HomeMy WebLinkAboutApp-Permit-ComplianceYARMOUTH HEALTH DEPT.
No. 1 146 ROUTE 28 FEE $50.00
10. YARM?HTYMMACHUSETTS
(
/Board of Health, YARMOUTH MA.
Application for a Permit to Construct( ) Repairo) Upgrade( ) Abandon( ) - ❑ Complete System ❑ Individual Components
Location 90
Valhalla Drive S Yarmouth
Owner's Name Thomas Ryan
Map/Parcel#
/#6 Ofs/,5
Address 90 Valhalla Dr S Yarmouth
Lot#
Telephone# 3 9 8— 8 6 4 4
Installer's Name
W E Robinson Septic Sry
Designer's Name Rick Judd
Address PO
Box 1089, Centerville, MA
Address
Telephone#
775-8776
Telephone#
Type of Building
Dwelling - No. of Bedrooms
Other - Type of Building _
3
No. of persons
Lot Size
sq. ft.
Garbage grinder ( 00
Showers ( ), Cafeteria ( )
Other Fixtures
Design Flow (min. required) gpd Calculated design flow 3,34, Design flow provided gpd
Plan: Date Number of sheets Revision Date
Title
Description ofSoil(s) over -dig to remove unperkable soil. replace w/ clean sand.
Soil Evaluator Form No. Name of Soil Evaluator Date of Evaluation
DESCRIPTION OF REPAIRS OR ALTERATIONS Title 5 Leaching according to the plans of
Rick Judd.
The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and
further agrees to not to lac he system ' o �eration until a Certificate of 'Compliance has been issued by the Board of Health.
Signed L/l/ t L y Date tS '43L�- q
Inspections
No. t
Ryan
COMMONWEALTH Of MASSAC14USETTS
Board of Health, YARMOUTH I MA.
CERTIFICATE Of COMPLIANCE
Description of Work: individual Component(s) ❑ Complete System
The undersigned hereby certify that the Sewage Disposal System; Constructed ( ), Repaired (g), Upgraded ( ), Abandoned ( )
by: 2E-�°Yl&i/t
at 90 ValhallaDrive, S Yarmo$th
has been installed in accordance with the provisions of
310 CMR 15.00 (Title 5) and the approved design plans/as-built plans relating to
application No. 9 dated Approved Design Flow _a;3 (gpd)
Installer
Designer: Rick Judd Inspector: Date:
The issuance of this permit shall not be construed as a guarantee that the system Nh funch as designed.
COMMONWEALTH, Of MASSAC14USETTS
Ryan Board of Health, YARMOUTH , MA.
DISPOSAL SYSTEM CONSTRUCTION PERMIT
- FEE --t-50. 0 0
Permission is hereby granted to; Construct( ) Repair (X) Upgrade( ) Abandon( ) an individual sewage disposal system
at 90 Valhalla Dr, S Yarmouth as described in the application for
Disposal System Construction Permit No. 2�9 `l dated S '�2'%�
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 S Board of Health
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