HomeMy WebLinkAboutApp-Permit-Compliance No. !l\ SIG- • 24 . IG� FEEJ5
f�► COMMONWEALTH OF MASSACHUSETTS
r (�1j �'6 V Board of Health, Yarmouth, MA
(�// / APPLICATION FOR DIS OSAL SYSTEM CONSTRUCTION PERMIT
Application for a Permit to Construct ❑()Upgrade()Abandon()-0 Complete System Individual Components Location 1 1 0lS t4 co(\ L--t' Owner's Name C.O I
Map/Parcel# 1 I ' 3 6 Address
Lot# Telephone#
installer's Name ) Designer's Name
Address .S\ '�11 J v 1 ry..ler
'.. {} Y) _ddress j,.,1 I I r (ii . G '/f1 4 Q..6(8
Telephone# S'C')c�:is -7 _z t�7 1 "LJ Telephone t# 1�`l ✓V
Type of Building Lot Size sq.ft.
Dwelling-No.of Bedrooms Garbage grinder( )
Other-Type of Building No.of persons Showers(),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 Evaluator Form No. Name of Soil Evaluatora /! Date of Evaluation
MUTTONS OF REPAIRS OR AL l \� W' — C (- ,j
.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 tn�l�the tem ha operation until a Certificate of Compliance has been issued by lie moil ptrteq r
r
Signed I Date V
AUG `A
Inspections AUG 't
HEALTH DEPT
No C`,'( 7-L4 \ 7 97) FEE ;/��
COMMONWEALTH OF MASSACHUSETTS 6.,tt /�
G
Board of Health, Yarmouth.MA l;3'�t 1
CERTIFICATE OF COMPLIANCE 1/
Description of Work: 0 Complete System Cl jairidual Components
The undersigned hereby certify that the Sewage Disposal System;Constructed() Repaired(�l'pgraded() Abandoned()
by: A bh, olt~-F4,1,r
at: 1-7„ aLm..
has been instal ed in accordance with the provisions of 310 CMR 15.00(Title 5)and the dupluved design plans/as-built plans relating to
application lN�h f/(l I_f ,dated 7.94 . Appr� Design Flow /" (gpd).
Installer: t-t 11.%
Designer: N4 Inspector: Date: - L"
The issuance of this permit shall mat be t.....ats...,.1 as a that the system will function as designed.
No. L L l (`� FEE 5
,l COMMONWEALTH OF MASSACHUSETTS
C/ 16 V Board of Health, Yarmouth,MA
DISPOSAL SYSTEM CONSTRUCTION PERMIT
Permission is hereby granted to. Construct() Repair(4/6pgrade() Abandon() an individual sewage disposal system at
I l V i t t9 r S f as described in the application for
Disposal System Construction Permit No. ( t/ A q ,dated W. 7-i'y .
Provided:Construction shall be completed wit in hree years of the date of this permit.All local conditions must be met.
Date &.'7'a‘I Board of Health
LOCATION A B
TANK IN 13.0' 38.6'
TANK OUT 19.1' 40.8'
D-BOX 24.5' 43.2'
SAS 33.2' 31.2'
LEACHING--\
TANK
135101/-
0
EGRESS 0
WELL
. if!'"
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U 0)= 'T.' /
Cl.) nn 0 ,,, I
110 BEACON STREET /
/
EXISTING DWELLING
/
Porch-x\
AUG 1 g 2024
HEALTH DEPT.
BEACON STREET
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SEPTIC AS-BUILT Moran Engineering Associates
LOCUS: P.O. Box 183
170 Beacon Street South Harwich, MA 02661
South Yarmouth, MA
PREPARED FOR: 508-432-2878
Louise Tremblay Cole
ASSESSORS' ID: 99_36 JOB NUMBER:
170 Beacon Street 24-148
South Yarmouth, MA 02664 -DATE: 07/25/2024 SHEET: 1 of 1
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