HomeMy WebLinkAboutApp-Permit-Compliance D_Zl' No. 1N \ -ZV• °"1` V FEE
1b;c'' . ,,Co3 t G 9 COMMONWEALTH OF MASSACHUSETTS i
Board of Health, Yarmouth,MA
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT
Application for a Permit to Construct()Repair 0)Upgrade krAbandon(1-Komplete System❑Individual Components
Location I V Pine , Owner's Name Lewis
Map/Parcel# /a3/ /../4/ AddressLIP, tt11"""7 0 5 Y'Yl.\) e / . 'NNS/!!
LL,��/ih
Lot# Telephone#l5'"$ 31(..p . 41V))T
Installer's Name cafe 1) /VC_ Designer's Name S wet f
n
Address #8-1.4060.016Address a0,5 t/e�
Telephone# SI/410D Telephone#(sox�/Lg�goo
Type of Buildinge 4/ Lot Size /1) "MI4 sq.R.
Dwelling—No.of Bedrooms Garbage grinder( )
Other—Type of Building No.of persons Showers(),Cafeteria()
Other Fixtures
Design Flow(min.required) ..i 36 gpd Calculated design flow 350 Design flow provided tigpd
Plan: Date Number of sheets Revision Date
Title
Description of Soil(s)
Soil Evaluator Form No. Name of Soil Evaluator Date of Evaluation
•
DESCRIPTION OF REPAIRS OR ALTERATIONS a a it ‘. _Al . GJ IDs• 1 I
Cap Info %ru,-ibrs ii 1/45-77)
.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 Date
Inspections DEC 0 4 2020 1
HEALTH DEPT. I
N°'-ei 2.0- D 1 1$ FEF,
COMMONWEALTH OF MASSACHUSETTS MetA
Board of Health, Yarmouth.MA
CERTIFICATE OF COMPLIANCE
Description of Work: Complete System I]Individual Components
The undersigned hereby e Ty that the Sewage Disposal System;Constructed O () ()Repaired Upgraded Abandoned()
by: Co-p, _ t+�"l C� //(f(.
at: PI 57- �.
has been installed in accords[ a with the prove ion of 310 CMR 15.00(Title 5)and thea roved design plans/as-built plans relating to
application No. A 2.0 I ,dated(2 OWApproved D-ign Flo. 1 (gpd).
Installer: I"' 1114. .
Designer: I_ , - .. wii , Inspector _ ,1'.,..A`- ,_ Date: T',!/ 02
The issuance of this permit shall not be construed as a guarAll int the sys ell will function as designed.
No. LJ l ; 2 O .al v FEE
COMMONWEALTH OF MASSACHUSETTS
Board of Health. Yarmouth,MA
DISPOSAL SYSTEM CONSTRUCTION PERMIT
Permission is hereby granted to• Construct() Repair() Upgrade k Abandon() an individual sewage disposal system at
/Li ?Mt Elf .\ ��++�.�mss described in the application for
Disposal System Construction Permit No. 0—. z ,datedT_.
Provide •Co�sstrruuctition shall be complete within t ee years of the date of this permit.All local conditions must be met.
l00
Date I Board of Health