HomeMy WebLinkAboutApp-Permit-Compliance• r No. FEE
COMMONWEALTH OF MASSAC14USEITS
YARMOUTH HEALTH DE T. C
Board of Health, ARMOU
11465 ROM E 28
APPLICATION FOP, DISPMTA9V9WM"%VUCTION PERMIT
Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) - ❑ Complete System ❑ Individual Components
Location 752 Route 6A
Owner's Name
Walden Cor Robert Dunphy
Map/Parcel# 134 59.2
Address 218
Blue Rock
Rd. , S. Yarmouth
Lot# 2
Telephone#
760-1318
Installer's Na me PKM Contractors
Designer's Name Sweetser
Engineering
Address Hokum Rock Rd. , Dennis,Ma.
Address 235
Gr. West.
Rd. , Dennis
Telephone# 385-5993
Telephone#
398-3922
Type of Building Single family house Lot Size 54,570 S.F.sq.ft.
Dwelling - No. of Bedrooms 4 Garbage grinder( )
Other -Type of Building No. of persons Showers ( ) , Cafeteria ( )
Other Fixtures
Design Flow (min. required) 440 gpd Calculated design flow 4 4 0 Design flow provided gpd
Plan: Date 1 .118.12 0 0 2 Number of sheets 1 Revision Date 3/ 13 & 4/ 3/ 0 2
Title Proposed Septic_ Design for Dublin ons r ui an ., T,ct 2.,#7S2 RC)ufp 6
Description ofSoil (s) See plan
Soil Evaluator Form No. Name of Soil Evaluator Date of Evaluation
DESCRIPTION OF REPAIRS OR ALTERATIONS
The unrs d ees to ' the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and
p, further to t 1 cyst eration until a Certific [;7�t�been issued by the Board of Health.
Signed Date
nf,
Inspections
No. ~ / FEE
COMMONWEALTH Of MASAl14SETS.10 1 1) C�
Board of Health, 61AAV0,11171 , MA.
CERTIFICATE OF COMPLIANCE
Description of Work: ❑ Individual Component(s) 06omplete System
The undersigned hereby certify that the Sewage Disposal System; Constructed , Repaired ( ), Upgraded ( ), Abandoned ( )
by: pv/
at w- %L�
has been installed in accordance with the provisions of 310 CMR 15.00 (Title 5) and the app ved design plans/as-built plans relating to
application No. �. Z"9"7 dated �' 6 -OZ . Approved. Design.FlowPd)
Installer
Designer: ?(����'/��i�. �/(�(�'(� Inspector: Date:. �.Z.
The issuance of this permit shall not be construed as a gu antee tha the system Will function as designed.`
No.�' - + fiT1 / /��Z �7�+� FEE
COMMONWEALTH Of MA SSACHUSETTS
Board of Health, ; MA. J
Permission is hereby granted to; Construct(4 Repair( ) Upgrade ( ) Abandon ( ) an individual sewage disposal system
at �/�.� f3 as described in the application for
Disposal System Construction Permit No. r*O dated
Provided: Construction shall be completed within.thx o roars of the date of this permit. All local conditions must be met.
Form 1255 Rev. 5/96 A.M. Sulkin Co. Boston, MA Date 5 6 402 --Board of Health" /