Loading...
HomeMy WebLinkAboutApp-Permit-ComplianceJ� 14Dc —19(- a8Bl Jee p LA 6-e, ru �^'r 4&A9 M' f CV ` No.( • ��At gg G Ile i/ lMt Board of Health, N D YY10 , MA. pet"Aake Pak 1W ©�APPLICATION.FOR DISPOSAL SYSTEM CONSTRICTION PERMIT -+ 1 Application for a Permit to .Construct( ) Re air()( Upgrade( ) Abandon( - ❑ Complete System ii ual Components: Location 14 F Ao ., L .M WQ - Owner's Name �y►�lezr Map/Parcel#t15 lj" - �'W Address -Zlf Fro�i W Lot# F 6 Telephone# Instal ler'sName M,&j-f c ., UC Designer's Name Address Z l aQvaan t�,.,,� Rd - l�..,r kl MA ozOS Address MAY 2 2 2019 Telephone#--77tj_LV)_ �3 gp Telephone#• Type .of Building $ml, Lot Size sq. ft. Dwelling - No. of Bedrooms Garbage grinder( ) Other - Type of Building No. of persons Showers ( ), Cafeteria. ( ) Other Fixtures Design Flow (min. required) gpd Calculated design flow .Design flow provided gpd Plan: Date Number of sheets _ Revision Date Title Description of Soil(s) Soil Evaluator Form No. Name of Soil Evaluator Date of Evaluation DESCRIPTION OFREPAIRS ORAI.TERATTONS T_,sA1 ty, WAP. CArusss o. Tdn�:+evlw. c,�n.r S G� - - -s• _ - KL The. undersigned agrees to install the above described Individual SewageDisposal System in accordance with the provisions. of TITLE 5. and; further agrees to not to place the system in operation until a Certificate of Compliance has been issued by the Board of Health. Signed Date s••ZZ-n Inspections. L' �! dy pO 7117 Cr,�P-el . 1^ No. COMMONWEALT14 Of MASSACHUSETTS Board of Health; / ' , MA. , : U CERTIFICATE Off' COMPI �ViA'� �,� �,� �7 Description.of Work: 6-ehdividual Components) ❑ Complete_$ystem C PQl Z -7 - The undersigned hereby cegif that he Sewage Disposal System; Constructed( ), Repaired ( ),Upgraded( ), Abandoned ( ) by has been installi ac r nce with theroVisiolas of 310 CMR.15.00 (Title 5) and the approved design plans/as-built plans relating to application No,Fdated S ! `' ` t 4J. Approved Design Flow (gpd) Installer Y s } s `^. Date: Designer:ua :E �..� const ..__ Inspector:gtlt! system � .on as desiened. :The issuance of flus. ermit shall not be construed as a arantee that the stem will function, Y • �� `�-D,-- . No. (� 1 i� � COMMONWEALTH Of MASSACHUSETTS 1� /0 ! --' Board of Health, �✓ V�A C' M. r kA DISPOSAL. SYSTEM CONSTRUCTION PERMIT � it Permission is hereby -granted to; Construct( ) Repair( ) Upgrade( ) Abandon( ) an individual sewage disposal system at ` ` t cas described in the application for Disposal System Construction Permit No. c dated <�— �_)_ � (9, 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. Chadestown, MA Date �'1 'f t Board of Health Al �•4.� ,1n !_ •�.. J'....A i iLg. l_ s`'•�,..,n f /�*��� YARMOUTH HEALTH DEPY. No. i"Q1WkTC- 15— v1 1146 ROUTE 28 �iJ� FEE Board of Health, I , MA/P - 0 s V APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION P MIT Application for a Permit to Construct( ) Repair (x1 Upgrade( ) Abandon( ) - C3 Complete System Individual Components Location a'y Ff Q %ri ftm Owner's Name -P- 1 (;I I Map/Parcel# Ar 0 Address 'a q c -o+- ) l ^ #--I- Aq I WAY Lot# Q Telephone# Installer's Name Nbr+h,,evotsr Con 5 f �G+� h is S+ 5 -A, Address,5a5,4,-,4 A/Aj �i �S Z Designer's Name Address Telephone# sb � lj ) Tele ne# Type of Building Dwelling - No. of Bedrooms Other - Type of Building _ Other Fixtures Design Flow (min. required) Plan: Date Title Description of Soil(s) _ Soil Evaluator Form No. Lot Size sq. ft. Garbage grinder ( ) ,00 MAE persons Showers ( ), Cafeteria ( ) culated design flow Design flow provided gpd of s ets Revision Date v ne of Soil Evaluator Date of Evaluation W OF REPAIRS OR ALTERATIONS off- h"V-0, A:np 42 Cu sem' lv + R7—; --p The undersigned agreesYr., further agrees to not to Signed Inspections No. zi •rev J, y�J�. v R y„�,,,....� . .� . ♦ �.. w. w� a.•. sv . v QIP •i. o. u—, V--Q-S4-V-*4 1-., —Nc- Q�,.,N.� t��+.w•�p �� . tall the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and the system in operation until a Certificate of Compliance has been issued by the Board of Health. Date COMMONWEALTH C Board of Health, CERTIFICATE 01 Description of Work: Ulxi�dividual Component(s) ❑ Complete Sy. The undersigned hereby certify that the Sewage Disposal System; Con by: f) o 'z--04 (-J\ � c. 0 051j,0 C- t o IQ at It -1 "o , ++ v lea e 4vN i\i l t)A a-1 has been installed in accordance with the provisions of 310 CMR application No. dated 11. A ro Installer S , ~Tb L.A..l ) Cn Ur-bigii pians/ as -Duet plans relating to I�ign Flow (gpd) Designer: '°"'� Inspector: NJ Date: The issuance of this permit shall not be construed as a guarantee that the system will function as designed. No. O iH e-��(^��®( .. j`J4�{Z S i.1Gtv`�1i2)CT IQ FEE ���. 00 COMMONWEALTH OF MASSACHUSETTS 62 BoardofHealth,�NIC)�3�i~` MA. DISPOSAL SYSTEM CONSTRUCTION PERMIT Permission is hereby granted to; Construct( ) RepairwUpgrade ( ) Abandon ( ) an individual sewage disposal system at Disposal System Construction Permit No. � , dated 47 as described in the application for Provided: Construction shall be completed within thre�oT he date of this permit. A41 local conditions must be met. Form 1255 Rev. 5/96 A.M. Sulkin Co. Boston, MA Date 1;- — Board of HealthV( I