HomeMy WebLinkAboutApp-Permit-ComplianceNo.bVff)>`'4+017-'- bL-b-M-6S--000 Z-9
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COMMONWEALTH LTH ®f MASSACHUSETTS
Board of Health, YAQv00V , MA.
FEE 4 116 � 60
4o� X 75
APPLICATION FOR DISPOSAL. SYSTEM CONSTRUCTION PERMIT
Application for a Permit to Construct Repair( ) Upgrade( ) Abandon( ) - 4Complete System ❑ Individual Components
Location t 1
Owner's Name S
Map/Parcel#
Address
Lot#20
Telephone#
Installer's Name
Designer's Name a- 2
Address
Address
Telephone# r a -
Telephone# - Q
Type of Building
Dwelling - No. of Bedrooms
Other - Type of Building _
Other Fixtures
Sl'10l I -e— 02 %^1, A,
Design Flow (min. re uired) r gpd Calculated design flow
Plan: Date 11_Number of sheets
Title �VA,Yince&-.eg aVL Cl
Description of Soil(s) _
Soil Evaluator Form No.
1
DESCRIPTION OF REPAIRS OR ALTERATIONS
Name of Soil Evaluator
No. of persons
Lot Size ® sq. ft.
Garbage grinder( )
Showers ( ), Cafeteria ( )
Design flow provided
Revision Date
Date of Evaluation
The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and
further agrees place thesyste in operation until a Certificate of Compliance has been issued by the Board of Health.
Signed Date 1157 --.,?0
No. n ®�a Ait , Al/��E
COMMONWEALT14 OF MASSAC14USETTS 01< -
Board
t< -Board of Health, 0 U73� , MA. 0
CERTIFICATE OF COMPLIANCE
� { � ;��-
3
Description of Work: ❑ Individual Component(s) `Complete System
The undermined hereby certify that the Sewage Disposal System; Constructed (, Repaired ( ), Upgraded ( ), Abandoned ( )
by: sN c W'
has been ins..le, n aoMfan�ce with tYie prtons o 310 CMR 15.00 (Title 5) and the approved design plans/as-built plans relating to
application No. daApproved Design Flow4y, 3 pd)
Installer
Designers--s[.tJ -Ap J ell !23 Inspector:` Date: 7—/6,-
The
/6,"
The issuance of this permit shall not be construed as a guarantee that the system will function as designed.
No. j�'7J77 J� `/'7 -�"r�L �' �LI�C> FEE
COMMONWEALTH OF MASSACHUSETTS CIA -,44
Board of Health, YAAWO 07-7 ' , MA.
DISPOSAL. SYST1M[ CONSTRUCTION PERMIT
Permission is hereby granted to; Construct Repair( ) Upgrade ( ) Abandon ( ) an individual sewage disposal system
at S- - S� ! 4L4Q _ YCLC 1Mca as described in the application for
Disposal System Construction Permit No. Q4/"/,4"!�Aa ed
Provided: Construction shall be completed w�thZn4ltree �Ys of`the date of this permit. Al
il local conditions must be met.
1
Form 1255 Rev. 5//996 A.M. Sulkin Co. Chadeslown, Date Board of Health
/fr)/V //iq-2 177�
No.:BOHDC-14-0122
= Commonwealth of Massachusetts Fee
so.00
Board of Health, Yarmouth, MA.
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMTT
Application for a Permit to:New Construction-Complete System
Location: 19 GRIST MILL LN,WEST YARMOUTH, MA 02673 Owner
Map/Parced1: 02973 � Name:
COSTA ANTHONY
Address:
49 GRANDVIEW DR SOUTN YARMOUTH,MA
02664
Phone:
Septic System Installer
Name:
BARROWS EXCAVATING
Address:
2 VINEYARD LANE HARWICH, MA
02645
Phone:
5084302663
Type ot Building:Dwelling Lot Size:021 sq.ft.
Dwelliog-No.of Bedrooms:4 Garbage Grioder:
Other Type of Building: No.of persons: Showers: Cafehria:
Other F�[urcs: .
Plao Date:04/14/2014 Number of S6cets: 1 .
Tit1e:PROPOSED SEP7'[C DESIGN Revision Date:06/]0/2014 '�.
Design Flow(min.required):440 gpd Calculated desigo/1ow:440 Design fiow provided:444.31 gpd '�
BPd
Description of Soi1s:SEE PLAN �.
Soil Evaluator Form No.: Naroe of Soil Evaluator: Date of Evaluation:04/09/2014 � �
' ROBIN W[LCOX,PLS
DESCRIPTION OF REPAIRS OR ALTERATIONS: 1500 GAL SEP77C TANK �
` DBOX
8 HIGH CAPACITY INFILTRATORS W/STONE:
64.43'XS'X2'
The undenigned agrees to install the above tleseribed Indivlduai Sewage Dispoaal System in accordance wHh the provisions �
of TITLE 5 and further aflrees not to place in operolion untll a Certlficate of Comolianee has been Issued bv the Boartl of Health.
Signed Date
Inspections
, Commonwealth of Massachusetts
Board of Health, Yarmouth, MA. F88
DISPOSAL SYSTEM CONSTRUCTION PERMIT so.ao
Permission is herby granted to;BRYAN BARROWS Address:2 VINEYARD LANE '
HARWICH,MA 02645
To perForm:New Construction an individual sewage disposal system.
Owner. COSTA ANTHONY
49 GRANDVIEW DR ��
SOUTH YARMOUTH,MA 02664 '��
Location: 19 GRIST MILL LN,WEST YARMOUTH,MA 02673
Disposal System Construction Permit No.: BOHDC-140122,Dated:August 20,2014
Provided:Construction shall be comple[ed wi[hin six months of[he date of this permit. All local wnditions must be met.
COI1dit10�3
Board ofHealth Agent to Inspect Soil Removal
Porposed 1 S00 gal Septic Tank, DBox, 8 High Capacity Infiltrators w/Stone. 64.43'x 5'x 2'
Bruce G. urph ,MPH, R.S., CHO/ L.von Hone, R.S.,CHO
Health Director/Assistant Health Diredor
The issuance of this permit shall not be construed as a guarantee that the system will function as designed.