HomeMy WebLinkAboutApp-Permit-Compliance . No* l/ft,''Z;22--• -6 FEE 55
COMMONWEALTH OF MASSACHUSETTS
' Board of Health, Yarmouth, MA
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT
Application for a Permit to Construct()Repair 0 Upgrade()Abandon()-❑Complete System%Individual Components
Location 21 SWAIN Late, Ito, Owner's Name
Map/Parcel# Address
Lot# Telephone#
Installer's Name 6 $ is £ .00.1),,A0, 1AG Designer's Name
Address j &.( R k 130 Sandti;on AD_ Address
Telephone# So 8•im- CgbS3 Telephone#
Type of Building i4s. ctuG'1'11K Lot Size sq.ft.
Dwelling-No.of Bedrooms Garbage grinder( )
Other-Type of Building No.of persons Showers(),Cafeteria()
Other Fixtures .
Design Flow(min.required) gpd Calculated design flow Design flow provided gpd
Plan: Date Number of sheets Revision Date
Title
Description of Soil(s)
Soil Evaluator Form No. Name of Soil Evaluator 1. Date of Evaluation
DESCRIPTION OF REPAIRS OR ALTERATIONS Reel am, 51 (i +o,\k. to SQ.(n� `Q(+C"'_10� _UNi .
U' I500 1 0-itaA N•(0 5(T. U
.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.
Signed rid ✓ Date 6111132,
Inspection
No.PIMDC:Z2-.'lU4, FEE g
COMMONWEALTH OF MASSACHUSETTS
RECEIVED
Board of Health, Yarmouth,MA
CERTIFICATE OF COMPLIANCE JUN 1 3 202.2.
Description of Work: 0 Complete System❑Individual Components HEALM l++1��^u q
The un'lerignid he;eby certify that thy Sewage Disposal System;Constructed O Repaired O Upgraded(I' tllah@d(y`
((��J ((�� 1.
y Up
has been iinsttaalle in accordance Ke th thprovisionsof 310 CMR 15.00(Title 5)and the approved design plans/as-built plans relating to
application No. Z— (..,cf dated G / Approved Design Flow (gpd).
Installer: n �.1c1 •on kAL. j / ,
Designer: N A Inspector: (vl i .lied• Date: C`/7/1 Z VK
� C .L
The issuance of this permit shall not be construed as a guarai?lee that the systemcewill function as designed. 36MA
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No.bl .2_2•(-WASFEE 66+
COMMONWEALTH OF MASSACHUSETTS
Board of Health, Yarmouth, MA ('�^
DISPOSAL SYSTEM CONSTRUCTION PERMITl' ��
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Permission is hereby granted t Construct() Repair(x) Upgrade() Abandon( ) an individual sewage disposal system at
Z$ swan 1 _ ( as described in the application for
Disposal SystemConstruction Permit No. ,dated
Provided:Construction shall be completed within three years of the date of this permit.All local conditions must be met.
Date 6 /i-p>Jtsoard of Health ,....&-r-d-,-.1--