HomeMy WebLinkAboutApp-Permit-Compliance_ YARMOUTH HEALTH DEPT.
z 1146 ROUTE 28 �CO�dE , FEE /
SO. YARMOUTH, MA 02664
,,ter? .COMMONWEALTH Of MASSACHUSETTS �
Board of Health, YARMOUTH MA.
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT y
Application for a Permit to Construct(JQ Repair( ) Upgrade( ) Abandon( ) - ❑ Complete System ❑ Individual Components
Location 14 R.i,chakd Road
Owner's Name
Ocean'.6 Edge Bu.i td i,ng Conn.
Map/Parcel# 102/Lot S71
Address
Box 320, E Sandwzch, MA
Lot#el
Telephone#
( 508) 362-8488
Installer's Name NO thein Seatcoa t -i n .i 8 Paving,
TAC DesignerIsName Yankee Su,%vey Conzuttantz
Address Box 995, Venn1,5po,%t,MA 02639
Address Box
265 Mautonb Md ttz, MA 02648
Telephone# 5
Telephone#
(508) 428-0055
Type of Building
Dwelling - No. of Bedrooms
Other - Type of Building
Lot Size sq. ft.
Garbage grinder( )
No. of persons Showers ( ), Cafeteria ( )
Other Fixtures
Design Flow (min. required) 1 1 0 gpd Calculated design flow Design flow provided -375'9' gpd
Plan: Date 9/9,199 Number of sheets 2 Revision .Date 9127199
Title 11 ContIr- SyAtom
Description of Soil (s)
Soil Evaluator Form No.
DESCRIPTION OF REPAIRS OR ALTERATIONS
Name of Soil Evaluator
Date of Evaluation
The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and
further agrees to not to place the system in operation until a Certificate of Compliance has been issued by the Board of Health.
Signed Date 2115100
Raymond , . Clue t i.no
Inspections
No. �(J
COMMONWEALTH OF MASSACHUSETTS
Board of Health, MA.
CERTIFICATE Of COMPLIANCE
FEE 11JV 4/0
a¢7
Description of Work: ❑ Individual Component(s) Q'Complete System
The undersigned hereby certify that the Sewage Disposal System; Constructed.( -Repaired ( ), Upgraded ( ), Abandoned ( )
by:
at
has been installed in accordance with the provisions of 310 CMR 15.00 (Title 5) and the a proved design plans/as-built plans relating to
application No - , dated 2- ) ) -a). Approved Design Flow p (gpd)
FEE �DU• l/
COMMONWEALTH OF MASSAC14USETTS 14,14 7
Board of Health,Z , MA. 1tviGY
DISPOSAL SYSTEM CONSTRUCTION PERMIT
Permission is hereby granted to; Construct( Repair ( ) Upgrade ( ) Abandon ( ) an individual sewage disposal system
at /tK �Gh�/P1��i Aeoll`Z as described in the application for
Disposal System Construction Permit No. 'lq- 4P0, dated 7 -,� 7 (V
Provided: Construction shall be completed within three years of the date of this permit. All local conditions must be met.
Form 1255 Rev. 5/96 A.M. Sulkin Co. Boston, MA Date 2 — �`'- oard of Health /
i&7
No.,'. / FEE
COMMONWEALTH OF M ASSAC14USETTS
Board of Health, `�/�� FNiC'�U'��, MA.
a APPLICATION FOP, DISPOSAL SYSTEM[ CONSTRUCTION PERMIT
Application for a Permit to Construct(/ Repair( ) Upgrade( ) Abandon( ) - ❑ Complete System ❑ Individual Components
Location
Owner's NameIE.C%�F4 C,
Map/Parcel# .55Q(2
Address
Lot# cJ -7
Telephone#
Installer's Name
Designer's Name L I YI
Addressgo G
-Address 1 v M (A V-5To 05
Telephone# +
Telephone# O ' _ -40<=)
Type of BuildingGi. C.,. Lot Size , �° -70-7 sq. ft.
Dwelling - No. of Bedrooms Garbage grinder (A/
Other - Type of Building No. of persons Showers ( ) , Cafeteria ( )
Other Fixtures
Design Flow (min. required) gpd Calculated design flow 3 e18 Design flow provided 34A gpd
Plan: Date r Number of sheets Z Revision. Date
Title _bNy -6 S f -W K 6:)!g-' IPL-t�,Eyj
Description of Soil(s) 0-6" � nAM, jam'/ loAMd-SAND 1"015Q" 5t4(kJ1�T °�- %20°` --^rO
Soil Evaluator Form No. Name of Soil Evaluator Al /LL/A M Date of Evaluation -,r
L If-cf-p-m 1414
DESCRIPTION OF REPAIRS OR ALTERATIONS
The unders wage Disposal System in accordance with the provisions of TITLE 5 and
further agn icate of Compliance has been issued by the Board of Health.
Signed _ ie _ f'0_1
tl
K
Inspection:
No. or
OLI &D
MASSACHU ETTS FETi!
Of COMPLIANCE
Descripti(te System
The undersigned hereby certify that the Sewage Disposal System; Constructed), Repaired ( ), Upgraded ( ), Abandoned ( )
by:
at
has been installed in actor ante with therovisions of 310 CMR 15.00 (Title 5) and the proved design plans/as-built plans relating to
application No. dated �- Approved Design Flow (gpd)
Installer
Designer: Wnf ` &2/ �Inspector: Date:
The issuance of this permit shall not be construed as a guarantee that the system will function as designed.
FEE
o-i:r"O
COMMONWEALTH OF MASSACHUSETTS >Af -7
N�
Board of Health, A,�7 ry ou-r , MA.
rcFl� DISPOSAL SYSTEM SYSTEM[ CONSTRUCTION PERMIT
Permission is hereby granted to; Construct(]-) Repair( ) Upgrade(') Abandon( ) an individual sewage disposal system
at 1- as described in the application for
Disposal System Construction Permit No. W--429 , dated )
\ rovided: Construction shall lie completed within three years of the date of this permit. All local conditions must be met.
1255 Rev. 5/96 A.M. Sulkin Co. Boston, MA Date? Board of Health
i