HomeMy WebLinkAboutApp-Permit-ComplianceNo. S a FEE 40
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OM LTH OF MASSACHUSETTS
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Y'AF'1"t.uUTH HEALTH DEPT. - 1 • q
Pu Board of Health, , MA. O �� 16
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APPLICATION FOR DISPOSA-P-MTffr-,MNffWCTION PERMIT
Application for a Permit to Construct( ) Repair( ) Upgrade(4 Abandon( ) - ❑ Complete System M Individual Components
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Location 822 Route 28, S. Yarmouth
Owner's Name 8 2 2 Reat1V Trust
Map/Parcel#' cf & A portion of 70 " f
Address 512 Route 28, W . Yarmouth
Lot# 1
Telephone# 508-771-0100
Installer's Name �
Designer's Name BSC Group, Inc.
Address 9.0 wels�
Address 349 Main Street, Unit D W.Yarm
Telephone# -"S,-3EfI9
Telephone# 508-778-8919
Type of Building Motel / R G t a i r a n t Lot Size 18 0, 911 sq. ft.
Dwelling - No. of Bedrooms Garbage grinder (K)
Other - Type of Building Mot 1 f Re. -,t -au rant No. of persons Showers ( ) , Cafeteria ( )
Other Fixtures
Design Flow (min. required) 7 0 4 0 gpd Calculated design flow 7 0 4 0 Design flow provided 7 6 9 6 gpd
Plan: Date 2 - 2 5 - 09 Number of sheets i Revision Date I. jo
Title Design for sewage disposal system upgrade-we_s-t55ern side
Description of Soils)
Soil Evaluator Form No. N / A Name of Soil Evaluator N / A Date of Evaluation N / A
StUt�f�
DESCRIPTION OF REPAIRS OR ALTERATIONS
gallon ease trap A_�
- ./ _01 - .T. -
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 place the system in operation until a Certificate of Compliance has been issued by the Board of Health.
Signed Date ( 1) IO -1
Inspections
No. 16 —,117
uth
FEE /7 r
COMMONWEALTH OF MASSACHUSETTS P, *14rf
Board of Health, Yarmouth , MA.
CERTIFICATE OFXOMPLIANCE
Description of Work: Y"Individual Component(s) ❑ Complete System
The undersigned hereby certify that the Sewage Disposal System; Constructed ( ), Repaired ( ), Upgraded (/)%Abandoned ( )
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. 10 7, dated % - /Z ��J . Approved Design Flow 76 % (gpd)
Installer H G C-'161
Designer: &Sj� &)Z744 ��%f'. Inspector: f C3W /h/ {f Date:
The issuance of this permit shall not be construed as a guarantee that the system will function as designed.
No.D !-- ► COMMON""FEE
I.111 OF MASSACHUSETTS /�,�
Board of Health, , MA.
DISPOSAL SYSTEM CONSTRUCTION PERMIT
Permission is herebygrantedto; Construct( ) Repair( �) Up/grade�Abandon ( ) an individual sewage disposal system
at 92 Z 4if:! : 1 Y,2, 7�P d ,!/S W as described in the application for
Disposal System Construction Permit No. /Q 0 _/ , dated / ' -16).
Provided: Construction shall be completed within three years of the date of this p"4. All local conditions must be met.
Form 1255 Rev. 5/96 A.M. Sulkin Co. Charlestown, MA / Date Board of Health
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