HomeMy WebLinkAboutApp-Permit-Compliance-00 1, S 5 S, FEE iS- - 0'0
COMMONWEALTH Of MASSACHUSETTS
" Board of Health,
i
APPLICATION FOR DISPOSAL SYSTEM[ CONSTRUCTION PERMIT
Application for a Permit to Construct( ) Repair( ) Upgrade.��Abandon( ) - ❑ Complete System .ZrVidividual Components
Location 23 )
Owner's Name � I
Map/Parcel# / f
AddressZ3 A n 5 C..t e„ I l l
Lot#
Telephone# Soo - - �
Installer's Name t n
Designer's Name
Address 1 �ee�
Address 90 V g
Telephone# _ 7' -
Telephone# k -3
Type of Building
Dwelling - No. of Bedroc
Other - Type of Building
No. of persons
Lot Size
sq. ft.
— Garbage grinder ( )
Showers( ), Cafeteria ( )
Other Fixtures
Design Flow (min. required) —gpd Calculated design flow Design flow provided gpd
Plan: Date`? Number of sheets Revision Date
Title
Description of Soil(s) _
Soil Evaluator Form No.
DESCRIPTION OF REPAIRS OR ALTERATIONS
Name of Soil Evaluator
Date of Evaluation q _ g (
The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and
further agrees t oto placeto operation until a Certificate of o pliance has been issued by the Board of Health.
Signed Date 6
r
No. � �• � "� �a i
COMMONWEALT14 Of MASSACHUSETTS
Board of Health,f oto q i , MA.
CERTIFICATE Of COMPLIANCE
a/
FEE
. 2•-7S7
Description of Work: „ hidividual Component(s) 0 Complete System
The undersigned hereby certify that the Sewage Disposal System; Constructed ( ), Repaired ( ), Upgraded ( ),Abandoned( )
by: -'� i iC IIcAb /) n l
at �i 1'1 t.if�(�d'UV�C. ---
has been installecf'in aEeM ancc'witl'i7e provisions of 310 CMR 15.00 (Title 5) and the roved design plans/as-built plans relating to
applicatiouNo./5- - Z 11, dated �l� ! Approved Design Flow (gpd)
Installer 1'�. okr-e-r f", i Lrv- -
Designer: -I < M�ekn 1 � ti --%\1 1 f/j a .Q' 4pmtor: Date:
—T
The issuance of this permit shall not be construed as a guarant that the system will function as designed.
,C0 1 Cr, .ccs .. 0?<re.C_V Cpp 11 rOpr.:00 C h C C CO OOF> C 00[. o o 0 C, C1 C u 1, 0 C%l:GL 0Oi, 0r CCf,C _4L 0Go^O.-OGr�.J,cO!'G _or0.7 c.,c,�(..-)n
No. iii d 4 i7 C ' 13 -� y'� i t - FEE � . O0
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COMMONWEALTH Of MASSACHUSETTS cktV 2,751
Board of Health, YMM 0 07-4 , MA.
DISPOSAL SYSTEM CONSTRUCTION PERMIT
Permissio® .i hereby granted to; C9nstruct( ) Repair( ) Upgrade (- '""Abandon ( ) an individual sewage disposal system
p
at 2� 1 t"Z st F` 'k` F "l �LU i 0 as described in the application for
Disposal System Construction PermittNNo. / -'1/ , datrd ,
Tin 1 ��*,teProvided: Construction shall be co p etedwtthin t f thof this permit. l local conditions' must be met.
