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HomeMy WebLinkAboutApp-Permit-Compliance EE SSI 00 0-22, COMMONWEALTH OF MASSACHUSETTS Board of Health, Yarmouth, M4 APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to Construct()Repair$Upgrade()Abandon()-0 Complete System 4ndividual Components ..ocation 9G ;,r. 'Br 3. Owner's Name I l,u ,owes Map/Parcel# Address 0 _ot# Telephone# �j 4-Zq c -. 1G 3 nstaller's Name 14913err aeVS co o 6 Designer's Name Address 36,E 1,4*.i .S Po=+1 5yi,o,coak 02 b 6Y Address Telephone# Telephone# Type of Building Lot Size sq.ft. Dwelling-No.of Bedrooms N/Pr Garbage grinder( ) Ot'ier-Type of Building No.of persons Showers(),Cafeteria() Ot ler Fixtures / De sign Flow(min.required) gpd Calculated design flow Design flow provided N/� gpd Plan: Date Number of sheets Revision Date Title Description of Soil(s) Soil EvaluatorForm No. Name of Soil Evaluator Date of Evaluation DESCRIPTION OF REPAIRS OR ALTERATIONS frp( t AtIAL Il ne CO-ST iron p c? pv f'�j;de ,04- kou e -1V rt IST 9-f €pri G T,4n K 'VAS/v-11 5vA; .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 a t _ 7 Signed Zittiftittitkie,er 091,9c .ra, Date JO+2C1 OCT 0 b 2020 Inspections atiC,pr /0/I�' de_ " EALTH DEPT. FEE COMMONWEALTH[ OF MASSACHUSETTS Board of Health, Yarmouth, MA DISPOSAL SYSTEM CONSTRUCTION PERMIT Permission is hereby granted to; Construct() Repair --Upgrade() Abandon() an individual sewage disposal system at e‘ 7;Jr\ 4Jf' as described in the application for Di sposa System Construction Permit No. 7.0-Z1/ , dated 'l b Le IL) Provided: Co struction shall be completed withi thr4gap of the date of this permit. All local conditions must be met. r Date 10 Board of Health jf'' •�� Commonwealth of Massachusetts Board of Health, Yarmouth, MA Fee DISPOSAL SYSTEM CONSTRUCTION PERMIT $55.00 Permission is herby granted to; ROBERT B. OUR COMPANY, INC., 153 COMMERCIAL STREET, MASHPEE, MA 02649 To perform: Repair-minor an individual sewage disposal system. Owner: ATKINS MIRIAM 86 CAPT BACON RD SOUTH YARMOUTH,MA 02664 Location: 86 CAPT BACON RD, SOUTH YARMOUTH,MA 02664 Disposal System Construction Permit No.: BOHDC-20-0384,Dated: Provided: Construction shall be completed within six months of the date of this permit. All local conditions must be met. CONDITIONS: :rucis f. Murphy, PH, R.S., CHO/Mallory R. Langler, R.S. Health Director/Assistant Health Director The issuance of this permit shall not be construed as a guarantee that the system will function as designed. o✓ 5 Hd ro v) c''. a' 0 -. U4 O "(D U1G 0' • `.0=0 O m w 0 cn u b cra o H or ytcl .m C O v,' C n O ro 75, O .z, 2 z C , - O a ci) O -. ta H O `° p b b �. Y tt n m z c x .< n 0 © O Cil 112,Z = 4n c; C a vo ("'� • O -s �' O C� O = CIro m H n : 4 y A: w CO im O n oN c:7, C 2 `" n I O o w oet a cm aFr =. - 3 = Or = 073 0 (1) 4 ep, C) tkl -, — _ (04 y 0t:$ CA ft u, - 0 o Fs v ¢ fg ro :t -. - N a 0 m to 0 -1,(" CD 0 0