HomeMy WebLinkAboutApp-Permit-Compliance .0 W eC �+ '_`l FEE 5S-
z _ COMMONWEALTH OF MASSACHUSETTS
Board of Health, Yarmouth,MA
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT
Application for a Permit to Construct()Repair(Y{Upgrade I)Abandon()-0 Complete System p lndividual Components
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Location is S Q 4 d Koo4 r Owner's Name v„,f h U OOd wes
Map/Parcel# 16' Address ` , Shy,,`FstA d 9..004
Lot# 11. Telephone#
Installer's Name Els C.xGa,�►'tir�On QAC Designer's Name Q 4C Mou EA1m.00v1(44
Address 314 Rook, (30 Address
Telephone# 50$. pp. p`53 Telephone#
Type of Building PIES• etL Aktfir Lot Size sq.ft.
Dwelling—No.of Bedrooms M 3 Garbage grinder( )
Other—Type of Building No.of persons Showers(),Cafeteria(
Other Fixtures
Design Flow(min.required) 330 gpd Calculated design flow Design flow provided 349 gpd
Plan: Date (e 221 8' Number of sheets , Revision Date
Title
Description of Soil(s) 14n3
Soil EvaluatorForm No. Name of Soil Evaluator b. Aaspn Date of Evaluation (el 24I2oa1
DESCRIPTION OF REPAIRS OR ALTERATIONS 1fl66allo.�%4 Of n(.0 SAS (2' SOO Anon Cho ntbvs) t
d-box C.onnockni -o •ex:si,t ►000 ekcel kr *-- �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.
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Signed Date_11611,1
JUL 0 6 2021
Inspections
yy'}(_��t('� - HEALTH DEPT
NP` `J�•2, 'CDC/59 FEE SS - ..
COMMONWEALTH OF MASSACHUSETTS
Board of Health, Yarmouth,MA 316
CERTIFICATE OF COMPLIANCE
its
Description of Work: 0 Complete System IX Individual Components
The undersigned hereby certify that the Sewage Disposal System;Constructed() Repaired 04 Upgraded() Abandoned()
by: l63 IS �x t44,1a:Uen lnl
ahat:
s beei ta e in cor nce wi t the pro si s of 310 CMR 15.00(Title 5)and the appprrooved design plans/as-built plans relating to
application No. 21- (!e3 ,dated "'t T T2oZ1 . Approved Design Flow 34{ 1 (gpd).
Installer: e,3a UConla:41en 11LL• /
Designer: Inspector:_pev c6 ./Z �,,,). Z
The issuance of this permit shall not be construed as a guarantee that the system will function as designed. P)(2-.
2.1 o 9 FEE -
FEE 51 g
COMMONWEALTH OF MASSACHUSETTS 1,74—C to
Board of Health, Yarmouth,MA /_ ifs - 6 Ul e--T"
DISPOSAL SYSTEM CONSTRUCTION PERMIT 2 _ 63,04/v e t
Permission is hereby granted to; Construct() Repair 04.Upgrade() Abandon() an individual sewage disposal system at
tSIC,{tcrt`L(d, 9.4l. as described in the application for
Disposal System Construction Permit No. -2(— /G 3 ,dated 'j//Art/
Provided:Construction shall be completed within three years of the date of this permit.All local conditions must be met.
Date '711/202/ Board of Health 57-z:z9f-,-,$ ) /t om