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COMMONWEALTH OF MASSACHUSETTS
Board of Health,Yarmouth.MA
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT
Application for a Pe mit to Construct(}Repair 0 Upgrade()Abandon()-a Complete System Individual Components
Location a.4r hrANtt44 t Owner's Name ee4 Cr e+t-
' .-Y""'•; } Map/Parcel# IN .7.� Address /1"' 6040-iii 54014 A
Lot# G I Telephone#.00-244-100
Installer's Name -4 Oa-CO Jg Designer's Name L
Address 3(3 `_� Address t
/7�^ ymmo LtfIi I � ,E�i�1It 'i
Telephone# /}-``,,n,,,,,w,-ss}? Telephone# .ag.�'-0 7 71-
Type of Building 1P4 `4Aat Lot Size 9/ sq.ft.
Dwelling-No.of Bedrooms 3 Garbage grinder( )
Otter-Type of Building No.of persons Showers(),Cafeteria()
Other Fixtures
Design Flow(min.required) 33(5 gpd Calculated design flow Designflowprovided y gpd
Plan:Date / / _D. Number of sheets 2., Revision Date
Title II'Bc•PMt '" ?mama r'
Description of Soil(s) 1�40 to_ slat l_h
Q I�/. Ae� ,$)snevi
Soil EvaluatorForm No. Name of Soil Evaluator As risas •o/ Date of Evaluation 11/1
42Da r
DESCRIPTION OF REPAIRS OR ALTERATIONS UV f'Iivavil •s b1. G i rt F al. '2 ` D-120:4-
-1'p a– a0 Wo l a«j cigul d5 ! L/ tcel- t.**Atinclut.
.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 ,. Date r+)/'//07J I/
Inspections
No. FEE P5
N S •. COMMONWEALTH OF MASSACHUSETTS
BoardofHealth,Yarmouth,MA
2: CERTIFICATE OF COMPLIANCE
Description of Work: 0 Complete Systerniandividnal Components
Thes r io� a byASewage Disposal System;Constructed() Repaired Upgraded() Abandoned()
by: $�(' �j �t� iltaae
has been installeji tqwith the .. '.' of 10 CMR 15.00(llde 5)and design plans/as-built plans relating to
applicari. 1�� dated Z 1 0 ( . Approved s Flow /if (gpd).
Installer: ; C—t Wir:17- Cc> f . /
Designer. t .. 7 tf. . .If/►alejt.11.� all. , Date: rL�.7fkk `.
The issuance of this permit shall not be construed as a guarantee that the cyst- .. ",n as designed.
Not/)\q-, 2-1‘k LOSS FEE -_
COMMONWEALTH OF MASSACHUSETTS
Board of Health,Yarmouth,MA
DISPOSAL SYSTEM CONSTRUCTION PERMIT
Permission is hereby an to nstruet() Repair Upgrade() Abandon ) an individual sewage disposal system at
as described in the application for
Disposal SystemConstruction Permit No. 2/ O 33 ,dated 2-114 r .
Provid •Coor on shall be completed ears of sdai of this permit All local conditions must be met.
Date Z t 1 ""2"( Board of Health a
-0Lo-re.-2.1-oo Li-St,4 ' i7�(7��
No.-'�`��- `-^I t"e o.!`� FEE
2 k 33 COMMONWEALTH OF MASSACHUSETTS
Board of Health, Yarmouth,MA
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT
Application for a Permit to Construct 0)Repair()Upgrade 0)Abandon()-0 Complete System)individual Components
Location (f'8eilei ae Ai& Owner's Namejp tioc �p �{��
Map/Parcel# 53 Address 15 n- Cate_Ave.5 ria tium
Lot# (Pr Telephone#,R,€._Rai- tq. )
Installer's NameQnil� }lad ( CO. inc.. Designer's Name 3-C_ ['>A Imam% l z--m_
Address -�j.3rw�r whiles
ft).* , Address (�'Q O�/�N2, J2 `�1T�us�
Telephone#VuO�14-44.....an_ Telephone^#/1 -•R93....C.571-
Type b.
Type of Building ge5fieelllita t Lot Size 1i 66' sq.ft.
Dwelling-No.of Bedrooms 3 Garbage grinder( )
Other-Type of Building No.of persons Showers(),Cafeteria 0
)
Other Fixtures pp gDesign Flow(min.re.uired) 330 gpd Calculated design flow Design flow provided 34l . gpd
Plan: Date / e, Number of sheets �2 Revision Date
Title II 7177 Mteno /11.1
Description of Soil(s) Soil(s)fro-f 5a.l (r Sir" c!!�r`Iti� "
aSoil EvaluatorForrn No. Name of Soil Evaluator Date of Evaluation
DESCRIPTION OF REPAIRS OR ALTERATIONS I: ' 1 4' 6'6.. 1 ii -' ' T4k' I'r b../)24(6
-to a-SW 64 don 'mason d+antilaS .,t L/Iee5I- at Qfle efa _ i nJy
.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 Date
Inspections
No. Z.N '21 • \la:35 FEE ✓
Nee4c.` COMMONWEALTH OF MASSACHUSETTS
I-aS fwV' Board of Health, Yarmouth,MA
2_ ar1 CERTIFICATE OF COMPLIANCE
�" ! FEBq
Description of Work: 0 Complete System, •andividual Components 1 FE0 4 2 0 21
The by: ��} () i
at: 1
p`GC�" Ott yt g DisposalSystem; () RepairedPg ()
has beenersr ne ere certif tl the Sewage Constructed raded Abandons 1
installed in accordance with the rowo s of 310 CMR 15.00(Title 5)and the so oved design plans/as-built plans relating to
application �R733� rdated�Z141 I . Approved Design Flow rff�1 (gpd).
Installer: Ko ,�— v{lvl
Designer: '1r_ [ ,1 4'%/it inc. Inspector: Date:
The issuance of this permit shall not be construed as a guarantee that the system will function as designed.
No. •Z I V+'✓ . '----- FEE t6
v
COMMONWEALTH OF MASSACHUSETTS
Board of Health, Yarmouth,MA
DISPOSAL SYSTEM CONSTRUCTION PERMIT
Pei its ion is hereb rantedlp; Cons ructA t O Repair Upgrade() Abandon ) an individual sewage disposal system at
�� f � `Aif" f�� ?. / as described in the application for
Disposal SystemConstrubtion Permit No. 21-0 3' ,dated 2.. 2. .
Provided:Co struction shall be complet-. it.' ,
1 e year ate of this permit.All local conditions must be met.
Date 2' "24 Board of Health •'l