HomeMy WebLinkAboutExpired Permit/BOHDC-22-1824 No. 2_2 L
COMMONWEALTH OF MASSACHUSETTS4111011
Board of Health,Yarmouth,MA
0 APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT
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a Application for a Permit to C6nstruct Repair()Upgrade()Abandon()-"Complete System❑Individual Components
Ik$, Location e2027 A!,\Az CrCre,enotkik Owner's Name azip<_ack /Q/a+ QACA/ AfA
Map/Parcel# /o /6 / Address d y7 i n,Iv *c &/,ftl
Lot# Telephone# J5 ,Jal-Z
Installer's Name Q aw- (, Designer's Name /3 fi�/11 VC, /te(J/Aj
Address )// (ram (,//U-krA/�( �rgrW�, Address 2,,p �( fi N,w/r �4 02(01
Telephone# ,f f- sf J'.2 0.4-3j�Q� Telephone
�# .S/,(0� 77� 7 L
(.Type of Building /AhlaC-�'t r/11 t1�/� /f�J ff5lr /0•"'l Lot Size PP At f sq.ft.
Dwelling-No.of Bedrooms Garbage grinder( )
Other-Type of Building No.of persons /19 Showers(),Cafeteria()
Other Fixtures
Design Flow(min. eq end/) j (7 gpd Calculated design flow l/y0 Design flowprovided Js1( gpd
Plan: Date 9 7[a/ Nuf berofsheets I / Revision Date /� II
Title Aifi-Sty .r .t'AMvr .. G-1CI caA"1- iF /%ego-c. .1i "+ (J^Or/ Ja7 F, F yr/`A /9,971.44A
Description of Soil(s) /�'f
Soil Evaluator Form No. Name of Soil Evaluator S/ % ./IV Date of Evaluation ,f)////J01-40
DESCRIPTION OF REPAIRS OR ALMIONS // --)
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 p e the system in operation until a Certificate of Compliance1 has been issued by the Board of Health.
Signed li Date /p1 Z 7il,
Inspections
No fT ZZ* L 1 A FEE \\D
COMMONWEALTH OF MASSACHUSETTS
Board of Health,Yarmouth,MA A t eJ
CERTIFICATE OF COMPLIANCEip,)''''Cef JAN 0 6 2022
Description of Work: ❑Complete System O Individual ComponentsLTH DEPT.
The undersigned hereby certify that the Sewage Disposal System;Constructed() Repaired() Upgraded() Ab:ndondd�
by:
at: .e
has b:gii instal ttaf�cord the provisions of 310 CMR 15.00(Title 5)and the approved dent n plans/as-built plans relating to
application No 6— ted . Approved Design Flow mod).
Installer:
Designer: Inspector: Date:
The issuance of this permit shall not be construed as a guarantee that the system will function as designed. Ak `\Y►�
No '22 `VZ� FEED\ l V
COMMONWEALTH OF MASSACHUSETTS Q A
Board of Health, Yarmouth,MA r f7 b�' L
DISPOSAL SYSTEM CONSTRUCTION PERMIT- kg, �w Crf'
Permi sion is hereb ranted to; Construct() Repair() Upgrade() Abandon() an individual sewage disposal system a
as described in the nt
for
Disposal System Construction PermitNo. ,dated
Provided:Construction shall be completed e e r e date of this permit.All local conditions must be met.
Date C-r "sf) Board of Health ✓