HomeMy WebLinkAboutApp-Permit / Voided and Approved No '1l c... 2\ , \SLAi ' FEE 5S
\ , .e,COMMONWC I , ,-I O .ASSAiCHUS T S
ZZ- od pj Board of Health, _Yarmouth, MA
APPLICATION ION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT
•
pplication for a Permit to Constructj;/�Repair()Upgrade()Abandon()-I�'t;ompiete System m individual Components
78 0 ``__ !,� (�
i Location go U' 'R)• so. 1L11U„OLA Owner's Name yc),h 1t, ' �I 0, / 1
Map/Parcel 3`Y/ �/y AddressvG / /!/7/• J`,/Cfj , /l� Dit/o`�b
Lot# 0 I- zf 3
Telephone# Lo/7- '7/ 9 • /!S! i
Installer's Name RV'1%C 1' (,0 Designers Name ?atm G} ,, '
v a i���.5�cvG
Address
4 S n V Address
X39 ,, ØwcJ,LJkf7/
o7S1
Telephone# ,_5'..... ...=, Tele phone# - ev t/_a 9
Type of Building Lot Size 013.7aS +_ sq.ft.
Dwelling–No.of Bedrooms Q..,„;51.4,5 of 3,-,_,f0„.....0 5 Garbage grinder(PO
Other–Type of Building No. of persons Showers( ), Cafeteria
Other Fixtures _
Design Flow(mi.n.r quired) O 50 gpd Calculated design flow Design flow provided •,j 4 C, gpd
Plan: Date�Ot rn&,jj aE Number of sheets I _ Revision Date Light 31, �o7.__
Title 1 -O-L i1 J_ika.JY� 4 k- j Rld Fe] l Se. '/G/UV out \/
Description of Soil(s) St.,"k4_,A. ' '- lo E-'
Soil EvaluatorForm No. Name of Soil Evaluator Date of Evaluation_
DESCRIPTIO`:OF P.EPAWS OR ALTERATIONS UQQ 0100 0-10 d{x. �amkc94yyi `/ '.� ie ) d/yrs
� p
4.box 0'1 0t t ((L.. _ 5 j /_. _ % .. _ f'A
AL../ , _
.The undersigned agrees to install t. ove described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and
further agrees to not to pla e s ":ern in operation until a Certificate of Compliance has been issued by the Board of-Health.
Date 01././34,1,,,
RECEIVED
eD
Signed L L`B p 2 S n
Inspections f. 4 2Q22
HEALTH DEPT.
No-,DMV-J2-1. • \ t FEE__
COMMONWEALTH OF MASSACHUSETTS IJ.
_ etc r't-'e..1. pew I7
Board of Health, Yarmouth, 1l4 — Ag 4 6u''-7
'''11.1---
DISPOSAL SYSTEM CONSTRUCTION ' ERMI sort.s1 wAt.C,P
A P-IA,At..
loissio z i 1 ereby'-a ted to; Construct,( Repai () Upgrade() Abandon() an individual sewage disposal system at
A.. At - ,A,, as described in the application for
Disposal S tem Construction Pert s "o. -0 8 , dated 3 EV 2o2t-
Ko�+r+
Provided: C nstrtetion shall be completed within t_ ac y-ocrc�S of the date of this permit. All local conditions must be met.
Date 31 I S/2i2.1 Board of Health ST-its, D •S
N �_-7 l` FEE
-
1454COM l=ONWEALTH OF -ASSACHUSE -
Zz —vt1+ Board of Health, Yarmouth, MA DEC 0 9 2021
APPLICATION FOR DISPOSAL SYSTEM CONSTRU C .iii,•'i®;it.,
Application for a Permit to Construct/Repair()Upgrade()Abandon()-iXomplete System 0 individual Components
Location 95//100 ilizikin AI
,Jy Owner's Name�no//S4/G(R ! �Ga—
I Map/Parcel 43y// Q9 �- 2ces AddressiO84' est L,t/ �...4. J9i EA 0/ °?O
Lot# y,.9 f y� Telephone# L 1'?_0ig _ al!g �/
Installer's Name a' Designer's Name �o 4J
�,Qt, ,vl�.�,.;��Vii, -L�ng9L
Ciarp 1-1'
FIs/ �/%f�'- 'Yw J��t5 e)o�o6 Address
Address � �
Telephone#5Q�- 94 - 935' Telephone#
•
Type of Building
L Size �$ ± sq.ft.
Dwelling-No.of Bedrooms Garbage grinder
Other-Type of Building _No •f persons Showers(). Cafeteria()
Other Fixtures ZZZ g d
Design Flow(min.req tired) o7 oZ U gpd Calcula d design ter Designflow provided p
Plan: Date .%A,,/_ _.•._ Number of sheeeIs v Revision Date)'e�'T�t�`4` ( Tu I //r4 2.02-7--
Title'_ .._:,_ .1,- A., Ai
. a..2 ,
,, , L aTS 2's'.ni
Description of Soil(s) e5_z_ ,(zbf /�f' .e - .,
Soil Evaluator Form No. Name t Soil Evaluator Date of Evaluation
- I,
DESCRIPTION OF REPAIRS OR kLTE TION g/o /SO�f. I, , /dK ., . _is .• . y 0 ', %"'f,�
• - ;, P4Vr1.!).
.The undersigned agrees to install t e above desc.;'ped Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and
further agrees to no '.•. —stem in op;-ation until a Certificate of Compliance as been issued by the Board of Health.
_•
Sign-- Date AA-211al
i
Inspections
p
Fi:E_,
No. ��� _
COMMONWEALTH OF MAS SACE� _ r+s -60,--7-
l 4 -��T c� 4..--4 LT
Board of Health, Yarmouth,
eo-x. ,�ty,�-s eEx-�
SPOSAi SYSTEM M ,CONS RUCTION PERMIT eo,e_s, w4-1.4, PvHP
Permi,sion i c" y gra te to; Copstru,t(Repair " Upgrade() Abandon() an individual sewage disposal system at
/ ias described in the application for
Di posal Syst- 1Construction Permit NV 22.- OI.`‘. , dated r MI 7-4•1-1—
Provided: Construction shall be completed within three years of the date of this permit. All local conditions must be met.
Date 1/14 1162:2- Board of Health__5T (' i4-4-04-5