HomeMy WebLinkAboutBHDC-24-189 septic plan/plana
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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
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