HomeMy WebLinkAboutApp-Permit-ComplianceNo. 6044 4—® 6 z -
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Board of Health , MA.
APPLICATION FOR DISPOSAL SYSTEM[ CONSTRUCTION PERMIT
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Application for a Permit to Construct( ) RepairV Upgrade( ) Abandon( ) - III Complete System ❑ Individual Components
Location
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Owner's Name
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Map/Parcel#
AddressRJ
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Lot#
Telephone#
Installer's Name �A l .
Designer's Name
Address6`�
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�ddress V
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Telephone#
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Telephone#
Type of Building
Dwelling - No. of Bedrooms
Other - Type of Building _
Other Fixtures
No. of persons
Lot Size sq. ft.
Garbage grinder
Showers ( ), Cafeteria ( )
Design Flow (min. required) 33S� gpd Calculated design flow Design flow provided 23 gpd
Plan: Date i t t lam— Number of sheets t Revision Date
Title
Description of Soils) - ear, 1. 1:�ro1.fe b
Soil Evaluator Form No. Name of Soil Evaluator Date of Evaluation
DESCRIPTION OF REPAIRS OR ALTERATIONS
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The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and
further agreas to not to place the system in operation until a Certificate of Compliance has been issued by the Board of Health.
Signed 1 Date t a � c� I
Inspections
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COMMONWEALT14 Of MASSACHUSETTS f ZTJ I
Board of Health, `�iMfll�i-i , MA.
CERTIFICATE OF COMPLIANCE
Description of Work: ❑ Individual Component(s) 8"Co omplete System
The undersigned hereby certify that the Sewage Disposal System; Constructed ( ), Repaired (, Upgraded ( ), Abandoned ( )
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has been installed in aecordance with the provisions of 910 CMR 15.00 (Title 5) and the approved design plans/as-built plans relating to
application No. /C'-0 G,. , dated �" 3� %J Approved Design Flow (gpd)
Installer 6.0A/ / f
Designer: eZ Inspector:<' 1 Date: The issuance of this permit shall not be construed as a guarantee that the system will function as designed.
No. i5OW iDc -44 -0-7+2— .. SC01V GPNO t-+ FEE �Y��a 00
COMMONWEALTH Of MASSACHUSETTS �--� 2-77
Board of Health, U -M , MA.
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_..DISPQSAL SYSTEM[ CONSTRUCTION PERMIT
Permission is hereby granted to; Construct( ) Repair( Upgrade( ) Abandon( ) an individual sewage disposal system
at e J' 1 Zoe -AIA l W N ST as described in the application for
Disposal System Construction Permit No. / )-- , dated "
104111-e J/ -a79<
Provided: Construction shall be completed within th*@oAw-ws of the�4te of this per/mit. All local conditions must be met.
Form 1255 Rev. 5/96 A.M. Sulkin Co. Chadeslowo, MA Date �' ~ / Board of Health
No.: BOHDC-14-0742
Commonwealth of Massachusetts FeB
E55.00
Board of Health, Yarmouth, MA
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT
Application for a Permit to: Upgrade-Complete System
Location: 85 NORTH MAIN ST, SOUTH YARMOUTH, MA 02664 Owner:
HUNTER ZACHARY G
Map/Parcel#: 070.18 10 THISTLE CIR
YARMOUTHPORT,MA 02675
Phone:
Septic System Installer Designer
STEPHEN HAAS.PE
113 OLD YARMOUTH ROAD HYANNIS, P.O.BOX 16
MA 02601 SOUTH DENNIS,MA 02660
Phone: (508)362-8132
Type of Building:Dwelling Lot Size:0.75 Acres
Dwelling-No.of Bedrooms:3 Garbage Grinder:
Other Type ot Building: No.of persons: Showers:
Other Fiztures:
Plan Date: 12/11l2014 Number oPSheets: 1
Cafeteria:
Tit1e:SEPTIC SYSTEM DESIGN 85 NORTH MAIN STREET Revision Date:
Design Flow(min.required):330 gpd Calwlated design ilow:330 gpd Design flow provided:333 gpd
Description of Soi1s:5EE PLAN
Soil Evaluator Form No.: Name of Soil Evaluator: Date of Evaluation: 10/01/2014
STEPHEN IfAAS,PE
DESCRIPTION OF REPAIRS OR ALTERATIONS:REPAIR-1500 GAL SEPTIC TANK,H-20 DBOX,4 LC CHAMBERS H-20 W/4'
STONE SIDES,2'ENDS:33'X 11'X 1'
- The undenigned agrees to install the above described Individual Sewage Disposal System in accordanee with the provisions of
TITLE 5 and further aarees not to olaee in ooeratian until a Certificate of Comoliance has heen issued bv[he 8oard of Heakh.
Signed Date
Inspections
. Commonwealth of Massachusetts
Board of Health, Yarmouth, MA FeB
DISPOSAL SYSTEM CONSTRUCTION PERMIT sss.00
Permission is herby granted to;
To perform:Upgrade an individual sewage disposal system.
Owner: HIJNTER ZACHARY G
10 THISTLE CIR
YARMOUTHPORT,MA 02675
Location: 85 NORTH MAIN ST, SOUTH YARMOUTH,MA 02664
Disposal System Construction Permit No.: BOHDC-140742 ,Dated: January O5,2015
Provided: Construction shall be completed within six months of the date of this permit. All local conditions must be met.
Conditions
1. BOH TO INSPECT SOIL REMOVAL
2. REPAIR- I500 GAL SEPTIC TANK, H-20 DBOX, 4 LC CHAMBERS H-20 W/4'STONE SIDES, 2'
ENDS: 33'X I l'X 1'
v
Bruce G. ur y, MPH, R.S., CHO/Amy L. von Hane, R.S., CHO
Health Director/Assistant Health Director
The issuance of this permit shall not be construed as a guarantee that the system will function as designed.