HomeMy WebLinkAboutApp-Permit-Compliance All 20 -2 1 r \10
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APPT Tr A TT1VSI FflP TlTSPCORAT RVSTFM CONSTT?T'f TTON PPPMTT
Aonliration for a Permit to('nnctnrr$!I Renair! )4 hairdo°I 1_ Cmmnl.te Svet•m Ft Tndivdh.al Cmomwto etc
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Location 3 4Co4N /9/11 I
11ap.Parcel# aS�l 3 Address AMA' 7:07/10-4/
Lot# f/f t /0 Telephone# .row'774 Good
Installer's Name T,-,7 a_-,7kes- Designer's Name
7e re,4re e NA •c r
t Address Ti/ U/!Pe✓ Q.„...0 - 4 Address
Telephone# i''Of/� e f fl 7 rG' Telephone# er eg 4' /9 c
%1 Type of Building e.r Lot Size 6 9r3 sq.ft.
Dwelling- No,of Bedrooms 6 Garbage grinder( )
Other-Type of Building No.of persons_ _ Showers O,Cafeteria()
Other Fixtures
Design Flow(min.required) G 4e __gpc! Calculated design flow_44ef_ 6_ Design flow provided d 7 gpd
Plan: Date /d! 4 O _Number of sheets Revision Date
Title— ‘.Pr: __1.f &Ud/roe L/1c J 'e
Description of Soi!(s)___ _
Soil Evaluator Form No. __ Name of Soil Evaluator __. _Date of Evaluation
DESCRIPTION OF REPAIRS OR ALTERATIONS
Th.r.ndrrciorwti aore.c to inetall tho above dvcrr:lwl Indivirloal S.wn..Dien/Kai Svetem in air o.elsn..with tbo nrnvicinnc of TITT F 5 and
fro-thew sores c to not to-dare the cvct.m in niter-at-ion instil a C.rtirrat.of Cmmwiliotw,hoc!won hcoorl by tin.Rnaml of Health
Signed -- � Date /��/A er
Inc nertinnc.
CfA. MCINTI'PAT TN(lP AITARRArT-TT'.t, T. 4,e f1/,lf
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f PPTTFTCATF (1F COMP! TANCF `(ggo-
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Description of Work: Complete System Cl Individual Components
The nndorcioned hereby certify twat the Sewnoo Dicnocal System'Constructed t 1 Renaired T!ner, eei!1 Abandoned 1 1
in-: r ri' !✓d 4✓�
at: / C 4i1! f9/// /1 A/vLs
has boon installed in arrordanre with the orry jci I1 CHAR 1 S On!Tide 51 and the/annr lurd decion m el ans/ac-hnilt mans ratino to
application4.o.LV'2ri,dated 1 �1W HA
Approved Design Flow Le Le
`` (gpd).
installer:��f 42-r/ wA/
Designer:DZe c n.tt Hayti Inspector: rtrat►L_t_IZ/ fr Date: �f 3, d o�
The issuance of this permit shall not be construed as a guarantee that the system will function as designed. /
Nu._�[ ,f V C17-5SCC.5 FEE 1 1 D
COMMONWEALTH OF MASSACHUSETTS
Board of Health, Yarmouth.MA
DISPOSAL SYSTEM CONSTRUCTION PERMIT
Permission is hereby ranted to; Construct() ()Repair Upgrade Abandon() an individual sewage disposal system at
_3 4 ok~hereby
as described in the application for
Disposal SystemConstruction Permit No. -7,0- ,dated �h I<<(/l0
Provideed Con ruction shall be completed within erears o f t ris permit.All local conditions must be met.
Date 11 24 Board of Health .11 nifiggirr