HomeMy WebLinkAboutApp-Permit No. KA-'2Z . Okc)
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COMMONWEALTH OF MASSACHUSETTS _
`� Beard of Health, Yarmouth, MA JUL 1 4 2022
APPLICATION FO ID ISPOSAL SYSTEM CONSTRUCTIO y pi' 1;:261111 EPT.
Application for a Permit to Construct()Repair()Upgrade()Abandon()-Z'Complete System 0 Individual Components
Location • 5 / ��� Owner's Name eamovisto, Ci 4,,Vic/'
Map/Parcel# 20/7_3 Addressy73�j� f/«G ,s7--
Lot# Telephone# yy8 6'3 741
Installer's NampzAt rocs Designer's Name ,fC G /0
Address
577G`, y arm +ddress 3qa—
9 t . Ke�,rmcof'£f
Telephone# S im_ 77 - � 'z Telephone# szjizZaWtor— ` � 7T'-cA9/9
Type of Building 5, Lot Size 76; Per sq.ft.
.Dwelling-No.of Bedrooms_ Z ✓/ Garbage grinder( )
Other-Type of Building No. of persons Showers(),Cafeteria()
Other Fixtures
Design Flow(min.required) .1'412 gpd Calculated design flow Design flow provided gpd
Plan: Date 67_- Z Number of sheets l Revision Date
Title
2s//!!sem! �So�i✓ :13��
Description of Soil(s)_ �f
Soil Evaluator Form No. Name of Soil Evaluator Date of Evaluation
DESCRIPTION OF REPAIRS OR ALTERATIONS
fee// /liCrr� 47 ;-S' /3cx. �'.2s !/ ' k5WC, cc/ fr-2
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.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.
Date 77i-��
Inspections
No.CSO- 2- 0‘0 1 FEE
COMMONWEALTH OF MASSACHUSETTS 6,1 e c
•
A . b /1
Board of Health, Yarmouth, MA
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DISPOSAL SYSTEM CONSTRUCTION PERMIT ` ��''�, -�.
Permission is hereb granted to; Construct() Repair() Upgrade() Abandon() an individual sewage disposal system at
30 - }�� /fG�r as described in the application for
Disposal System Construction PertnitNo. _ - , dated AMP
Provided: Construction shall be completed within three years
of the
date of this permit. All local conditions must be met.
Date.S•'"" �' Z. Board of Healt f CAA—€1