HomeMy WebLinkAboutApp-Permit-Compliance No 22. 5S5 rEF=. 5-1V
D-W, 2Z ���(p COMMONWEALTH OF MASSACHUSETTS
Board of Health, Yarmouth, MA
0 APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT
Application for a Permit to Construct+Repair>tUpgrade()Abandon O-%Complete System 0 Individual Components
Location tab VEL rd Jocd WM Owner's Name Wtll;an Finn
Map/Parcel# 3{p-1(o Address $l• Wm:Waco 1j0.0
Lot# a Telephone# 1
Installers Name 6 b Desi er's Name
�.xca�a.�iot, lttc• � iinvtetu;n� t J�efpks Inc,.
Address Sty r o SandtAeh Address 11, W'es1 GcOsscktA (40 4
Telephone# I.• y1.1,. �`S 3 Telephone# 5o9• �'�'� 53(.3
Q
Type of Building r,SS vU4<<�f Lot Size 174 720 sq.tt"
Dwelling-No.of Bedrooms y Garbage grinder(00)
Other-Type of Building No.of persons Showers(),Cafeteria()
Other Fixtures
Design Flow(min.required) yI gpd Calculated design flow Design flow provided 1454 gpd
Plan: Date 114 ll`Vt. Number of sheets Z Revision Date
Title
Description of Soil(s) 5p Q(o'^S
Soil EvaluatorForm No. P4*tt, Pt. Name of Soil Evaluator SC- LS42. Date of Evaluation Z4 3+2'L
DESCRIPTION OF REPAIRS OR ALTERATIONS tntkCatokiOr% o4 Ilk IN) SDO Q6.\tOn S(I , et-box
&Ad •5- 5-oo n?' °' qc.'s, J
.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.
RECEIVED
Signed %j Date 31144'ZL '
H A R 2 5 2 0 22
Inspections
HEALTH
DEPT
No. FEE �J M
N4e•o(
COMMONWEALTH OF MASSACHUSETTS 3 -
Board of Health, Yarmouth,MA 4t A78 6 r S C C r
CERTIFICATE OF COMPLIANCE
Description of Work: 16 Complete System 0 Individual Components t � \
The u e signed ilereby certify that the Sewage Disposal System;Constructed Skepaired(*Upgraded() Abandoned() r�
by: b TACO V0.{; \enc. _ 7
at: t•} t^d cm.A Wpy1
has been installed in accordance with the prodfsions of 310 CMR 15.00(Title 5)and the approved design plans/as-built plans relating to }
application No. `Q O,dated � Approved Design Flow 4.5 d/ (gpd).
Installer: ( 1 g [� I
Designer: Inspector: ett! (�c .tre Date: 1r oc, ei/i S/
The issuance of this permit shall not be construed as a guarantee that the system will function as designed.
No �� 3JGS FEE 55•
t\TCOMMONWEALTH OF MASSACHUSETTS e e I
As bulli
Board of Health, Yarmouth, MA -, F s 1 it c r I f2 C r
DISPOSAL SYSTEM CONSTRUCTION PERMIT
Permission is hereby granted to: Construct) Repair(�j, Upgrade( ) Abandon() an individual sewage disposal system at
g7 ^e�WQta as described in the application for
Disposal System Construction Pdm it No. ' ,•- 0ID ,dated 1/ g -a.Z
Provided:Construction shall be completed within three yoacs.ci.tthe date of this permit.All local conditions must be met.
Date V-4" � Board of Health 0/0.",.....0