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App-Permit-Compliance
No. B10WbC-��- 00�b ��' �-� � �) FU /�/ ®Jfv ��G�S FEE hS:00 40 CC'S � Zqo C®MMO LM ®&ASSACHUSETTS Board of Health, ) OQTI+ , MA. APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to Construct( ) Repair( ) UpgradeQr Abandon( ) - ❑ Complete System WIndividual Components Location a Owner's Name \,_0Un7 Map/Parcel# IFAddress Mmb Lot# Telephone# 606 Installer's Name o Designer's Name ^' Address)` g °.1� Address Telephone# ? Telep e# .awl tall Type of Building Dwelling - No. of Bedrooms Other - Type of Building _ Other Fixtures Design Flow (min. required) Plan: Date Title Description of Soil(s) _ Soil Evaluator Form No. gpd Calculated design flow Number of sheets Name of Soil Evaluator Lot Size sq. ft. Garbage grinder ( ) No. of persons Showers ( ), Cafeteria ( ) Design flow provided gpd Revision Date Date of Evaluation DESCRIPTION OF REPAIRS OR ALTERATIONS /! C /'%lam fid !y "7—a� !r .� i1 fig'^ � o Tom C� �"ri� �!/' fi-:.z o ,c7-��o�ir ..s�s/o // r�so�•s � .� � 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. SignedDate Inspections 10 No. i;C �j i, ( `- Ci �� �j s' 6 ��� L �/j o COMMON LTII Of 'MASSACHUSETTS o.� (4_* 11(13 Board of Health, 7A"4D UTii , MA. CERTIFICATE ©F C6MPLIANCE Description of Work: J% Individual Component(s) ❑ Complete System �� d The undersigned hereby certify that the Sewage Disposal System; Constructed ( ), Repaired 61, Upgraded ( ), Abandoned( ) at has been installed in actor ante with the provisions of 310 CMR 15.00 (Title 5) and the approved design plans/as-built plans relating to application No. dated Design Flow (gpd) Installeru �_,.., ,`^,�-.:>> �� c r_ ..rte r Designer: Inspector: , (-f I %! Date: TX The issuance of this permit shall not be construed as a guar tee that the system will function as designed. 6, ffr?3Gr2/ t�� FEE A" 5 .00 COMMONWEALTH OF MASSACHUSETTS 2 Board of Health,t,�,VmO ITC • , MA. DISPOSAL SYSTEM CONSTRUCTION PERMIT Permission is hereby granted to; Construct( ) Repair(k) Upgrade( ) Abandon( ) an individual sewage disposal system at _Z 5- as described in the application for Disposal System Construction Permit No. %4 `�dated -� Provided: Construction shall be completed within tlire , s o th date of this permit' All local conditions must be met. Form 1255 Rev. 5/96 A.M. Sulkin Co. Chadeslavn, MA Date Board of Health ,.tom ! J No.: ReoBOHDC-14-0085 Commonwealth of Massachusetts Fee $55.00 Board of Health, Yarmouth, MA. APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT , Application for a Permit to:Upgrade-Individual Component(s) I� Location: 251 WHITES PATH, SOUTH YARMOUTH, MA 02664 Owner ��� Map/Parcel#: 109.3 Name: ''��. LOCK UP-CAPE COD LMTD PTNRSHP Address: 800 WEST FRONTAGE ROAD NORTHFIELD, IL 60093-1241 Phone: Sepdc System Installer Name: NEIGHBORHOOD WASTE WATER Address: ��. 350 ROUTE 28 WEST YARMOUTH, � MA 02673 Phone: 5087752820 Type of Building:Other Type of Building Lot Siu:3.63 sq.ft. Dwelliog-No.of Bedrooms: Garbage Grinder. � Other Type of Building:The Lock-up S[orage Faciliry No.of persons: Showers: Cafeteria: Other Fiatures: Plan Date: Number of Sheets: Title: Revision Date: �. Design Flow(min.required): gpd Calculated design Flow: gpd Design Flow provided: gpd �. Description of Soils: ��. Soil Evaluator Form No.: Name of Soil Evaluaror: Date of Evaluation: � DESCRIPTION OF REPAIRS OR ALTERATIONS:Replace existing Septic Tank with H-20 1500 gal.Septic Tank,H-20 DBoac, Covers and Risers to grade The undersigned agrees to installlhe above descrl6ed Indivitlual Sewage Disposal System in accordance with the provisfons of TITLE 5 and fuKher aprees not to place in operation until a CeRHieate of Compllance has been issued by the Boartl of HeaHh. Signed Date Inspections Commonwealth of Massachusetts Board of Health, Yarmouth, MA. Fee DISPOSAL SYSTEM CONSTRUCTION PERMIT E55.00 Permission is herby granted to; Address:350 ROUTE 28 WEST YARMOUTH,MA 02673 To perform: Upgrade an individual sewage disposal system. Owner: LOCK UP-CAPE COD LMTD PT'NRSHP 800 WEST FRONTAGE ROAD NORTHFIELD,IL 60093-1241 Location:251 WHITES PATH, SOUTH YARMOUTH,MA 02664 Disposal System Construction Permit No.: ReoBOHDGI4-0085,Dated:August 04,2014 Provided:Construction shall be completed within six months of the date of this permit. All local conditions must be met. CondiHons Insta111500 H-20 Septic Tank, H-20 DBox, Risers and Covers to grade. Bruce G. Murphy,MPH, R.S., CHO/Amy L.von Hone, R.S.,CHO Health Director/Assistant Health Director The issuance of t6is permit shall not be construed as a guarantee that the system will function as designed.