HomeMy WebLinkAboutApp-Permit-ComplianceNo �� eJ ° / FEE IWI i/(J,Q
COMMONVONMT,01-�1LAA
S�ACJUUSETTS SO. YARMOUTH,
Board ofllealth, , MA. (�
APPLICATION /1.1014 DISPOSALSYSTEM CONSTRUCTION PETNIT ' 6
Application fora Permit to Consn-uct(,� Repair( ) Upgradc( ) Abandon( ) - Elleomplete System ❑ Individual Components
Location
Owner's Name
Map/Parcellf
oy &-z—
Address -41 Narrows n
S Yarmouth
Lotif 2
Telephonc# 760-1318
h,staller's Narnc PKM Contractors
Address
Hokum Rock Rd.,Dennis,Ma.
Address d 1�
Telephone4f
-R5-15-99 3
Telephone# Jc_Z-L
Type of Building
Dwelling -No. of Bedrooms
Other -Type of Building _
�%7Cn�Gr� _ e �I Lot Sire T�,� / sq. fl.
;[ � � �i,pRt '� 1 L��%f1 ,1.y Garbage grinder (,)�JO
No. of persons Showers ( ), Cafeteria ( )
Other Fixtures
Design Flow ,,(m//in. required) gpd Calculated design flow
Plan: Date LJ- 2-e, 7-00D Number of sheets
Title _fo�6sa� SSnc �Q3�G.J , o c %�v lac
Description of Soil(s)
Soil Evaluator Form No. TC ��—UU Name of Soil Evaluator
DESCRIPTION OF REPAIRS
The tinders' ned age to
farther a e s o
Signed
Design flow provided gpd
Revision Date
t rrcrzu. J
Date of Evaluation NO(%2Z, ZG_&L3
described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and
operation until a Certificate of Co p lance has been issued by the Board of Health.
Date / G+
FEE
COMMONWIIAI III OF MASSA1( IIUSI1TTS
Board, ofllua/lk, /i"`r.' /ta.�c !li ,/VIA.
1-TRTUICATI OF COMPLIANCE
Description of Work: O Individual Component(s) U-Co-mpletc System
The undersigned hereby certify that the Sewage Disposal System; Constructed (,)!Repaired ( ), Upgraded ( ), Abandoned ( )
by:
at ..:a J ..f�-
has been installed in accordance with the provisions of 310 CMR 15.00 (Title 5) and the approved design plm,s/as-built plans relating to
application No 191- 33 ,dated "/ .o -'Z9 Approved Design Plow "`Jl�i``i, gpd)
Installer
Designer. Z/(.//t//(.,l'ospector: s `�:?' F, w'i'...e'�£` Date: t ._..
The issuance of thispermit shall not be construed as a guarantee that die )system will function as designed.
No. M11 r .=k: {"- f'/` ,l FEE f`GA
CIOMMONWEALTII OF MASSACHUSETTS
41.. Board of Ileahla,
DISPOSAL SYSTEM CIONSTRUC'TION RERMIT
Permission isherebygrantedto; Construct(.k�Repair( ) Upgrade( ) Abandon( ) an individual sewage disposal system
Disposal System ConstKuqu(m,Perrinit )oto
Provided: Construction' shall be completed wi
Fo,m 1255 Bev.5/96 A.M. Sulkln Co. Boston, MA Date /
as described in the application for
Pled
_tbieeV Vat -s -of the date of this permit. All local eonclidons mt�t be met.
� e� Board of Health `+