HomeMy WebLinkAboutApp-Permit No. � LT-1 -•ZZ • .SGg 2l\�� 22 CG06t)1'1r
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a ` 0 7 / COMMONWEALTH OF MASSALCHUS TS
• Board of Health, Yarmouth, ./16,4
APPLECATION FOR DISPOSAL SYSTEM CONSTRUCTION PE RI
Application for a Pennit to Construct()Repair()Upgrade( Abandon()-0 Complete System 0 Individual Components
Location \thsker uzy• wpm . vedyrad6Owner's Name Oe f(-) wed6 3
Map/Parcel 4 i 1 aft ,et Address '7 i'.1-4 f r _ r. • 1 - i
Lot# Telephone#f„ ,/7 &,35q-7
Installer's NamereorleicA Ane i/cocoo,Inc . Designer's Name Wn c -e i flees p)Q
Address P !ov/�tU 51i 5 O�O Address 1%1 v (1/ivl, yClfl ft ��" 06.75.-
-
75
�� � Telephone# `-'��. ' (�'� - i
Telephone# 50 : . '71. 9'.0�0 P I .
Type of Building �€>$i ddi tG Q( _Lot Size I L1, I ( I sq.It
Dwelling–No.of Bedrooms 9 Garbage grinder( ')
Other–Type of Building_ No. of persons Showers(),Cafeteria()
Other Fixtures (--/ /�v �t
Design Flow(min.required) y y 0 gpd Calculated designflowL/ Designflow provided '7
fedy
Plan: Date Mare gt c10,3__.).. I
Number of sheets Revision Date A/ /A
Title
Description of Soil(s)
Soil EvaluatorFormNo.0O4 / Name of Soil Evaluato>iI�(t•nj el G fe Ii)PS Date of Evaluation a/9/e7Q
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DESCRIPTION OF REPAIRS OR ALTERATIONS 1_ ... , I ./.r 0 (1 'I4-1CA�_
■ - 1 ,• ` i d,• • fl • 1_'t.a� � i1 �'���EM_ 4 '
Sofrboeided t/e4 )e J1) i 5 'W x y0'L L,Rpe6i /-ea r�-rnot / ung;//�i
.Sc�i`Iy tie) e(evk,�r&) <o•�, 166 0,%y �3y.7 eV� a
.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.
Signe • is / Date 3A(44, RECEIVED
Inspections MAR 2 8 2022
HEALTH DEPT,
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COMMONWEAl I Ii OF MASSACHUSETTS - As b ,; c7`-
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BoardofHealth, Yarmouth, 1,L4 — 3 of ft
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DISPOSAL SYSTEM CONSTRUC"TION PERMIT
E.RAY IT
Permission is ereb granted to; Con trice (Repair() U rade(/Abandon() an individual sewage disposal system at
Ri Wa_L/+ 1" 7 1 as described in the application for
Disposal SystemConstriction ermitNo. / dated S/- 6 - a L.
ot`
Provided: Constriction shall be completed within mNtthe date of this permit All local conditions must be met.
Date 4/--6_-;_1_ Board of HealthV�_/vv-e.• —.