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HomeMy WebLinkAboutApp-Permit-Complianceff ff 1 ` i r� 2- f , Tom' oil e,v No. �nN 1� C'" � �"� 11 � � FEE - COMMONWEALTH OF MASSACHUSETTS YAR-kin-UTH HEALTH DEPT. Board of Health, 1 146 ROUTE 28 , MA. G - APPLICATION FOR DISP®SALT M I I®N PERMIT Application for a Permit to Construct( ) Repair(/)_,U,,pgrade( ) Abandon( ) - ❑ Complete System [`Individual Components Location �' 'r/E/y✓'i�j ,.�Q Owner's Name Map/Parcel# 6 9 " i Address c V-1,%94' Lot# Telephone# '6-0 4P %% (-X Installer's Name z4gly �` Designer's Name,6.46eo� 9P Address 4<3 �� j �i�' Address Telephone# Telephone# / g6r o,, Type of Building c::�P Lot Size y sq. ft. Dwelling - No. of Bedrooms Garbage grinder ( ) Other - Type of Building No. of persons Showers ( ), Cafeteria ( ) Other Fixtures Design Flow (min. required) c:� D gpd Calculated design flow 3 Plan: Date %/ ( 7 19-" 10�Number of sheets .00e Title Design flow provided a -5�R gpd Revision Date Description of Soil(s) 'j'4t,!F Soil Evaluator Form No. Name of Soil Evaluator Date of Evaluation DESCRIPTION OF REPAIRS OR ALTERATIONS The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further agrees to to, pla a system in operation until a Certificate of Compliance has been issued by the Board of Health. Signed Date I,;L Inspections TAPe- 04- ST e- -Tj4_ Mr. l w c -,) "e G Se P r t C..cc jP64-C.i No. t3oia1DC-t�-(o(1 65�.®0 COMMONWEALTH OF MASSAC1IITSE�T / t A c%t 3S g Cep Board of Health, , CERTIFICATE OF COMPLIANCE Description of Work: Zdhidual Component(s) ❑ Complete System r) ( (jr C The undersigned hereby certify that the Sewage Disposal System; Constructed ( ), Repaired (�pgraded ( ), Aban ned ( ) has been instalr',e acc�),Q-, T wtfi'(4tprovisions of 310 CMR 15.00 (Tule 5) and the approved design plans/as-built plans relating to application No. Xe 0 dated Approved Design Flow 3J,9(gp ) Installer�el Q Designer: 'P Inspector: % Date: I C, The issuance of this permit shall not be construed as a guarantee that the system will function as designed. No. 130tyyC—i5--w`-T - \!+ boa* Se?nC szo1cvr FEE 5:5 ©0 COMMONWEALT14 Of MASSACHUSETTS Board of Health, �/{���y� , MA. DISPOSAL SYSTEM CONSTRUCTION PERMIT Permission is hereby granted to; Construct( ) Repair(:K Upgrade( ) Abandon( ) anindividual sewage disposal system at ���%/5�ll1'' ����`� �� y�� as described in the application for Disposal System Construction Permit No. -tel , dated .k- /(�_ Provided: Construction shall be completed within tbxoe years of the date of this permit. All local conditi .ns must be met. Form 1255 Rev. 5/96 A.M. Sulkin Co. Chadestown, MA Date _­)g_/�Board of Health 7`�� % No.:BOHDGIS-6114 ' ° Commonwealth of Massachusetts F� ' $55.00 Board of Health, Yarmouth, MA APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to:Upgrade-Individual Component(s) Location: 9 CAPT BEARSE RD, SOUTH YARMOUTH, MA 02664 Owner: KUEHNJOSHUAJ Map/Parcel#: 067.94 9 CAPT BEARSE RD SOUTH YARMOUTH,MA 02664 Phone: Septic System Installer Designer JIM LEBOEUF SEPTIC DAVID B.MASON,R.S. 63 CIT AVENUE HYANNIS, MA 02601 4 GLACIER PATH Phone: EAST SANDWICH,MA 02537 5087750707 508-833-2177 Type of Building:Dwelling Lot Size: 13,068.00 Sq.Ft. � Dwetling-No.of Bedrooms:2 Garbage Grinder: Other Type of Building: No.of persons: Showers: Other Fixtures: Plan Date: 11/30/2015 Number of Sheets: 1 Cafeteria: Titie:SITE AND SEWAGE PLAN 9 CAPTAIN BEARSE ROAD Revision Date: Design Flow(min.required):220 gpd Calculated design flow:220 gpd Design flow provided:349 gpd Description of Soi1s:SEE PLAN Soil Evaluator Form No.: Name of Soil Evaluator: Date of Evaluation: 11/24/2015 DAVID B.MASON,R.S. DESCRIPTION OF REPAIRS OR ALTERATIONS:SEPTIC DISPOSAL-REPAIR-EXISTING 1000 GAL SEPTIC TANK,H-20 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 Cemoliance has been issued bv the Board of Health. Signed Date Inspections � f , • Commonwealth of Massachusetts � : ; Board of Health, Yarmouth, MA Fee ' DISPOSAL SYSTEM CONSTRUCTION PERMIT ass.00 Permission is herby granted to; E JIM LEBOEUF SEPTIC SERVICE,63 CIT AVENUE, HYANNIS, MA 02601 To perform:Upgrade an individual sewage disposal system. Owner: KIJEHN JOSHUA J 9 CAPT BEARSE RD SOUTH YARMOUTH,MA 02664 Location:9 CAPT BEARSE RD,SOUTH YARMOUTH,MA 02664 Disposal System Construction Permit No.: BOHDC-15-6114,Dated:December 28,2015 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-EXISTING 1000 GAL SEPTIC TANK, H-20 DBOX,2-500 GAL PRECAST CHAMBERS W/4'STONE:25'X 12.83'X 2' 2.ZONE II MAXIMUM 2 BEDROOMS � � f Bruce G. Murph ,M , R.S.,CHO/Amy L.von Hone, R.S.,CHO Ith Director/Assistant Health Director The issuance of this permit shall not be construed as a guarantee that the system will function as designed. � i Commonwealth of Massachusetts Board of Health, Yarmouth, MA Fee CERTIFICATE OF COMPLIANCE $55.00 Description of Wark:Individual Component(s) The undersigned hereby certify that the Sewage Disposal System; Upgraded by:JIM LEBOEUF SEPTIC SERVICE at:9 CAPT BEARSE 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-15-6114,dated Ol/06/2016. Installer:JIM LEBOEUF SEPTIC SERVICE Address:63 CIT AVENUE HYANNIS,MA 02601 Inspector:BRUCE MURPHY,R.S. Designer:DAVID B.MASON,R.S. Conditions 1.SEPTIC DISPOSAL-REPAIR-EXISTING 1000 GAL SEPTIC TANK,H-20 DBOX,2-500 GAL PRECAST CHAMBERS W/4' STONE:25'X 12.83'X 2' 2.ZONE II MAXIMUM 2 BEDROOMS Bruce G. Murphy,MPH, R. ., HO/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_D isposal_Construction_CofC.rpt i `