HomeMy WebLinkAboutApp-Permit-Compliance 0L 21-004'111
No.4r -_ _\-Z1. Z D95 FEE
01_ OLP' COMMONWEALTH OF MASSACHUSETTS '
Board of Health, Yarmouth,MA
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT
Application for a Permit to Construct()Repair Upgrade()Abandon()-0 Complete System Individual Components
Location ! C ye RoA� IIY��� Owner's Name Jib ? FjGki<SoI J/L u. pq p e TP,pSr.
Map/Parcel# 14 — 39 Address(UI Cath kk E4.boW Q 0€0;44.1t 4111
Lot# Telephone#
Installer's Name RoB -T 43 0,44_ .....° Designer's Name BAs'5 R tve-Q,_LIQ,
Address 363 SEE 1 ms Det. S.y,4,42, Address ect e,ox u4,3 6.Z)e7 'k)(c
Telephone# S09—Li 7i 2 p,7 7 Telephone# t 0 g-2,G4 —cl6 se.8
Type of Building RES LQEArT 1 a c.. Lot Size .2•1i 2..(C.:11: sq.ft.
Dwelling—No.of Bedrooms 4 •(" ( C5, Garbage grinder( )
Other—Type of Building No.of persons Showers(),Cafeteria()
Other Fixtures
Design Flow(min.required) 5 co gpd Calculated design flow Design flow provided 555(3 gpd
Plan: Date ( —13-2-02.-1 Number of sheets ( Revision Date
Title I C O Yt Ca Q v c'S i Yi4 Dc)irW
Description of Soil(s) ht t�tcht4 .,,4,v•D 4'S H/SCE Pc-4-Al
Soil EvaluatorForm No. Name of Soil Evaluator.I ili LEG L.4I/ Date of Evaluation i2..-(4-;0›.4...,-
DESCRIPTION OF REPAIRS OR ALTERATIONS V Se 6Yc STI41-4 I,Otr) Q*.6.0L1 5c907s4—"7G%)g• s- t&)Ste_
iU <) ‘09,00 t c.cauTc c:-"T 0./e 3::/7k' 17 lI O er: G4 L•Ges..o Pc:}47.4? C444•444411
NI D•-Role No) Tketrt cQva.tc / Pc-vs co4,4(6C to.) a Ft‘a-t. dip6JF1Ce--,
.The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and
further agrees to no lace the system in operation until a Certificate of Compliance has been issued by the Board of Health.
Signed C57 Date Z -Z(- 2-t
Inspections
---- No._ +• Z I` LV l6 — FEE55
_—__—
�� COMMONWEALTH OF MASSACHUSETTS _
'(� Board of Health,Yarmouth,MA
2- t fix% ' MAH, ;J "i 2021
L/ CERTIFICATE OF COMPLIANCE
Description of Work: 0 Complete System yIndividual Components
The undersigned hereby certify that the Sewage Disposal System;Constructed() Repaired( ()Upgraded Abandoned()
by: ri) E1iZ:C I?, DO? CLO
/
at: ( C'vea IZ.c.,4'p west VAa1"1wUTl(
has been installed in accor a with the pro isi s of 310 CMR 15.00(Title 5)and the a roved design plans/as-built plans relating to
application No.Z—'0 dated 3 Z Approved DesiF,Flow (gpd).
Installer: 0,5 (b O00. a%C) i
Designer: 134)S As I b l J Inspector: J�1.L: ,,/�.. _ Date: (
WI
The issuance of this permit shall not be construed as a guarantee the sysliiik function as designed.
No. \DA Z\ 2,0q5 FEE _
COMMONWEALTH OF MASSACHUSETTS
Board of Health, Yarmouth,MA
DISPOSAL SYSTEM CONSTRUCTION PERMIT
Permission is hereby granted to; Construct 0) Repair Upgrade() Abandon() an individual sewage disposal system at
I Cove Q.oab War-4r y u-i,tj as described in the application for
Disposal SystemConstruction Permit No. ,dated
Proviidde C nstruction shall be completed withi ee year :' of this permit.All local conditions must be met.
Date J�(1�� Board of He. . '�1,01►�y _�� ir