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11461
No. 7u�/ %S , SO. Y,
THE COMMONWEALTH OF
YARMOUTH
HEALTH DEPT.
►g 50.00
1,H, MA 02664 FEE
ASSACHUSETTS 4 67,7 % l
6 �kyylirativn for PisposalSgstem
Application is hereby made for a Permit to Construct( ) or Repair (X) an
HUSETTS
rurttIIn P"ermit"
Sewage Disposal System Vit:
Location Address or Lot No. ,y7/ �j
Owner's Name, Addr s and Tel. No. q
40 VIOLET GLEN ROAD /� (J a
l�l�
CAPE COD COOP R''IVE BANK"` Ii
221
SOUTH YARMOUTH, MA
WILLOW STR T, YARMOUTH J'
Instal�r'�l�Te6.}1,fflT-P-fMT�l,l`IoST. CO
EDI ARDNE e' KELLEYand Tel. No. �Z— v,7�
23 ENTERPRISE ROAD, YARMOUTH PORT, MA
CUMMAQUIS, MA
Type of Building:
Dwelling
Other
Design Flow
Plan Date
Title
No. of Bedrooms
Type of Building
Other Fixtures
110
4/27/98
Description of Soil SEE Spit LIQ
0
gallons per day
Garbage Grinder VW
No. per Persons Showers ( ) Cafeteria ( )
Number of sheet
Nature of Repairs or Alterations (Answer when applicable)
SEE PLANS
Date last inspected:
Agreement:
The undersigned agrees to ensure
system in accordance with the provisions
r Certificate of Compliance has been
Signed
Application Approved by
Calculated daily flow440 gallons.
s 3 Revision Date
onstruction and maintenance of the aforedescribed on-site sewage disposal
5 of the Environmental Code and not to place the system in operation until a
�s Bo d of t . _
Date
Date
Application Disapproved for the following reasons
Permit No. �� �� Date Issued
THE COMMONWEALTH OF MASSACHUSETTS
YARMOUTH MASSACHUSETTS
Cgertifirate of C o ttylianxe
THIS IS ;Q CERT Y hat the On-site Sewa a Disposal System installed ( ) or repaired/ replaced (X ) on
7� b E� LIS BROTF RS CONS. Cu. for HAPS COD COOPERTIVE _BANK
at L AD, has—been constructed in
accordance it�?he r isions of Title 5 and the for Disposal System Construction Permit No. 7 dated
tJ - .'_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
DATE '�" Y ', Inspector
THE COMMONWEALTH OF MASSACHUSETTS ,y
C, FERNSUTH ,
No. /u �� 7� ,MASSACHUSETTS FEE
i$ IIstti 5 s#exn C�IIns#rne#tIIn ernti# �� 7 62-)
Permission is hereby granted to
ELLIS BROTHERS CONST. CO.
to construct( ) or repair ) an On-site Sewage System located -at 40 VIOLET GLEN ROAD
and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her
duty to comply with Title 5 and the following local provisions or special conditions.
All construction must be completed within three years of the date below. ���
DATE _ Approved by
FORM 1255 Rev. 3/95 A.M. SULKIN CO. - BOSTON, MA