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Home My WebLink AboutApp-Permit-Compliance=>-il.i No. 13 61 1W YW G'L�C��CGQ FEE SS• W �>aq pC- 15 -2-2-43 COMMONWEALTH Of MIASSAC I1S $ 8 7015 Board of Health, v {EgLTH DEPT. 0KAPPLICATI®N F®I, DISPOSAL SYSTEM[ COATIPIRTON PERMIT Application for a Permit to Construct( ) Repair( ) Upgrade�ndon( ) - 0 Complete System QhTclGidual Components Location a e AG.� "T'p /I% L A .Aj Owner's Name e A^) H fl a u-) A� K Map/Parcel# Address Le j l ,,J(? Tp w L .N „ Lot# -2) a Telephone# -5 M,;— Ug, —aa If. Installer's Name R r C) L2 (20 �S:� C Designer's Name .ST-e,-PAe�j A, MAAI Address P ©, t .� r »�1�1� Address 1" y O �u ,� Telephone#— 3�-- �� (� Telephone# Type of Building Dwelling - No. of Bedrooms Other - Type of Building G Other Fixtures Design Flow (min. required) 0 gpd Calculated design flow Plan: Date A Number of sheets 'T TtIP Description of Soils) Soil Evaluator Form No. Name of Soil Evaluator Lot Size f / � �'� � � sq. ft. Garbage grinder No. of persons Showers ( ), Cafeteria ( ) Design flow provided gpd Revision Date S_, 1 DESCRIPTION OF REPAIRS OR ALTERATIONS N P—W U L S TR vb J F o J-, V tN�%c:s'�-��c�S� t�©b �gilr�r� _�--Cc�r�•P��'M�� Date of Evaluation The undersigned agrees to ins a above d cribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further agrees to not to pla tem ' eration until a Certificate of Compliance h en issued by the Board of Health. Signed Date �l� Inspections F-- 1 -e- 1., No. }�j0kT)C. .Z-2-1A�i FEE �.,cJrJ,ao COMMONWEALTH LTH ®E MASSACHUSETTS -.�� -fOo—3 7 Board of Health, YAP—MO Q 1 }i , MA. CERTIFICATE Of COMPLIANCE Description of Work: J"dividual Component(s) 0 Complete System The undersigned hereby certify that the Sewage Di osal System; Constructed ( ), Repaired ( I�Upgraded ( ),Abandoned( ) by: �a�n 0 c- 1 �. (3( 2 at��yy�I r)O has been installed in a'ccofd�'nte wit Nthej o ilio s of 310 CMR 15.00 (Title 5) and heoved design plans/as-built plans relating to application No. / S — �7 /� ,dated > ` Zd" / Approved Design Flow) �p (gpd) Installer r . ©U R, C G / C —�' Iv �. Designer: Q tr P h�� A S Inspector: 1_�" " �� Date: _ The issuance of this permit shall not be construed as a guarantee that the system will function as designed. No. - i;�,o t -t 1/ C — (`moi 2-22--A F C, 0 (Z— COMMONWEALTH Z— COMIM ON LTH Of M ASSAC14USETTS Board of Health, Vrrp M O Vn+ , MA. DISPOSAL SYSTEM CONSTRUCTION PERMIT FEE -ve 00 -7 / Permission is hereby granted to; Construct( ) Repair( "f Upgrade( ) Abandon( ) an individual sewage disposal system at _ _ i L e �) �'h_ L as described in the application for Disposal System Construction Permit No.—�/ , dated Provided: Construction shall be completed pwithin tlr>Fee-yea1}e..,date of this permit. /�l local conditions must be met. Form 1255 Rev. 5/96 A.M. Sulkin Co. Chadeslown, MA Date `� -� �i Board of Health C No.:BOHDC-15-2243 ' Commonwealth of Massachusetts Fee 555.00 Board of Health, Yarmouth, MA APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to:Upgrade-Individual Component(s) Location: 3 LEXINGTON LN,YARMOUTH, MA 02675 Owner: fiARWICK JEAN TR Map/Parcel#: 116.95 3 LEXINGTON LN YARMOUTH PORT,MA 02675 Phone: Septic System Installer Designer ROBERT B.OUR STEPHEN HAAS,PE P.O. BOX 1539 HARWICH, MA 02643 P.O.BOX 16 Phone: SOUTH DENNIS,MA 02660 (5081362-8132 Type of Building:Dwelling Lot Size: 11,761.20 Acres � Dwelling-No.of Bedrooms:3 Garbage Grinder.X Other Type of Building: No.of persoos: Showers: Other Fixtures: Plan Date:04/13/2015 Number of Sheets: 1 � Cafeteria: Tit1e:5EPTIC SYSTEM DESIGN 3 LEXINGTON LANE Revision Date:OS/11/2015 Design Flow(min.required):330 gpd Calculated design ilow:330 gpd Design flow provided:350 gpd � Description of Soi1s:SEE PLAN Soil Evaluator Form No.: Name of Soil Evaluator. Date otEvaluation:04/02/2015 STEPI-IEN HAAS,PE ' DESCRIPTION OF REPAIRS OR ALTERATIONS:REPAIR-EHISTING 1000 GAL SEPT[C TANK,DBOX,24 HIGH CAPACITY INFILTRATORS W/OUT STONE:25'X 19.5'X 11" The undersignetl agrees to Install the above describetl Intlivitlual Sewage Disposal System in accordance with the provisions of ' TITLE 5 and fuRAer aarees not to elate in oceratlon until a Certifieate of Comollance has 6een issued W the 8oartl of Heakh. Signed Date Inspec[ions Commonwealth of Massachusetts Board of Health, Yarmouth, MA FeB DISPOSAL SYSTEM CONSTRUCTION PERMIT $55.00 Permission is herby granted to; ROBERT B. OUR COMPANY INC., P.O. BOX 1539, HARWICH, MA 02643 To perform: Upgrade an individual sewage disposal system. Owner. IfARWICK JEAN TR 3 LEXINGTON LN YARMOUTH PORT,MA 02675 Location: 3 LEXINGTON LN,YARMOUTH,MA 02675 Disposal System Construction Permit No.: BOHDC-1S2243,Dated:May 2Q 2015 Provided: Conshuc[ion shall be completed within six mon[hs of[he date of this permi[. All bcal conditions must be met. Condi6ons 1. REPAIR-EXISTING]000 GAL SEPTIC TANK, DBOX, 24 HIGH CAPACITY INFILTRATORS W/OUT STONE:25'X 19.5'X Il" 2. BOH TO INSPECT SOIL REMOVAL 3. MFC VARIANCE: 1. WETI,AND SETBACK 2. FOUNDATION SETBACK 4. SYSTEM DESIGNED FOR GARBAGE DISPOSAL �v � Bruce G. M hy, MPH, R.S., CHO/Amy L. von Hone, R.S.,CHO Health Director/Assistant Health Director . The issuauce of this permit shall not be construed as a guarantee that the system will function as designed.