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HomeMy WebLinkAboutBHDC-24-172 permit/plansy n d i C7 C�1 n O z O '17 0 y�y F� C+7 z 11 cn C z c �-1 R 0 o > �• H r" O ? y O 1 1 r i � 1 R R C �s 't a t r r b j f V O y C CPS n Q- R v C� O �o o � L LL a o H O O A 9 S� Nip. COMMONWEALTH OF MASSACHUSETTS Board of Health, MA. FEE 1 APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to Construct( Repair( t U radr. , /Abandon ( Qtomplete System © Individual Components Type of Building �� y Dwelling - No. of Bedrooms _ Other - Type of Building `Father Fixtures _ Lot Size i r 7C sq. ft. Ir Garbage grinder( } No. of persons Showers ( ), Cafeteria ( } !sign Flow (min. required) �!:� gpd Calculated design flow Design flow provided -17 gpd Plan: Date ?L=% Number of sheets _- _ Revision Date Title Description of Soil (s) 5il Evaluator Form No. Name of Soil Evaluator ate of Evaluation DESCRIPTION OF REPAIRS OR ALTERATIONS oc�--> c� The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further agrees to riot to place the systetp in operation until a Certificate of Compliance has been issued by the Board of Health. Signed r- Date 7 Inspections Nu. COMMONWEALTH OF MASSACHUS S' Eric FEE 4 Board of Health, r ,,,. t�, �, �! MA, p /N ? CERTIFIC/ATE OF COMPLIANCE Description of Work: D Individual Component(s) U1 omplete System The undersigned hereby certify that the Sewage Disposal System; Constructed ( ), Repaired ( ), Upgraded (>Abandoned ( } at i._ _17} o t , ,. -r - - 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. t - dated `� ;- � Approved Design Flow '-/`Ah (gpd) Instailer"91N ` y Designer-� ,-.,,,. C-a.T ti 6 Inspector: )i��� _ Date: ! The issuance of this permit shall not be construed as a guarantee that the system will function as designed. No. ' -72 COMMONWLALT14 OF MASSACHUATTS Board of Health, ,bra -h .r MA. DISPOSAL SYSTEM CONSTRUCTION PERMIT FEE ✓ 5 Permission is hereby granted to; Construct( } Repair( ) Upgrade(�/Abandon{ ) an individual sewage disposal system at _7_ --,� L—e- ,� as described in the application for Disposal System Construction Permit No. c dated t . Provided: Construction shall be completed within for-e&i4 roof the date of this permit. All local conditions must be met. Form 1255 Rev. 5/96 AM. Sulkin Co Charlestown, IAA Date �, t 1. Board of Health 11 IN JCL a < �0 i CD� ��c� a _ , %, a vt r CA o C� H O ,mod zo N 22 = o trJ coo � n CD r nC � C/1 H i O c w CD wIf °o 0! f � co 7 } kEL k $rt o@a 4Er 00 e ) o c m m �_ 2� 0 CD O k 3 /§ 2 J > 2 ? o0 CL 2 CD a @ O-a ���0 g 0— ] CD 7 < -< §E�@ w CD v o g Z § ( q C 7/ �— ca � c C m CD0 2k rQ§ k 7 CD � ƒ / � En Ch ccCD PO • 0 � � � � f � 0 2 ; p j jag / o § o f �' cn \ 0- :4. \ �, W 2$ cn 2� ` � k R CL_ d /� F gg �@Z ® n z � m �� t2 r# =2/a i 3»r ƒ 2•r J =� (D 4& ¥� 'Dqo o r c 7 o C.0 c A Q� CD q 9�(n CL � m C @ ■ ® O 0 § ono»o @ k = CD 2 F - « f 7-4) G = ° \ k k k £ - m CDgam R �f / �, f §k �n ) W ( � @ � m RECEIVED ff HEALTH DEPT_ i a1 Ln 4 W ` � 7 co +CAn L D N s o 0 Er In 00 M (n -' (D A 0 s a 3 O C ut 3 y O_ 0 0 m Q? 3 r. 3 (cD n 0 � O ,r _ = a _ ~1 3 7 O fD m S in m Q co S C O m ro = Q. i 0 x 01 o - o d u3i r+ O x N C) W (A 3 � � z CD N r Q 8 m w Z a w 61 n d to s rn N z v ro CD 0) a O 0 m m x LU 0 GI r► ro 5 IA d a 0 O cr (D N CC) IV O N 3 N z ro O 7 ro Ul O OD ro OD -0 OD G) x o CJI cr