Loading...
HomeMy WebLinkAboutApp-Permit-Compliancer� �EP0 YARMOUTH HEALTH � 1146 ROUTE 28 No. SO. YARMOUTH, MA 02664 FEE THE COMMONWEALTH OF MASSACHUSETTS 1 0I. ty—rr rr k MASSACHUSETTS }n ,XXyylYrativn for Ptspoent *Votern C onatrurtion Verntit Application is hereby made for a Permit to Construct ( ) or Repair 04an On-site Sewage Disposal System at: Location Address or Lot No. A +. rt � � 13 ,4PF 2DA,� Owner's Name, Address and Tel. No. gyp, `� C�II-lg4' � Z34� 11�C LAc-t_ _S s �I Ay,iU _m?, n � 56 ' U � ��if! S ,v- © 6 -7 Installer's Name, Address, and Tel.No. Designer's Name, Address and Tel. No. i2 .J�7cx� Other Fixtures Design Flow W..k0 67 Type of Building: Dwelling No. of Bedrooms Other Type of Building Other Fixtures Design Flow 330 Plan Date 3 l 2,1 I Q 6 Title 91 T-6: Pc.rt,v izwl 3 gallons per day. — Number of Garbage Grinder (01? No. per Persons Showers ( ) Cafeteria ( ) M Calculated daily flow 336 gallons. s Revision Date �– Description of Soil I=-2�o� JF N6 Sid I cry r s�q 1-e �r S� 4 G l 4cee ril,", 1 Nature of Repairs or Alterations (Answer when applicable) Date last inspected: P' Agreement: The undersigned agrees to ensure the construction and maintenance of the aforedescribed on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. / / Signed , �- Date 3U 96 Application Approved by Date �_3 2 %— Application Disapproved fort a following reasons Permit No. , 7/ Date Issued n� C&I-{ /� � , THE COMMONWEALTH OF MASSACHUSETTS SIA rni e J� MASSACHUSETTS `,r �� Certifirate of Tamplian.ce THIS IS TO CERTIFY, that the On-site Sewage Dis osal System installed( I) or repal ed/replaced (x) on by / � ZIrl v,,7A� for MvrY ,l el J0tJ15S 1^ at kh2j2X 1� ' �a been constructed in accordance with the provisi�Lri of Title 5 and the for Disposal System Construction Permit No. 2.7, dated .� .2. 7— 7 . 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 6 =� _ �� Inspector���/