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Home My WebLink AboutApp-Permit-ComplianceNo. D � � � L� LD )2- 00 32 FEE4 . 0 COMMONWEALTH Of MA?Sk0`S6feeP>f h/ , Board of Health, NA9 M,0 l7`T}} , MA. J� APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to Construct() Repair() Upgrade �bandon() - a -Complete System ❑ Individual Components Location Owner's Name Map/Parcel#ho/ Address/ /� 1�hq c ,eo Lot# Telephone# � OR -3 76 Installer's Name -�� u 1.0nDesigner's Name Address )if -r"l_ ab L /--jrar Address �� 1 l / Telephone# Telephone# 9 — Type of Building ��.Sl r Lot Size sq. ft. Dwelling - No. of Bedrooms Garbage grinder ( ) Other - Type of Building No. of persons Showers ( ), Cafeteria ( ) Other Fixtures Design Flow (min. required)gpd Calculated design flow ::;�F— Design flow provided gpd Plan: Date o! 1 6 �?30Number of sheets A Revision Date Title Description of Soils) _L Soil Evaluator Form No. Name of Soil Evaluator7l lcill� Date of Evaluation 2 �� DESCRIPTION OF REPAIRS OR ALTERATIONS The undersigton ees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further agret place the Am in o eration until a Certificate of C mplanceasbeen issued by the Board of Health. Signed 011 Date No. bombc -is- I b COMMON LTII OF MASSACIIUSETTS FEE � (�� Board of Health, YINRIAOUD4 MA. CERTIFICATE OF COMPLIANCE Description of Work: ❑ Individual Component(s) g_Complete System The u7n-dersigned hereby certify that the Sewage Disposal System; Constructed( ), Repaired ( ),Upgraded L,), -Abandoned ( ) at has been instable in�ccordance wit2i he provisions of 310 CMR 15.00 (Title 5) and the roved design plans/as-built plans relating to application-Ny. dated �✓ %� �r! L�Approved Design Flow _ (gpd) 2 Installer b'" Designer: - aFi 1- V t -.• i .1`E 1 / Inspector: N ��'; 1 r C Date: i The issuance of this permit shall not be construed as a guarantee that the system will function as designed. I No. 16a` ljCwi♦eJ_ i2� .il<.�-�tir; j�0i� FEE? COMMONWEALTH Of MASSACHUSETTS ck -o ► Board of Health, YA P -MI) OT- 4 , MA. DISPOSAL SYSTEM CONSTRUCTION PERMIT Permission is hereby granted to; Construct( ) Repair(;) Upgrade(iT�bandon( ) an individual sewage disposal system at 1 t 11 __1 '; (.,i' 0l t '-''C- f as described in the application for Disposal System Construction Permit No. /�i'� (�^, dated �l Provided: Construction shall be completed within tlh o+ea s of the date of this permit. All local conditions must be met. Form 1255 Rev. 5/96 A.M. Sulkin Co. Chadestow MA Da e > % `Board of Health � r - i , No.:BOHDGIS-1260 ! ' Commonwealth of Massachusetts F� sss.00 Board of Health, Yarmouth, MA APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to:Upgrade-Complete System LceaHon: 14 RICHARD RD,YARMOUTH PORT, MA 02675 Owner: WFIITF[ELD,GORDON A TRS Map/ParceUl: 114.54 WHI7P[ELD,JOAN O � 14 RICIIARD RD � YARMOiJT[Il'ORT,MA 02675 � Phone: I Septic System Installer Designer I B&B EXCAVATION FLAHERTY ENVIRONMENTAL SERVICES 14 TEABERRY LANE FORESTDALE, P.O.BOX 81 MA 02694 YARMOUTHPORT,MA 02675 Phone: (508)362-1657 Type of Building:Dwelling Lot Siu:033 Acres Dwel6ng-No.of Bedrooms:3 Garbage Grinder. � � Other Type of Building: No.ot persons: Showers: � � Other Fiztures: Plao Date:02/25/2015 Number of Sheets:2 Cafeteria: TiNe:SITE AND SEWAGE PLAN FOR 14 RICI�IARD ROAD Revision Date: Design Flow(min.required):330 gpd Calculated design flow:330 gpd Desigo flow provided:348 gpd DescripNon of Soi1s:SEE PLAN Soil Evaluator Form Na: Name of Soil Evaluaror: Date of Evaluation:02/25/2015 DAVID FLAHERTY,R.S. ' DESCRIPT[ON OF REPAIRS OR ALTERATIONS:SEPTTC DISPOSAL-REPAIR-1500 GAL SEPT[C TANK,DBOX,2-500 GALLON LEACH CHAMBERS H-20 W/4'STONE:25'X 12.83'X 2' The undersigned agreas M insfall Ne above Aeseribed Intlivitlual Sewage Diaposal System in aeeordanee wRh the provisions ot � TITLE 5 antl further aarees nM to olace in oceration untll a Certlficate M Camoliance has heen issueA M the Board of Heakh. Signed Date Inspections . ; Commonwealth of Massachusetts �I ' Board of Health, Yarmouth, MA F� � DISPOSAL SYSTEM CONSTRUCTION PERMIT $55.00 Permission is herby granted to; B&B EXCAVATION, 14 TEABERRY LANE, FORESTDALE, MA 02644 � i To perform: Upgrade an individual sewage disposal system. � I Owner: WHITFIELD,GORDON A 7RS j WHITFIELD,JOAN O 14 RICHARD RD j YARMOUTHPORT,MA 02675 � Location: 14 RICHARD RD,YARMOUTH PORT,MA 02675 Disposal System Construction Permit No.: BOHDGIS-1260,Dated: March 25,2015 Provided:Conshuction sha11 be completed within si�c months of the date of this permit. All local conditions must be met. 1.SEPTIC DISPOSAL-REPAIR- 1500 GAL SEPTIC TANK, DBOX,2-500 GALLON LEACH CHAMBERS H-20 W/ 4'STONE:25'X 12.83'X 2' � 2.ZONE II-MAXIMUM 3 BEDROOM Bruce G urphy, MPH, R.S.,CHO/Amy L.von Hone, R.S.,CHO HeaRh Director/Assistant Health Director Th ' uance of this permit shall not be construed as a guarantee t6at the system will func6on as designed � I � Commonwealth of Massachusetts Board of Health, Yarmouth, MA F� CERTIFICATE OF COMPLIANCE sas.00 Description of Work:Complete System The undersigned hereby certify that the Sewage Disposal System; Upgraded by:B&B EXCAVATION at: 14 RICHARD RD,YARMOUTH PORT,MA 02675 Has been installed in accordance with the provisions of 310 CMR 15.00(TiUe 5)and the approved design plans or as-built plans relating to applicarion No.: BOADG1S1260,dated 03/31/2015. Installer:B&B EXCAVATION Address:l4 TEABERRY LANE FORESTDALE,MA Inspector.AMY VON HONE,R.S. 02644 Designer:FLAHERTY ENVIRONMENTAL SERVICES Bruce G. Murphy,MPH, R.S., CHO/Amy L.von Hone, R.S., CHO Health Director/AssistaM Health Director The issuance of this permit shall not be construed as a guarantee that the system will functioo as designed. BOH_Disposal_Construdion_CofC.rpt I i