�j 4 %(,Board
Form 1255 Rev. 5/96 A.M. Sulkin Co. ChadWown, MA Date / ' -� 1' Board of Health
No.: BOHDC-15-4451
� Commonwealth of Massachusetts F�
sss.00
Board of Health, Yarmouth, MA
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT
Application for a Permit to:Upgrade-Individual Component(s)
Location: 23 PINE GROVE RD, SOUTH YARMOUTH, MA 02664 Owner:
� BOYLE FREDERIC G
� Map/Parce�: 041.42 BOYI,E LESLIE E
23 PINE GROVE RD
SOUTH YARMOUTH,MA 02664
Phone:
Septic System Installer Designer
B&B EXCAVATION FLAHERTY ENVIRONMENTAL SERVICES
14 TEABERRY LANE FORESTDALE, P.O. BOX 81
MA 02644 YARMOUTHPORT,MA 02675
Phone: 508-362-1657
Type otBuilding:Dwelling Lot Siu: 15,246.00 Acres
Dwelling-No.of Bedrooms:3 Garbage Grinder:
Other Type of Building: No.of persons: Showers:
Other Fixtures:
Plan Date:09/09/2015 Number of Sheets:2 Cafehris:
TitIe:SITE AND SEWAGE PLAN 23 PINE GROVE ROAD Revision Date:
Design Flow(min.required):330 gpd Calwlahd desigu flow:330 gpd Desigo flow provided:348 gpd
Description of Soi1s:SEE PLAN
Soil Evaluator Form No.: Name of Soil Evaluator. Date of Evaluatioo:09/09/2015
DAVID FLAHERTY,R.S.
DESCR[PTION OF REPAIRS OR ALTERATIONS:SEPTIC DISPOSAL-REPAIR-EXISTING 1000 GAL SEPTIC TANK,DBOX,2-500
GAL PRECAST CHAMBERS W/4'STONE;25'X 12.83'X 2'
. The undersignetl agrees to install the above described Individual Sewage Disposal System In accordance wifh the provisions of
TITLE b and further aarees nat to olate in ooentlon untll a CertificaM of Comoliante has heen issued bv the Baard of Heakh.
Signed Date
[nspections
, Commonwealth of Massachusetts
Board of Health, Yarmouth, MA F�
DISPOSAL SYSTEM CONSTRUCTION PERMIT 555.00
Permission is herby granted to;
B&B EXCAVATION, 14 TEABERRY LANE, FORESTDALE, MA 02644
To perform: Upgrade an individual sewage disposa] system.
� Owner: BOYLE FREDERIC G
BOYLE LESLIE E
23 PINE GROVE RD
� SOUTH YARMOUTH,MA 02664
Location:23 PINE GROVE RD,SOUTH YARMOUTH,MA 02664
Disposal System Construction Permit No.: BOHDC-1S4451 ,Dated:September 28,2015
Provided: Cons[ruction shall be completed wi[hin six months of the date of[his permit. All bcal wndi[ions must be met.
CONDITIONS:
1. SEPTIC DISPOSAL-REPAIR-EXISTING 1000 GAL SEPTIC TANK, DBOX, 2-500 GAL PRECAST
CHAMBERS W/4'STONE; 25'X 12.83'X 2'
� ��Jc-'�.-r
Bruce G. M ,MPH, R.S., CHO/Amy 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.
Commonwealth of Massachusetts
Board of Health, Yarmouth, l�iti Fee
CERTIFICATE OF COMPLIANCE sss.00
Description of Work: Individual Component(s)
The undersigned hereby certify that the Sewage Disposal System; Upgraded
by:B&B EXCAVATION
at:23 PINE GROVE RD,SOUTH YARMOUTH,MA 02664
Has been installed in accordance with the provisions of 310 CMR 15.00(Title 5)and the approved
design plans or as-built plans relating to application No.: BOHDC-15-4451,dated 10/Ol/2015.
Installer:B&B EXCAVATION
Address:l4 TEABERRY LANE FORESTDALE,MA Inspector:AMY VON HONE,R.S.
02644
Designer:FLAHERTY ENVIRONMENTAL SERVICES
V CS�C�
Bruce G. Murphy P , R.S., CHO/Amy L. von Hone, R.S.,CHO
Health Diredor/Assistant Healfh Diredor
The issuance of this permit shall not be construed as a guarantee that the system will funMion as designed.
BOH_Disposal_Construction_CofC.rpt