HomeMy WebLinkAboutApp-Permit-Compliancedd22*�� o c- {s -23 40
No. W THE COMMONWEALTH OF MASSACHUSETTS FEE
X_ I� �� BOARD OF HEALTH
ovi OF
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT
Application for a Permit to Construct( ) Repair ( ) Upgrade /Abandon ( ) - ❑ Complete System Individual Components
2,3 monief Dov&.l\j
p£ation
��Map/Parcel/iParcel !/J9
,� AInstaller'
JLTL41:7 —EL 6,7f /7E ss6,��L f)
—'Tolcphonc ##
Type of Building: -42
Dwelling — No. of Be rooms
Other — Type of Building
Other fixtures
Design Flow (min. required) gpd
Plan: Date T)N
.LJ ✓v L-11
-3to Lf/_a 1111
Telepifone #
De igner's Name
f
Address
Telephone #
LotSi 4 4.Sq. feet
/ G #le Grinder ( )
o. of�e4ns 1� Showers ( ), Cafeteria ( )
A
edes'g w� gpd Design flow provided/ apd
;ts
A Revision Date
Description of Soil(s) Wel 0
Soil Evaluator Form No. Name o Soil Evaluator 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 s not to place the system in operation until a Certificate of Compliance has been ]issued by the Board of Health.
Signed Date
Inspections
FORM 1 - APPLICATION FOR DSCP DEP APPROVED FORM 5/96
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No. 0C-15-00(7 THE COMMONWEALTH OF MASSACHUSETTS FEE -45-5 —.0 0
BOARD OF HEALTH
E TIFICATE OF COMPLIANCE
Description of Work: Individual Component(s) ❑ Complete System
The undersigned hereby certify that the Sewage Disposal System; Constructed ( ), Repaired ( ), Upgraded (andoned ( )
by: i3t,8�A ca v f1 v
at Z_n
has been installed in accoi
plans rel
j%to, applicatio.
Installer
a'nce with the,provisions of 310 CMR 15.00
No. ! = Y dated ,6 3 -- l '
5) and the approved desi n pla /a -built
Approved Design Flow (gpd)
Designer: Inspector Date
The issuance of this certificate shall not be construed as a guarantee that the system will function as designed.
FORM 3 - CERTIFICATE OF COMPLIANCE DEP APPROVED FORM 5/96
No. �jO��DCI THE OMMONWEALTH OF MASSACHUSETTS FEE loo
y�CUMBOARD OF HEALTH CA 7,1)8
DISPOSAL SYSTEM CONSTRUCTION PERMIT
Permission is hereby ranted to Construct ( ) Repair ( ) Upgrade ( ) Abandon ( ) an individual sewage
disposal system at � r l n as described
in the application for Disposal System Construction Permit No. _ �S-�/� dated
Provided: Construction shall be completed within tfi*e&yr9 S of tie date o`f this permit. A1�cal copditions must be met.
,_ 6 `
Date r ' i - / ( oard of Health . (�J�G
FORM 2 - DSCP DEP APPROVED FORM 5/96
FORM 1255 (REV 5/96) H&W HOBBS&WARREN TM PUBLISHERS -BOSTON
% u 0)-7
No.: BOHDC-15-2346
Commonwealth of Massachusetts FeB
$55.00
Board of Health, Yarmouth, MA
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT
Application for a Permit to:Repair-minor-Individual Component(s)
Location: 23 MERRYMOUNT RD,WEST YARMOUTH, MA 02673 Owner:
LOVELY DANIEL J
Map/Parcel#: 023.85 MEI.IZA KELLY
23 MERRYMOUNT RD
WEST YARMOUTH,MA 02673
Phone:
Septic System Installer Designer
B&B EXCAVATION HEA CONSULTING
14 TEABERRY LANE FORESTDALE, 7 WEEKS POND DRIVE
MA 02644 FORESTDALE,MA 02644
Phone: (5081477-8268
Type of Building:Dwelling Lot Size: 10,454.00 Acres
Dwelling-No.of Bedrooms:3 Garbage Grinder:
Other Type of Building: No.of persons:� Showers:
Other Fiaturos:
Plan Dah:06/30/1999 Number of Sheets: 1 �
Ca[ehria:
Title:SEPT[C SYSTEM REPAIR 23 MERRYMOUNT ROAD Revision Dah:
Design Flow(min.required):330 gpd Calculated design Flow:330 gpd Design Flow provided:343.9 gpd
Descriptioo of SoiIs:SEE PLAN
Soil Evaluator Form No.: Name of Soil Evaluaror: Dah of Evaluatioo:OS@2/1999
JOHN HCINTER,PE
DESCRIPTION OF REPAIRS OR ALTERATIONS:MINOR REPAIR-REPLACE H-10 DBOX TO EMSTING 1500 GAL SEPTIC TANK,
5 INFILTRATORS W/STONE 4'SIDES,2'BOTTOM:3125'X 11'X 10"
The unde�signetl agrees to install the above tleseribed IndNidual Sewage Disposal System in accordance with fhe provisions of
TITLE 5 antl fuMher aarees not to olace in ooaration untll a Cerlificate of Comollance has been issued hv the Board of Neakh.
Signed Date
Inspections
Commonwealth of Massachusetts
Board of Health, Yarmouth, MA Fee
DISPOSAL SYSTEM CONSTRUCTION PERMIT 555.00
I
Permission is herby granted to;
B&B EXCAVATION, 14 TEABERRY LANE, FORESTDALE, MA 02644
To perform: Repair-minor an individual sewage disposal system.
Owner. LOVELY DANIEL J
MELIZA KELLY
23 MERRYMOUNT RD
� WEST YARMOUTH,MA 02673
Location:23 MERRYMOiJNT RD, WEST YARMOUTH,MA 02673
Disposal System Construction Permit No.: BOHDC-15-2346,Dated:June 03,2015
Provided:Construction shall be completed within six months of the date of this permit. All local conditions must be met.
Conditions
1. MINOR REPAIR-REPLACE H-10 DBOX TO EXISTING I500 GAL SEPTIC T.9NK, 5
INFILTRATORS W/STONE 4'SIDES, 2'BOTTOM. 31.25'X 11'X 10"
Gl �U C�/ L��S�
Bruce G. Murp , H, R.S., CHO/Amy L.von Hone, R.S., CHO
yealth Director/Assistant Health Diredor
�
The issuance of this permit shall not be construed as a guarantee that the system will function as designed.