HomeMy WebLinkAboutApp & Permit No.P1A'•J V :- 10• 52-N2- FEE _
20• t70(�P3�1� COMMONWEALTH OF MASSACHUSETTS (�k' i V *
Board of Health,Yarmouth.MA
20— 14 I APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT
Application for a Permit to Construct(Repair()Upgrade()Abandon()-0 Complete System Andividual Components
Location 1 3t 1 lee.,(\ �j- Owner's Name C---)I2__,L__ t ' la ld
Map/Parcel# 1 D.� ' 1 (:::) Address \' .5t Yj I [Leit.i
Lot# ' 3,g. Telephone# 5 b 50 6,40-3
Installer's Name (,QLci _ l�G Designer's Name �)a 5 P`ve,r f
Address 2� � (n r`11► . Address M ii 3 �h n
Telephone# ` D' 11(Q U 4(QO Telephone# Q) L9 qb,s(
Type of Building ` aJ Lot Size la i 16') sq.ft.
Dwelling—No.of Bedrooms .3 Garbage grinder( )
Other—Type of Building No.of persons Showers(),Cafeteria.(()
Other Fixtures 3% '
Design Flow(min.required) 3c3c> gpd Calculated design flow_33Design flow provided gpd
Plan: Date Number of sheets Revision Date
Title
Description of Soil(s)
Soil EvaluatorForm No. Name of Soil Evaluatory� Date of Evaluation
toinAT
DESCRIPTION OF REPAIRS OR ALTERIONS X I 1 1 'r \ , 1I i `1\- u .
ty ilur (--U20 rcc,-,4)( Czsn-ks )
.The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE S and
further agrees to not to place the system in operation until a Certificate of Compliance has been issued by the Board ofHealth.
Signed Date (P/
Inspections
rte/ �7 1 ---------------------------------------------------------------
No.__e A —2fl•8212 FEE X
ki GeG�s: 55
COMMONWEALTH OF MASSACHUSETTS Com'
tV- Board of Health.Yarmouth.MA
p�� � surd 2 � 2020
CERTIFICATE OF COMPLIANCE
HEA•.!_TH DEPT..
Description of Work: D Complete SystemAndividual Components __._,,
The undersigned hereby c rtify ()that t e Sewage Disposal System;Constructed RepairedO ()Upgraded Abandoned()
C
by: CCI-4a HCl
at: --t' ,
has been installed niaccor a with the ro iolf_4141CMR 15.00(Title 5)and the gid ed design plans/as-built plans relating to
application No. dated e 2 [�t./ Approved Design Flow 3 (gpd).
Installer. l�.,r+')Q \ Y\ C--
Designer: -0,,,er, ' e Inspector: Date:
The issuance of this permit shall not be construed as a guarantee that the system will function as designed.
No., \moi 2.0•SZ‘` FEE___ ____
COMMONWEALTH OF MASSACHUSETTS CA-A\'-65
EMOI
Board of Health.Yarmouth.M..4
DISPOSAL SYSTEM CONSTRUCTION PERMIT
Permissic9.4fierely granted
Construct() ()Repairk Upgrade Abandon() an individual sewage disposal system at
l0 as described in the application for
Disposal Sys tem Construction Permit No.2.0---(41 ,dated�.
Provid CfZ'Ol*OBoard
nstruction shall be completed within t ee years oft - •• - of this permit.All local conditions must be met.
Date IP of Health r 1����d _►`—„ i_
`►