HomeMy WebLinkAboutApp-Permit-ComplianceNo. �_9 [l/ 41�;_ FEE
COMMONWEALTH OF MASSACHUSETTS rol& pl-kW.i
YARMOUTH HEAL 9g�pT.
Board of Health, 11 " ROUTE 28
, IDPA.
APPLICATION FOR DISP® y� "MWMJCTIO Y PERMIT
Application for a Permit to Construct( ) Repair( .) Upgrade (xi Abandon( - Cf Complete System ❑ Individual Components
Ronpnn i on nDri
Location 26 Z ephy)L VnL i.v e, ya)rnou thpott
Owner's Name
David Barmy
Map/Parcel# Book 207 Pg. 55 o /
Address
3 Diamond Stneet Non oti2 MA
Lot# 26
Telephone#
Installer's Name Nonthekn Seatcoating INC.
Designer's Name
We ten 9 A.Shoc,i,ates
Address lox 995, Denn zpont, MA 02639
Address 1645
Fatmowth Rd Cent. MA 02632
Telephone# (508) 398-9474
Telephone# (508) 775-0735
Type of Building Lot Size sq. ft.
Dwelling - No. of Bedrooms 3 Garbage grinder ( )
Other - Type of Building No. of persons Showers ( ) , Cafeteria ( )
Other Fixtures —5p S7�1
Design Flow (min. required) 330 gpd Calculated design flow Design flow provided -44.0— gpd
Plan: Date Number of sheets Revision Date
Title
Description of Soil(s) _
Soil Evaluator Form No.
DESCRIPTION OF REPAIRS OR ALTERATIONS
Name of Soil Evaluator
Date of Evaluation
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 place the system in operation until a Certificate of Compliance has been issued by the Board of Health.
Signed I Date 12/28/99.
aymon a ea.c,no
Inspections
COMMONWEALTH Of MASSAC14USETTS
Board of Health, AVIA.
CERTIFICATE Of COMPLIANCE �.
FEE
)205
Description of Work: ❑ Individual Component(s) LWi6mplete System
The undersigned hereby certify that the Sewage Disposal System; Constructed ( ), Repaired ( ), Upgraded ( �bandoned'
( )
by:— /�/ORT7h w /at
has been installed in acco -dance with the provisions of 310 CMR 15.00 (Title 5) and thea prove edg ans/as-built plans relating to
application No. —' dated f'� — Approved Design Flow p tl
Installer /�/�2 Y�'it / �", -
/�� ."
Designer: Inspector: ate:
The issuance of this permit shall not be construed as a guarantee that th system will functi . designed.
No. ' CP4� FEE
COMMONWEALTH Of MASSA# USETT� C��
Board of Health,
DISPOSAL SYSTEM STEM CONSTRUCTIO PERMIT
Permission is hereby granted to; Construct( ) Repair ( ) Upgrade (4 ---.Abandon ( ) an individual sewage disposal system
at -�[� ���/�� / ,�/c/�/�—/ 5_ as described in the application for
Disposal System Construction Permit No. dated
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. SWkin Co. Boston, MA Date 42) -� Board of Health L i