HomeMy WebLinkAboutApp-Permit-Compliance No. t4 —24f FEE ` t 0.
COMMONWEALTH OF MASSACHUSETTS
. 9 Li /b3 Board of Health,Yarmouth,MA
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT' }-
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Application for a Permit to Construct( Repair( Upgrade O Abandon O-0 Complete System 0 Individual Components <J>y
Location V// y'`1//Z ,c/, Owner's Name/a;(7t/Z Ile 6�,42(litiknek
Map/Parcel# /P3 — 3t3 Z Address Qet d'ex 39y Ate4 4.05b art /41,
Lot# Telephone# ,j?e1 �E:3._ e/Y_3 '+
Installer's Name e�j`�?Q &c;4.a#7760 Designer's Name H./1 g";e' /Le �jtJc�
Address /✓f4,uLy�fkti 4.z,4 f„/ Airg -e Address 1�.4/aw l -74.
Telephone# ,T77,',2 j— 737/ Telephone# L)Is -.$76:5. 0/it 3'
Type of Building Lot Size sq.ft.
Dwelling-No.of Bedrooms `q Garbage grinder( )
Other-Type of Building No,of persons _ Showers(),Cafeteria()
Other Fixtures 2
Design Flow(min.required) ✓d Calculated designflow ,� L7 Design flow provided .�6'7 gpd
Plan: Date /.Z'7-Zj�/ Number of sheets Revision Date
Title Tiff-1 V
Description of Soil(s) G 1Qy.R /k2G_i 5' ''n
Soil Evaluator Form No. Name of Soil Evaluator
ZAI to ( 4/'t'M'9ate of Evaluation /Z—�— 3
DESCRIPTION OF REPAIRS OR ALTERATIONS I>Qd l ��<<-- 1) - ?:;;;Z-3 ,g - .Sv6.) + 6
G/14/4b'z s a/%4 r-QA)'-
.The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and
further agrees to no to place e system in oper on until Certificate of Compliance has been issued by the Board of Health.
Signed Date S �
47
Inspections
COMMONWEALTH OF MASSACHUSE TS1',6-ay
_____47_4-,i.
Board of Health,Yarmouth,MA
CERTIFICATE OF COMPLIANCE & T"
Description of Work: 0 Complete System 0 Individual Components
The undersized hereby certify tha the Sewage Disposal System;Constructed) Repaired() Upgraded() Abandoned()
6,/by: L f'20 '•4.7-44T7 E7,.J
at: 3// ,s d fl::¢//L C( l/.4(/tQaz'7--e1 r.44r
has been installe in accordance with the provisions of 310 CMR 15.00(Title 5)and the ap roved design plans/as-built plans relating to
application No t [0 ,dated 6•/v-dui . Approved Design Flow (gpd).
Installer: t fur el k G.-.
Designer: /no/y.1 I c yv5 Inspector: 1)y\b• y 5c o' Date: _isx�2l,2tltitl
The issuance of this permit shall not be construed as a guarantee that the system system will function as designed.
No Q-• FEE //V
COMMONWEALTH OF MASSACHUSETTS
Board of Health,Yarmouth,MA
DISPOSAL SYSTEM CONSTRUCTION PERMIT
Permission is hereby muted to; Construct, Repair() Upgrade() Abandon() an individual sewage disposal system at
3i/ /144 yf 4iiZ- ad tj el cr -rs--I as described in the application for
Disposal System Construction Permit No. L'. ib) ed 6 -/0 07t! •
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Provided:Construction shall be completed - the date of this permit.All local conditions must be met.
Date 6-w `I Board of Health