Sr i Cr Type of Building GC,(- Ca— ak- Dwelling - No. of Bedrooms Other - Type of Building Other Fixtures Lot Size L4 2 XAa b sq. ft. Garbage grinder (NO No. of persons Showers ( ), Cafeteria ( ) Design Flow in. required) gpd Calculated design flow Design flow provided _ S d gp Number of sheets Revision Date Title Description of Soil (s) L Soil Evaluator Form No. Name of Soil Evaluator C \ O Date of Evaluation J DESCRIPTION OF REPAIRS OR ALTERATIONS k�_ C c t i S? C w,A The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TTTLE 5 and further agrees to not to place the system in operation until a Certificate of Compliance has been issued by the Board of Health. Signed Date (,/ (I Inspections 0i L l N. L) (l' jy FEE�� COMMONWEALTH OF MASSAC14USET Board of Health, �`� <<'� D tr MA - ut CERTIFICATE OF COMPLIANCE Description of Work: ❑ Individual Component(s) WComplete System The undersigned hereby certify that the Sewage Disposal System; Constructed (11, Repaired ( ), Upgraded ( ), Abandoned ( } by: 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 application No. nL` ,' / /(i dated '"' IL aL>f— Approved Design FlowyY(gpd) Installer 5ri,]� M 'G rY„r\�/� DesignerInspector: 4c,., }parr• <.. I i I t . The issuance of this permit shall not be construed as a guarantee that the system 4 function as designed. o. FEE _1_ COMMONWEALTH OF MASSACI4USETTS Board of Health, r# 1 0'-t�4'� MA. DISPOSAL SYSTEM CONSTRUCTION PERMIT Permission is hereby granted to; Construct(V) Repair( } Upgrade( ) Abandon( ) an indk idual sewage disposal system at 31 C C�fl Q as described in the application for Disposal System Construction Permit No. ZV dated. Provided: Construction shall be completed within tr years of the date of this. All local conditions mast be met. Form 1255 Rev 5/% AM Suakin Co ClwleSam,MA Dat /- ` L _ Board of Health - n £ a) \ ZL � o D R / g§ i = e m = 0= O X _ e a c m o R ± E® n m m R#° f - g = , m \ ƒ 2 \ ƒ CD ! Cr.,)& 2 nM / \\ 4 = ¥ 4 2 k R ] E m G m q 7 0 _\ \ \ 0 ) z / � 2 8 ® (D =1 f ± £ ¥ § n a @ > » o0 / \ 0) \ 2 \ / m� �(k \ 2 / j� ° w k io � CD 0 0 \ w z o _ NJ ± / ° / [ = R / f % o E \ / CL 2 5 § 9 \ 0 \ c CD, E \ i ¥ 3 En j / 0 E § Gf� 7 � cn \ 6 co c 0 / Z, & a ) / E _ fD CD CD Fr \ e-V r w m m _£ 7 / k CDzr ? CD\ ) e CD+ 0 W \ / t ®ƒ \§ a 0 o k ° to0 \ / k J > \ 2 f i / co S ^ -0 CD o \ 0 2 \ 0 cm w + G1 V1 A W N 1-+ 1 I ) I 0 o O JA vt,4 cX �% -��- .Oi to 1 1 � pl v N3 o O 7 _ � c a r: v, d s � 3 - � I v 'n t A Q th 0! a N ID tr V %i s 3 V m A O 3 1)< 1 Z C c C4 3 fC m D CL a O H H [J Flo ., 0 0 to ID b wwWwW J 0\ to A W W W W N• -• O NNNNNNNNNNW+-����r��� �o 00 vPli N P W N �-• O �O 00 v 1 G1 to A W N �- C)p�rs- xCrsknt7GG<c�o = �5.1 � �o CDvirn�nbvl�o o r�ytro o troth cdop�c ?d7d a.� c.a.o w 9 c�r m•`� �SSSA A ed� C a o' o '� m s, a. o a °.� m 7�o A a: � 3 �, e a "� c� to o • i .. `� �° ::r =' 3 m cr ry Q C A ^�► l9 A .r 0 C f� ° O 0 O CD .�. A m y ~0.0�p O O �NFA C 0 ��j vj� O " pV]ay._ R G g. 0 C � A Or � R. � .� 'z G C fn CD �. y fp � OO ''� s R: � O. �E `t 01CqD ? aN ° .Ar Ei' p N 7C ' O ° p Q G. C s� O a. cr r% 'X lP G. ° "�f b•D QCD cr D (gyp 'n► yp� ► g A G. z 7 ° C y �► ,yr O A o m c ° rs •• °• " p, g• N � C C CD c 9F v y eo � � :` � �• CD e� LA x 'rA ry <<to. . :. g m _.a o a oCA CID, CD rA CD m o cDQ o a z � a 0 O cO CL