HomeMy WebLinkAboutApp-Permit-Compliance No.g -212-7 FEE 5 ✓.o
COMMONWEALTH OF MASSACHUSETTS
1 5 Board of Health, Yarmouth,MA
(75-
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT
Application for a Permit to Construct()Repair Upgrade()Abandon()-O Complete System AIndividual Components
Location A 6 Ac reJ Owner's Name C,ka.r l er'e TT 5i I Pit'
Map/Parcel# Address Lit, Acr 3 A tfc IA , y�fjy►�dl�n-
Lot# Telephone wit.e71-/ef Agw -rpf
Installer's Name /ei d-�3 j( {_,c Designer's Name
Address3&3 !�)ht s Path. 5• �Il�`bV�'` Address
Telephone G .5O £473B 341 f..4 ,i7-... Telephone#
Type of Building g+'6 /te rs o-'1 Lot Size sq.ft.
Dwelling-No.of Bedrooms__ Garbage grinder( )
Other-Type of Building No.of persons Showers O,Cafeteria()
Other Fixtures
Design Flow(min.required)_ gpd Calculated design flow Design flow provided gpd
Plan: Date Number of sheets Revision Date
Title - - - - -
Description of Soil(s)
Soil EvaluatorForin No. Name of Soil Evaluator Date of Evaluation �t "� ((1�
DESCRIPTION OF REPAIRS OR ALTERATIONS Zi' i'101► A ne+a b 8-3 14-i c b o)c W 1 1k Alter.
Pe( nrie 5rnspLer,•on
.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 placeac the system
in operationuntil a Certificate of Compliance has been issued by the Board of Health. nrAV 17dNM
Signed��A IPoi r 8.&X •(,.Tee._- Date 7-2( Z3 JUL2 I 2023
Inspections ""`
HEALTH DEPT.
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No. -23. 2.I2:1 FEES--
COMMONWEALTH OF MASSACHUSETTS
Board of Health,Yarmouth,MA
CERTIFICATE OF COMPLIANCE
Description of Work: 0 Complete System$Individual Components
The un$ery�tgned hereby certify that the Sewage Disposal System;Constructed() Repaired* Upgraded() Abandoned()
by: l�4DG�7 8.BNf. ZD. 1G.
at: Kb Rertes 4i�.
Y1'
has been installed in accordance with the provisions of 310 CMR 15.00(Title 5)and the approved design plans/as-built plans relating to
application No. dated . Approved Design Flow (gpd).
Installer: %Kea TnG
Designer: Inspector: Date:
The issuance of this permit shah not be construed as a guarantee that the system will function as designed.
No.I`f h Z I Z FEE 55
` COMMONWEALTH OF MASSACHUSETTS
Board of Health, Yarmouth,MA
DISPOSAL SYSTEM CONSTRUCTION PERMIT
Permission is hereby granted to; Construct() Repair Upgrade() Abandon() an individual sewage disposal syste at
yb Acrt.3 Aviv— as described in the application for
Disposal System Construction Permit No.a T'/1y ,dated Sr. 7-,2 k.),? .
Provided:Construction shall be completed within three years of the date of this permit.All local conditions must be met.
Date 5.7-1te 5 Board of Heagsy—