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HomeMy WebLinkAboutBHDC-24-65 septic permit/plan0 N r 'L3 O (D Jc C � 5 tA A � J +_ A A fi r fl ! _-f � iC r^ FEE 7 - COMMONWEALTH OF MASSAC14USETTS 0 Board of Health, _T(fmi& h MA. APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to Construct Repait) Upgrade( ) Abandon( ) - ,b Complete System © Individual Components Location S? G 4-K4e l?v Owner's Name '1 0 ate Cam- Address 5? Q4a `? Telephone# Designer's Name - Map/Parcel# I Lot# Installer's Name Rc�lx� l3 Address Address Telephone# Telephone# S" j? Type of Building ��� .hYrfla [ T_ Lot Size 1 i,Ulf sq. ft. Dwelling - No. of Bedrooms 3 Garbage grinder( ) Other - Tvpe of Building No. of persons Showers p O,Cafeteria ( ) Other Fixtures Design Flow (min. required) 33o gpd Calculated design flow Design flow provided 3y9, 41 gpd Plan: Date 3I2-71701-1 Nttmber of sheets I Revision Date Title 5i V2("AUMA` 020�t( Description ofSoil(s) Med . -Fv F+rk ;nA,? _. Soil Evaluator Form No. Name of Soil Evaluator Wl. i�i„n� ha. [ Date of Evaluation DF;,SCRIPTION OF REPAIRS OR ALTERATIONS N_Q) th6bbe11J(W Sr Af -16AV ?t•, WiAJ j l%+V LfloY1 6)( -tv '_''QU �1h1LM (iV�t>L�11`' The undersigned agrees `instidl the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and Efurther agreot to not tVplacv the system in operation until a Certificate of Cpmpliance has been issued by the Board of Health. _ Date 5� 1)J Signed V --- � - e Inspections LL Olt, 6It No. 6 3 dtd FEE _Ll� COMMONWEALT14 OF /MASSACI-IUSETS Board of Health, /Gi► ll'u l I MA. 1, CERTIFICATE OF COMPLIANCE Description of Work: ❑ Individual Component(s) X) Complete System The undersigned hereby certify that the Sewage Disposal System; Constructed V), Repaired (;�), Upgraded ; ), Abandoned ( } by: at has been installed in accordance with the provl)1ons of 310 CMR 15.00 (Title 5) and the approved design plans/as-built plans relating to application No. �: dated f+ Approved Design Flow i � ,gpd ) Installer Designer: _ Inspector: Date:AV The issuance of this permit shall not be construed as a guarantee that the system will function as designed. No. -2L ' Ft?B COMMONWEALTH OF MASSACHUSETTS Board of Health, __�rLLI,,, aq. DISPOSAL SYSTEM CONSTRUCTION PERMIT Permission is hereby granted to; Construct(y) Repair(X) Upgrade( ) Abandon( ) an individual sewage disposal system at 57� 4Y 6, ,Ivo kl eow _%,fti pv{Gl as described in the application for Disposal System Construction Permit No. t' dated G 1 . Provided: Construction shall be completed within�SWL� 4 of the date of this_ermit. All local conditions must be met. Form 1255 Rev 5/96 AW Sulkin Co. Chat wn,WA Date {� � --Board of Health r o w n 3 P9 v n � � G a � ` z s Z A Ln Ln 22 a n m f a)M o y 02 a. D m m u� LN o N q� LO) � o s m Lo CD p tD s 0 P4 $ t 4 y � s ° V s m cn -, m m s o m m 0 � J I m O =- o �' y 0 C, ^ �Pub -t n' io �:r o 5 `C w b G 0 `� a (.� s ro � O, C C N o n — GI . G CD r. v� n �:t N sy a O— o ¢ O° c G 00 0 O Q C c o ' o p• cn cv � O O �- O cr C .:.T 00 CD CD ` O (rD ,a ti y fb l J v� � u � y O c� Cl. � t/] w S• ti• �, F� /V �I CLr n �• NJ V QO :J O ii CD (� n �Q • c a W W W W �]Otit/iAwN�--•O�OtoJQ�v� W W W W N N N N N N N N AwN►�O�G�O+IO�tAAwN...q:Q00JO�tn�wN�-- N N� �--+••• --• ��� �•- �-. (•)'T1y�CrfCr1CU< s o Cr1'" tnz IQ cnv}tncn. Cry. �. �' G7d a$� ..yO �.�* _.5'$.��I�`�.a��'R5''"°5_5'gSq'35'c^'��°•ih v,.� � "',� N,:; O � O � � SC O � �� �' 3 �•�•7•�•Q'�t�T O O O A_ O CD iK� g' y' c*pp,�* •-• N< CL Er S 7 S CD O —1 m' tD O 7• ryhA 4'FK1 w� R � � C/Z O ¢(p. �� 9 � �' � O• pry �' • � "--' '� �p, z = O vi y ti az uoa $ cs 0 =- d co ri••p a < < < <; N ��iZo W C9 00 �o� a n m rr z a cn z 0 a O O ki is Ya y G y f r� o q x� V � � � y n 8 � a cn iI CD 9e G ® APR n. 2424 HEALTH DEPT. Lo� i