HomeMy WebLinkAboutApp-Permit-Compliance .. No.ZCAIX:-•' 2- ' (Y1CI° '-100e-......-\--\-- FEE i 1 CD
COMMONWEALTH OF MASSACHUSETTS Erzx sr7-I- (9 E5 Board of Health,Yarmouth,MA
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT
Application for a Permit to Construct jRepair()Upgrade()Abandon()-W omplete System o Individual Components
Location 7 V c_AA lI�(AYA y., I.5 �J, Owner's Name PoMpo,. tSA/ iY\�•,
•
_ Map/Parcel# 1l` / 13, 1•Z Address l� c t C la;T E
Lot# LiTelephone# SUB q 63 - r9(Ct
Installer's Name 1i1' CfU(V1d.,, Designer's Name Doeim C\ egfe 'n
Address %3 CA.r*.Lb hip"i filif taU1\\MP ddress 93Ct Nka:,✓1 Si-. \lafw\".+1'1'\Qar
Telephone# 617 - y t.1(5 ^ m,50 / 61360, Telephone# Gob 3 6a- 9 Si I
Type of Building 55", e r^t'y Lot Size Lb, ooc' sq.ft.
Dwelling-No.of Bedrooms g I Garbage grinder,(
Other-Type of Building No.of persons Showers(3'Cafeteriaa
Other Fixtures tr/ A !' `
Design Flow(min.rpquired) 'i't p gpd Calculated design flow t(�fektary..4�11 D Design flow_ S 3__gpd
Plan: Date 3/�(/ 24 Number of sheets 1 Revision Date (S l=-1
Title n �y
Description of Soil(s) *fC• c2 C*e /L-A M tW/(/1C k 60,55 I 56 1 S
Soil EvaluatorForm No.* 135 p? Name of SoilEvaluatorO l_E Gory5aig Date of Evaluation ? l a 1 a I
DE ION OF REPAlp OR AFERATIONS C V\C `U -\, .11c1 L W
s ,1n 05 r G
`"I T 5�rd all PIA htxG'�
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.
Y
Signed 6 = J Date L
Inspections
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No. 2�- l G► --------- -- rrt I CCU
2s Zt.OIMONWEALTH
OF MASSACHUSETTS
—
Board ofHealth,Yarmouth,MA N� .1.,
. CERTIFICATE OF COMPLIANCE —
Description of Work: KComplete System❑Individual ComponentsII }�, � 7-15-a 3
The
by:e undersigned hereby certify that the Sewage Disposal System;Constructed Repaired(fUP PAT( bath()
at: '70 ar-ts N-dhwRs.S J2..
has been installed in accordance with the pro i of 310 CMR 15.00(Title 5)and the approved design plans/as-built plans relating to
application No. 2(- (9 S ,dated 1,1 As r') • Approved Design Flow ¢'S'S (gpd).
Installer: G'gov V
Designer: ,C$6C_ Inspector: 6kaa. Date: f_y-��
The issuance of this permit shall not be construed as a guarantee tha the system will function as designed.
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No.Z/- (Qe FEE it U
ZEAN '24' CVMMONWEALTH OF MASSACHUSETTS a-col+ Ten
Board of Health,Yarmouth,MA AV ,�T1`ry7CJu
DISPOSAL SYSTEM CONSTRUCTION PERMIT O (zi
P ission is hereby granted to; Construct m Repair() Upgrade() Abandon() an individual sewage disposal syste at
Ana ce,"b 14 410 04.0�s as described in the application for
Disposal SystemConstruction Permit No. 'Z�� (��,dated b/3Ila'14 •
Provided:Construction shall be completed within th e721Tr the date of thispermit.All local conditions must be met.
Date ehI/ze.2l Board of Health 57�106Ea-'6ti_)
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