HomeMy WebLinkAboutBHODC-20-4950 run Commonwealth of Massachusetts
Board of Health, Yarmouth, MA Fee
CERTIFICATE OF COMPLIANCE $55.00
Description of Work: Pipe Repair
The undersigned hereby certify that the Sewage Disposal System; Repair-minor
by: CAPE DIG INC.
at: 44 &46 IVANHOE AVE, WEST YARMOUTH, MA 02673
Has been installed in accordance with the provisions of 310 CMR 15.00 (Title 5) and the approved
design plans or as-built plans relating to application No.: BOHDC-20-4950, dated 06/01/2020.
Installer: CAPE DIG INC.
Address:P.O. BOX 726 SOUTH YARMOUTH, MA Inspector:
02664
Designer:
Bruce G. Murphy, MPH, R.S., CHO/Mallory R. Langler, R.S.
Health Director/Assistant Health Director
The issuance of this permit shall not be construed as a guarantee that the system will function as designed.
BOH_Disposal_Construction_CofC.rpt
5 No.f `ZV • ` 1 D FEE S/
20 l IC COMMONWEALTH OF MASSACHUSETTS C 1 ?'�
ope
Board of Health, Yarmouth, MAj CJ V
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT
Application for a Permit to Construct(Repair()Upgrade()Abandon()-❑ Complete System 0 Individual Components
Location 111-' l Q `�f1 �i_ v U Owner's Name /Qj/UcAcig 141-4* -fq
Map/Parcel# `� Address `(Q L�\n"IS H ( m I S
Lot# Telephone# cam 5- -7
Installer's Name C1419 ' Designer's Name
Address �I3 `� 1L— S, A „,,-,( Address
Telephone# '7 1 (1) l ll`'f(0,6 Telephone#
Type of Building a-e`cve,n-h oc( -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}1l��pd Calculated design flow `C LSfi nei Design flow provided gpd
Plan: Date Number of sheets leevision Date
Title
Description of Soil(s)
Soil EvaluatorForm No. Name of Soil Evaluator Date of Evaluation
DESCRIPTION OF REPAIRS OR ALTERATIONS TP(Pe., re pP- I Q b/V L Y
.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.
Signed � � Date a4
Inspections MAY 2 Y 2020
1•1 EA,LT h CP"'f.
No.QD C_- 3(7 FEE t75
COMMON EALTH OF MASSACHUSETTS 04--V4 3
Board of Health, Yarmouth, MA P� lap `4
DISPOSAL SYSTEM CONST!"U CTION PERMIT alums
Permission is hgreby granted to; Coons ct ) Repay( Upgrade() Abandon() an individual sewage disposal system at
11 V, �-'y �` as described in the application for
Disposal System Construction Permit No. 1 S , dated (P ( I I .
Provided:I Construction shall be complet d i ee ye orth date of this permit.All local conditions must be met.
Date (j! i 17-0/0 Board of Heal