HomeMy WebLinkAboutApp-Permit-ComplianceYARMOUTH HEALTH DEPT.
1146 ROUTE 28
''No•9 Z—,) -V SO. YARMOUTH, MA 02664 FEE
THE COMMONWEALTH OF MASSACHUSETTS
MASSACHUSETTS to a
�yylirativn for Vislausttt *Votem (gonstrurtion Ifermit
Application is hereby made for a Permit to Construct ( ) or Repair ( L,%'a"n On-site Sewage Disposal System at:
Locationdress or Lot No.
33 A 4XM 4-VI� /4 cs� V�W f
O er's Name, Address and Tel. No.
X -A W, Mars'an
4A-7 e %
'Vaukta
cs'
Installer's Name, Addr s, n eNco
�d
Designer's Name, Address and Tel. No.
0+n/1 �'� 3 `) F-7)7>163
3500 Main Street
7
W. Yarmouth MA 02673
Type of Building:
Dwelling
Other
Design Flow
No. of Bedrooms 13
Type of Building
Other Fixtures
3(� S gallons per day,
Garbage Grinder ( )
No. per Persons Showers ( ) Cafeteria ( )
Calculated daily flow 3 .3'C) gallons.
Plan Date CD - 30-97 Number of sheets Revision Date
Title &y<_ rt�-
Description of Soil %fl /l1
Nature of Repairs or Alterations (Answer when applicable) - of I OQ 1i4A1
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the aforedescribed on-site sewage disposal
system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a
Certificate of Compliance has been issued by t is Bo d of Health.
Signed Date ?'
Application Approved by Date
,e
Application Disapproved for the following reasons
Permit No. Date Issued =LI'
THE COMMONWEALTH OF MASSACHUSETTS
YCUnroy,� A MASSACHUSETTS
(9.ertttt.cttte of (foutlatiMtre
T IS IS TO ERTIFY, that the On-site Sewage Disposal System installed ( )or repaired/ replaced �on
� 44A/60 for /w:
at X 14vAe- 3,0 • - has been cotructed in
accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. )5)- �Y — dated
7-2,1" 9: Use of this system is conditioned on compliance with the provisions set forth below:
The issuance of this certificate shall not be construed as a guarantee that the system will function as designed. This
Certificate expires on
C
DATE
Inspector