Loading...
HomeMy WebLinkAboutApp-Permit-Complianceo� No. FEE 4a/ COMMONWEALTH Of MASSAC14USETTS Board of Health, YARMOUTH HEALTH DEPT. . � . 1146 R / �r� <�G r A Application for a Permit to Construct( ) Repair(✓jUpgrade( ) Abandon( ) - ❑ Complete System "In vidual Components Location © i a &CA Owner's Name f7, Map/Parcel# Address Lot# Telephone# Installer's Name - ocs Q -t S t Designer's Name ? Address !�-U f tLt �L S �, (,G,Q�/((6 Address P. D, 1304 -74-al , Telephone#`Q-6 . _ 0 Telephone# Q `6 - 2(,;r2- 2 41 2 Z Type of Building �S e litglle —QC nA»j-i Lot Size sq. ft. , Dwelling - No. of Bedrooms Garbage grinder ( ) Other - Type of Building No. of persons Showers ( ) , Cafeteria O u Other Fixtures Design Flow (min. required) 11C> gpd Calculated design flow Design flow provided gpd Plan: Date, o4 14 ?cc6 Number of sheets Revision Date Title Description of Soil(s) Mr -4 Scyh04 Soil Evaluator Form No. Name of Soil Evaluator bv%1gm Date of Evaluation ?0 o S DESCRIPTION OF REPAIRS ORALTERATIONS �%'��+ (� eJ -=3 14►D O✓l F I �n ��"� S 130 2 . �I 1 e 5 �yvl Oki 5, ,ft, 0 d S 30f L-!�j Theunder ' ed agrees to further e s to not to p Signed Inspections--4- the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and system in operation until a Certificate of Compliance has been issued by the Board of health. Date /0.lz% 7 7 7 - No. FEE . COMMONWEALTH.. Of MASSACHUSETTS Board of Health. U JV't- 5' , `1VIA. CE CERTIFICATE OF �COMPIIAN Description of Work: Cak d'vidual Component(s) ❑ Complete System 7 1, The undersigned hereby certify that the Sewage Disposal System; Constructed ( ), Repaired (,1 Upgraded (,<Abandoned ( ) has been installed iij, accordanc with the provisions of 310 CMR 15.00 (Title 5) and the ap oved design plans/as-built plans relating to application No. M �49 dated /10 'i% Approved Design Flow (gpd) installer i k ,� ®q Designer: Trv.✓t rJ / 'S Inspector: Date: 7.1 The issuance of this permit shall �not be construed as a guar, ' tee that the system will function as designed. No. lf(�iG FEE COMMONWEALTH: Of. MASSAC14USETTS Board of Health; DISPOSAL SYSTEM C % NSTR CTION PERMIT % Permission is hereby granted to; Construct( ) .` Repair( Upgrade( ) Abandon( ) an individual sewage disposal system at as described in the application for Disposal System Construction. Permit No. , dated ` /7/d Provided: Construction shall be completed within t, of the date of this per it: All local condi 'ons must be met. Form 1255 Rev. 5/96 A.M. Sulkin Co. Boston, MA / Date / 1 Ill 14 -Board Board of Health /ice /l / /_ ,e !./%-4 /%) �t/I /1111,.4 -fNZ-1 /