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HomeMy WebLinkAboutBHDC-24-189 septic plan/plana Cr7 z 0 O z O z cr i r •v a 0 0 0 7 X Qc W `C s N ^ C � a 1 �• o O C' y O. a oo' 0 F z c rn •- s y � C vc• � r-• � C O � 'C 'o O v' S fp 0. R n y n" g a O O H N y n ro - I Zi H C n eb w n N+ arD O O y v rb 0 w � J 1 O Ir U z O tiz d x ai C a cr a vi ® l o o n � VI) � 1tAa C. O � No.. [�{,"' �y�1 �/ 7�Gno Jr ) ��f`& #'�` '✓�� 21 -�Sj FEE S G I-eGr C° r-a�,-fa vO MONWEALTLI OF MASSAC14USETTS t Board of Health, __ APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to Construct( ) Repair( ) Upgrade(-!) Abandon( ) - ❑ Complete System ,Individual Components Type of Building _A� 1( A'4l 5- - Lot Size _ 16), )!J(� sq. ft. Dwelling - No. of Bedrooms 3 _ Garbage grinder( } Other - Type of Building No. of persons Showers ( ), Cafeteria ( ) Other Fixtures Design Flow (min. required) 912 gpd Calculated design flow... ej Design flow provided d Plan: Date /D'/�' ZUZ�/ NuRevision Date Number of sheets gP I, /J Title _ 1 [h, %1t11'tAff*/ M1[W L/H1d 41, Mf Description of Soo(q t • -fD 1, r' l 00 Soil Evaluator Form No. Name of Soil Evaluator _e, �%/sf��c� Date of Evaluation OESCRIPT�qNOFREPAIRS ORALTERATIONS I� l 411r1-1'6 A d1j-6f1,j,-17o4k �, The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TTrLE 5 and !further agrees toFVot to!place the system in operation until a Certificate of Compliance has been issued by the Board of Health. Signed Date 0 -/`' " ZG?Z/ Inspections 0t SIC No. - COMMONWEALTH OF MASSACHV$ETTS Id dd' FEE Board of Health, Q/y%lAL{�l MIA. CERTIFICATE OF COMPLIANCE Desorption of Work: ,'Individual Component(s) 0 Complete System The undersi ned hereby certify that the Sewage Disposal System; Constructed ( ), Repaired ( ), Upgraded ir') Abandoned ( ) by: - , i L� at >4f lAVIV has been installed in accordance with the pr visr s of 3I0 CMR 15.00 (Title 5) and the approved design plans,.,-as-builtplans relating to application N . !J ' / dated �, / - - - Approved Design Flow S ; (gpd) Installer ��d (10, Designers —err rk)ldE! j.9/e %1! _Inspector;41 ri4 6, t f �� f / _ Date: _' _= i `, The issuance of this permit shall not be construed as a guarantee that the system will function as designed. No COMMONWEALTH OF MASSACHUSETTS Board of Health, _ „_ �, _ MA. DISPOSAL SYSTEM CONSTRUCTION PERMIT FEE Permission is hereby granted to; Construct{ ) Repair( ) Upgrade(,(6 Abandon( ) an individual sewage disposal system at 1 fit` / / /y f as described in the application for Disposal System Construction Permit No.,2r/ 14.k , dated � Provided: Construction shall be completed within %" -.1 rs of the date A)€- it. All local conditions must be met. Form 1255 Rev. 51% A.M. Sulkin Co. CharWamq MA Date /o a< < Board of Health a wwww w ww W NNNN N NNNNNr►+rrr.... �l CtitA Awta..•O�Ooe V O�tnA wNrO�p�o V C�tn�a W N••••O�OOO�lQ�tn izJW � too � to W CA CA�y AwNr-• pr O gLl �o cc cr Go ams Ir C R. m m '. '► O r IBM air I� ICI 6A ,Oh (c9' ILA to y CD m � � `I I °, I,, I °r I -\1 �l � I ,,� 1-\ I tI�� I <\I� k Ir\k 1-,\l �, I�kT vr"� �Tff� Nq )2fowvg� tj -, � -iki ld30 HJ-773H tizoz 8 L 100 6oq 169 . , CD m a O N IIrt7 fD 3 fD a: m T ^ D rD m ro M CD u v o � � rD fi U- O fo EA y fU CD o_ CD O rD fU o N LM SL1 CD fD O - CD .zi fD AI m v � v l � a In 0 CD CD CL CD CD R CD [) C O p C: C 0N0 0 Q N -s O O r+ M ' r CD is9 lD ¢, p p CD O rA os O 0 oc � R Z R co `a O }� n ti SW t j CL R CL ~n "'• v ti .�d0 �G � N R v vOi O rjo Jy-r O n (D CD n R- r C � w _ U.. d o m o rn Q