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N � � 9 CJ� 6 �T9, — [5— 6 0'& 1 V FEE SS. 00
'l_® ® ALTI4 Of MASSAC14USETTS Ck 71q 7
Board of Health, �A�e.�t0073+ , MA.
APPLICATION FOR DISPOSAL SYSTEM[ CONSTRUCTION PERMIT
plication for a Permit to ConstructV(Repair( ) Upgrade( ) Abandon( ) - Q)/Complet�ltem 0 Individual Components
Location
Owner's Name roA
Map/Parcel# p
Address g S o
Lot#
Telephone# .ga e7
Installer's Name 1
Designer's Name
Address Qi r/ o B
Address P O o
Telephone# S0 O
Telephone#
Type of Building �� l���3 co LotSize sq. ft.
Dwelling - No. of Bedrooms Are -QGarbage grinder (�)®
Other - Type of Building No. of persons Showers ( ), Cafeteria ( )
Other Fixtures
Design Flow (min. required) 110 gpd Calculated design flow 330 Design flow provided,.3 5'a, `f & gpd
Plan: Date # 3 — 2 o 4y Number of sheets Revision Date
Title
Description of Soils) V - /o �i4 Q Lbr4,.A{i ,�� /o =-W!8 1/ S as3 %� E NiJ Mr 1
Soil Evaluator Form No. Name of Soil Evaluator „1LGo Date of Evaluation
DESCRIPTION OF REPAIRS OR ALTERATIONS w u,..ro
The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and
further agrees to not to place a syste in operation until a Certificate of Compliance has been issued by the Board of Health.
Signed Date
Inspections
No. 8,B r rli EE zc.
COMMONWFALT14 OF MASSACHUSETTS,,, 6�C^ z!644-7
Board of Health, V (Z/1 �1O VM MA. / /
CERTIFICATE Of COMPLIANCE
Description of Work: ❑ Individual Component(s) ZComplete System
The undersigned hereby certify that the Sewage Disposal System; Constructed Ve< Repaired ( ), Upgraded (Abandoned ( )
by: C,.. V .' , a ...
at
has been installe i�nac6ordan'te w(th Mf provisions of 3TU CMR 15.00 (Title 5) and the approved design plans/as-built plans relating to
application No. /r, - dated _'�✓ ` Z �,�Approved Design Flowd)
Installer 12,C �.
Designer: Y.l \) K l f CA t j� VLCE�5Tnsp
Date:
The issuance of this permit shall not be construed as a guarante,wffi at the system will function as designed.
- C'J L•= n $l �_ra
g� OL -C _. _ - (J
No. 601A-1DC'" t9-17 8 .; M. FEE '" O
COMMON1.114 OF -7�J
.k, oB a d of Health, YMMQ Ii i , MA.
DISPOSAL SYSTEM ST CONSTRUCTION PERMIT
Permission is hereby granted to Construct(V% , Repair(( ) Upgrade (Vf- Abandon ( ) amindividual sewage disposal system
at J6 � n ,h a s s=3-- t t x �-9 F c 'f as described in the application for
Disposal System Construction Permit No. , daWd
Provided: Construction shall be completed within *h L& �zr� f the date of this permit. All local conditions must be met.
Form 1255 Rev. 5/96 A.M. Sulkin Co. Chadestown, MA Date �' r Moard of Health
No.:BOHDGIS-1788
Commonwealth of Massachusetts Fee
' S55.00
• Board of Health, Yarmouth, MA
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT
Application for a Permit to:Upgrade-Complete System
Location: 36 RUNE STONE RD, SOUTH YARMOUTH, MA 02664 Owner:
M[JRPHY VIRGINIA R
Map/Parcel#: 101.88 36 RUNESTONE RD
SOUTH YARMOUTH,MA 02664-1325
Phone:
Septic System Installer Designer
B.C.K. GENERAL PUNKHORN SERVICES
97 TOWN BROOK ROAD WEST P.O. BOX 483
YARMOUTH, MA 02673 SOUTH DENNIS,MA 02660
Phone: (5081564-8379
Type of Building:Dwelling Lot Size: 18,295.20 Acres
Dwelling-No.of Bedrooms:3 Garbage Grinder:
Other Type of Building: No.of persons: Showers:
Other Fixtures:
Plan Date:04/03/2015 Number of Sheets: 1 Cafeteria:
Title:PROPOSED SEPTIC DESIGN 36 Ri1NE STONE ROAD Revision Date:
Design Flow(min.required):330 gpd Calculahd design ilow:330 gpd Design ilow provided:352.98 gpd
Description of Soi1s:SEE PLAN
Soil Evaluator Form No.: Name of Soil Evaluator: Date of Evaluation:04/02/2015
ROBIN WILCOX,PLS
• DESCRIPTION OF REPAIRS OR ALTERATIONS:REPAIR-1500 GAL SEPTIC TANK,DBOX,2-500 GAL PRECAST CHAMBERS
W/4'STONE:2S X 13'X 2'
The undersigned agrees to install the above tlescribetl Individual Sewage Disposal System in accorclance with the provisions of
- TITLE 5 and further aarees not to olace in ooeration until a Certiflcate of Comoliance has heen issued bv the Board of Health.
Signed Date
Inspections
a��., _�Ly
Commonwealth of Massachusetts
� Board of Health, Yarmouth, MA Fee
DISPOSAL SYSTEM CONSTRUCTION PERMIT E55.00
Permission is herby granted to;
B.C.K. GENERAL CONTRACTOR, 97 TOWN BROOK ROAD,WEST YARMOUTH, MA 02673
To perform: Upgrade an individual sewage disposal system.
Owner: MURPHY VIRGINIA R
36 RUNESTONE RD
SOUTH YARMOUTH,MA 02664-1325
Location:36 RiJNE STONE RD, SOUTH YARMOUTH,MA 02664
Disposal System Construction Permit No.: BOHDC-151788,Dated: April 22,2015
Provided: Construction shall be comple[ed within six months of the date of this permit. Al]local condi[ions must be met.
Conditions
1 REPAIR-1500 GAL SEPTIC TANK, DBOX, 2-500 GAL PRECAST CHAMBERS W/4'STONE:25'X
13'X 2'
2. ZONE II MAXIMUM 3 BEDROOMS
l i
Bruce G. rphy,MPH, R.S., CHO/Amy L.von Hone, R.S., CHO
Health Director/Assistant Health Director
. The issuance of this permit shall not be construed as a guarantee that the system will funMion as designed.
��.w ��C�
Commonwealth of Massachusetts
Board of Health, Yarmouth, MA FBB
CERTIFICATE OF COMPLIANCE 555.00
Description of Work:Complete System
The undersigned hereby certify that the Sewage Disposal System; Upgraded
by:B.C.K.GENERAL CONTRACTOR
at:36 RUNE STONE 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-1S1788,dated OS/15/2015.
Installer:B.C.K.GENERAL CONTRACTOR
Address:97 TOWN BROOK ROAD WEST Inspector:AMY VON HONE,R.S.
YARMOUTH,MA 02673
Designer:PiJNKHORN SERVICES
Conditions
1REPAIR-1500 GAL SEPTIC TANK,DBOX,2-500 GAL PRECAST CHAMBERS W/4' STONE:
25' X13'X2'
2.ZONE II MAXIMUM 3 BEDROOMS
�
Bruce G. rp y, MPH, R.S., CHO/Amy L. von Hone, R.S., CHO
Health Direc[or/Assistant Health Diredor
The issuance of this permit shall not be construed as a guarantee t6at the system will function as designed.
BOH_D ispasal_Constructlon_CofC.rpt
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