HomeMy WebLinkAboutPermit and Certificate of Compliance - 2020BLD'rR- 2l'OOllbZ-
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COMMONWTALTI+ W MASSACHUSTTTS
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Board of Health,MA
APPI.ICATION TOR DISPOSAN, SYSTT}T CONSIRUCTION PTRMII
Application lor a Permit to Construct(./ Repair( ) Upgrade (/ lAunaon( ) - Ll Comptete Sl,rtelr hdividu.I Components
Lng - No. ofBedroomsfelliOth er
[*.,
- Type of Building
Fixtures
No. of persons
-
Showers ( ), Cafeteria ( )
lLo."rion lrv,'ll,I ,r/owner's Name /Vn f ia a ^p Felt i
Map/Parcel#Address
Telephone#
Insraller's Name ulk 6","f l'Designer's Name Ru-/"il;lLt
tq? il,//l rl-i t/";!tr i7Address Address /,. L|t h lrrnril
rerephone# io 6 - 43 O" A ,l l,Terephone# 528 .77 5 - 1 7 eO
Design Flow (min. r'equired)LV)gpd Calculated design flow Design flow provided
Revision Date
3/7 8?d
Ylan: nate $ : lL- Lo Number ofsheets
Title
Description ofSoil(s)5r? PL-t
Soil E\ahrator Form No.Name of soil Evalrra ru t a Co4//L/ Date of Elzluation e- Q- zu
t/etDL,SCruMION OF REPAIRS OR AIIERATIONS
The undersigned agrees to install lhe above described Individual Seuage Disposal Sptem in accordance wi& the provisions of TITLE 5 and
further agrees to not to the in operation until a Certificate of Complirnce has been issued by
Dut" f- ZV- Zo Ilealtb.
stP 0 2 i020
Signed
Inspections
FEE
-
COMMONWIAIIH OT N{ASSAC{IUSETTS
e undersignedtrerebyrrelry th
'.; ... ,'
al the Sewage Disposal Slstem; Constructed ( ), Repaired | ), Upgraded ( ), Abandoned ( )Th
al
has been instal
application No
led in accordance with the provisions of 310 CMR 15.00 (Tide 5) and the approved design plans/as.built Plans relating to
ADDroved Desisn F-low (spd)dated
lnstaller
Designer:Inspector:Date:
Tvoe ofBuildine l,ot Size so. ft.
Garbage Brinder ( )
Lot#7