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COMMONWEALTH Of MASSACITUSETTS
Board of Health, Yeo Wil+ , MA.
FEE
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APPLICATION FOR DISPOSAL SYSTEMCSN RUCTI®N PERMIT
Application for a Permit to Construct( ) Repair( ) Upgradet Abandon() - Complete System 0 Individual Components
Location -LV EQ kALVAC
Owner's Name C®r
Map/Parcel# d-( -3
Address C�,5 scyf2
Lot#
Telephone#, fog' — .401)
Installer's Name-
Designer's Name 119
Address I q- 7-eabPe P -
Address 9�n AL910st- fn
Telephone# 09'- q-7
Telephone# —3
Type of BuildingLot Size sq. ft.
Dwelling - No. of Bedrooms Garbage grinder ( )
Other - Type of Building No. of persons Showers ( ) , Cafeteria ( )
Other Fixtures
Design Flow (min. re fqu'red ) �V gpd Calculated design flow Design flow provided gpd
Plan: Date j I (7 Number of sheets Revision Date
Title
Description of Soil (s)
Soil Evaluator Form No.
Name of Soil Evaluator
DESCRIPTION OF REPAIRS OR ALTERATIONS i 600 go.I H I d -rank D
Date of Evaluation
1Z H I 0
The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and
further agree t to placesyste m peration until a Certificate of omplian�as been issued by the Board of Health.
Signed Date l 2-113(�
Inspections
No.
QN'"1�e7 1�SLL_.,7'd FEE J ��
7 COMMONWEALTH OF MASSACHUSETTS ' '
Board of Health,
YAIM o-1 MA.� ,
CERTIFICATE Of COMPLIANCE
Description of Work: ❑ Individual Component(s) .Complete System
The undersigned hereby certify that the Sewage Disposal System; Constructed ( ), Repaired ( ), Upgraded_(�!Abandoned ( )
t
at ! �� I ?r"y !) Ai.._j •�. ,' C�i i T i C 1 l
has been installed in accordance with the provisions of 310 CMR 15.00 (Title 5) and the pproved design plans/as-built plans relating to
application No. 16,9-0 dated �%` �� �� . Approved Design Flow (gpd)
Installer - 1 � �[.l l \° l.t. i l� ', i � 1� .(� i _
r
Designer: t-' C Inspector: 7 l' l Date:
The issuance of this permit shall not be construed as a guarintee that the system will function as designed.
No. t, -o t) ' �- .! 12- € 1 FEE
'U 7 COMMONWEALTH Of MASSACHUSETTS G f
Board of Health, yf�(ZP'1«� l)�� } , MA.
➢FISP®SAI. SYSTEM CONSTRUCTION PERMIT
Permission is hereby granted to; Construct( ) Repair( ) Upgrade(` --)-abandon( ) an individual sewage disposal system
at1 " u V t J t; iz % i J �'l.. as described in the application for
Disposal System Construction Permit No. f� 7 , dated
Provided: Construction shall be completed within thTee'years of the date of this permit. All local conditions must be met.
Form 1255 Rev. 5/96 A.M. Sulkin Co. Charlestown, MA Date f Board of Health
�
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� No.:BOHDGIS-7128
. Commonwealth of Massachusetts Fee
$55.00
` Board of Health, Yarmouth, MA
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT
�
Application for a Permit to:Upgrade-Complete System
Location: 25 BEVERLY RD,WEST YARMOUTH, MA 02673 Owner:
ELEFTHER ELEFTHERIOS
Map/Parcel#:039.317 ELEFTHER GEANY GEORGEKARIN
25 BEVERLY ROAD
WEST YARMOUTH,MA 02673
1
,
Phone:
' Septic System Instalier Designer
{ B&B EXCAVATION DOWN CAPE ENGINEERING
14 TEABERRY LANE FORESTDALE, 939 ROUTE 6A
i MA 02644 YARMOUTHPORT,MA 02675
Phone:
5084770653 508-362-4541
1
Type of Building:Dwelling Lot Size: 18,295.00 Sq.Ft.
Dweiling-No.of Bedrooms:3 Garbage Grinder•
Other Type of Building: No.of persons: Showers:
Other Fixtures:
Plan Date: 12/17/2015 Number of Sheets: 1 Cafeteria:
Tit1e:TTILE 5 SITE PLAN 25 BEVERLY ROAD Revision Date:
Design Flow(min.required):330 gpd Calculated design t1ow:330 gpd Design tlow provided:349 gpd
- . Description of Soi1s:SEE PLAN
� Soil Evaluator Form No.: Name of Soil Evaluator: Date of Evaluation: 12/16/2015
CRAIG J.FERRARI,S.E.
DESCRIPTION OF REPAIRS OR ALTERATIONS:SEPTIC DISPOSAL-REPAIR-PROPOSED 1500 GAL SEPTIC TANK,DBOX,2-
500 GAL PRECAST CHAMBERS W/4'STONE:25'X 12.83'X 2'
The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of
TITLE 5 and further aarees not to olace in ooeration until a Certificate of Comoliance has been issued bv the Board of Heakh.
Signed Date
Inspections
�
I
� +.
- Commonwealth of Massachusetts
�, Board of Health, Yarmouth, MA Fee
� DISPOSAL SYSTEM CONSTRUCTION PERMIT ass.00
Permission is herby granted to;
B&B EXCAVATION, 14 TEABERRY LANE, FORESTDALE, MA 02644
To perform:Upgrade an individual sewage disposal system.
Owner: ELEFTHER ELEFTHERIOS
ELEFTHER GEANY GEORGEKARIN
25 BEVERLY ROAD
! WEST YARMOUTH,MA 02673
i
Location:25 BEVERLY RD,WEST YARMOUTH,MA 02673
� Disposal System Construction Permit No.: BOHDC-15-7128,Dated:January 11,2016
� Provided: Construction shall be completed within six months of the date of this permit. All local conditions must be met.
CONDITIONS:
1. SEPTIC DISPOSAL-REPAIR-PROPOSED 1500 GAL SEPTIC TANK, DBOX,2-500 GAL PRECAST
CHAMBERS W/4'STONE:25'X 12.83'X 2'
�i�.I��aC����
Bruce G. Mu hy, PH, R.S., CHO/Amy L.von Hone, R.S., CHO
ealth Director/Assistant Health Director
The issuance of this permit shall not be construed as a guarantee that the system will function as designed.
F '
1
� Commonwealth of Massachusetts
i
Board of Health, Yarmouth, MA Fee
CERTIFICATE OF COMPLIANCE 555.00
Description of Work:Complete System
The undersigned hereby certify that the Sewage Disposal System; Upgraded
by:B&B EXCAVATION
at:25 BEVERLY RD, WEST YARMOUTH,MA 02673
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-15-7128,dated Ol/14/2016.
Installer:B&B EXCAVATION
Address:l4 TEABERRY LANE FORESTDALE,MA Inspector:
02644
Designer:DOWN CAPE ENGINEERING
Conditions
1.SEPTIC DISPOSAL-REPAIR-PROPOSED 1500 GAL SEPTIC TANK,DBOX,2-500 GAL
PRECAST CHAMBERS W/4'STONE:25'X 12.83'X 2'
��
Bruce . Mu hy, 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 function as designed.
BOH_Disposal_Construction_CofC.rpt