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HomeMy WebLinkAboutApp-Permit-ComplianceNo. 4c �x/ EE .00 S COMMONWTALTH Of MASSACHUSETTS Board of Health, YJ�gm D olu , APPLICATION FOR DISPOSAL SYSTEM[ CONSTRUCTION PERMIT � Application for a Permit to Construct( ) Repair( ) Upgrade( Abandon() - ❑ Complete System J;ari dividual Components Location tj 1 Owner's Name _:I,,,4 1/1 Ai Map/Parcel# Address 7, Lot# Telephone# Installer's Name LtC3 �sro� , Designer's Name �1! Address -;7-,3 <_ Address �I �� ije� l,�,,r Telephone# Telephone#a—� Type of Building / / Lot Size ©d 0P_ sq. ft. Dwelling - No. of Bedrooms Garbage grinder Other - Type of Building No. of persons Showers ( ), Cafeteria ( ) Other Fixtures Design Flow (min. required) a gpd Calculated design flow_ Plan: Date Number of sheets Tide fir% Description of Soil(s) _ Soil Evaluator Form No. DESCRIPTION OF REPAIRS OR ALTERATIONS Design flow provided 34�'6Z - Z-59pd Revision Date Name oked, Evaluator 5D'►�s« Date of Evaluation to —N aS- The undersigned agr to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further agrees t to p164 the to ra til a Certificate of Compliance has been issued by the Board of Health. Signed � � �Date Z-.2- r 37— Inspections No. i�� I� (006 FEE _ --?,60 IS _.2,5- COMMONWEALT14 OF MASSACHUSETTS Board of Health, YA L2 M 0 UTN , MA. G -t CERTIFICATE OF COMPLIANCE Description of Work: JaIndividual Component(s) ❑ Complete System The undersigned hereby certify that the Sewage Disposal System; Constructed ( ), Repaired ( ), Upgraded(.Abandoned ( ) at has been Cs �m� 3 e fifth the provisions of 3 CMR 15.00 (Title 5) and the approved design plans/as builf'pl'ans relating to application No. r`,.�p` dated %� - ' O �i� . Approved Design Flow � :.� gpd) //''�� Installer / ' Via] I1x�iG - - -- 'Zo( /!/l L�.rl - Designer: Inspector: (A Date: � /I,, / t� The issuance of this permit shall not be construed as a guarantee that the system will function as designed. t�.'I�N Ur,�L;C'�`"t.:j(�,;;:C;.t.v_Oc:'QVP:v, CGC JC"`VOCCCOt]r..•OGC7(%^�:CGt`OCOOOC�JCc>ocuer;,pci�goocc �'oe co:-'.acoo..o•]o c0000GcoCb(i('.9 o.Cc2gc.0000:3T Oeco'•�J000+. No. b rl "_D C r� 5`(00 9 K0 FEE 15S, Q COMMONWEALTH LTH ®f MASSACHUSETTS r Board of Health, ykl2WLDunf MA. DISPOSAL SYSTEM[ CONSTRUCTION PERMIT Permission is hereby granted to; Construct( ) Repair( at 5�1 Upgrade( -- Abandon( ) an individual sewage disposal system as described in the application for Disposal System Constr�tion Permit No. -,)a,, dated Z �'.., W'� Provided: Construction shall be completed within tkx_ev__g�"1of the date of this per -All local conditions must be met. Form 1255 Rev. 5/96 A.M. SWkin Co. Charlestown, MA Date - oard of Health . Ste' No.:BOHDC-15-6096 � Commonwealth of Massachusetts Fee ' $55.00 Board of Health, Yarmouth, MA ' APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to:Upgrade-Individual Component(s) ' Location: 17 DAISY LN,YARMOUTH, MA 02675 Owner: PRIEST DAVID E Map/Parcel#: 110.26 PWEST HELEN W 17 DAISY LN SOUTH YARMOUTH,MA 02664 Phone: Septic System Installer Designer ELLIS BROTHERS MEYER&SONS,INC. PO BOX 59 YARMOUTHPORT, MA P.O.BOX 981 02675 EAST SANDWICH,MA 02537 Phone: 508-360-3311 5083626237 f { Type of Building:Dwelling Lot Size:9,583.00 Sq.Ft. Dwelling-No.of Bedrooms:3 Garbage Grinder: Other Type of Building: No.of persons: Showers: i Other Fixtures: Plan Date: 10/26/2015 Number of Sheets:2 Cafeteria• Title:SEPT'IC SYSTEM REPAIR PLAN 17 DAISY LANE Revision Date: . � Design Flow(min.required):330 gpd Calculated design flow:330 gpd Design flow provided:342.25 gpd � I Description of Soi1s:SEE PLAN � . i Soil Evaluator Form No.: Name of Soil Evaluator: Date of Evaluation: 10/14/2015 i DARREN MEYER,R.S. DESCRIPTION OF REPAIRS OR ALTERATIONS:SEPTIC DISPOSAL-REPAIR-EXISTING 1000 GAL SEPTIC TANK,DBOX,2-500 GAL PRECAST CHAMBERS W/4'STONE:25'X 12.8'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 Certiflicate of Comoliance has been issued bv the Board of Health. ' Signed Date Inspections I � , � Commonwealth of Massachusetts Board of Health, Yarmouth, MA Fee DISPOSAL SYSTEM CONSTRUCTION PERMIT sss.00 Permission is herby granted to; ELLIS BROTHERS CONSTRUCTION, PO BOX 59,YARMOUTHPORT, MA 02675 To perform:Upgrade an individual sewage disposal system. Owner: PRIEST DAVID E PRIEST HELEN W U DAISY LN SOUTH YARMOUTH,MA 02664 Location: 17 DAISY LN,YARMOUTH,MA 02675 Disposal System Construction Permit No.: BOHDC-15-6096,Dated:December 04,2015 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, DBOX,2-500 GAL PRECAST CHAMBERS W/4'STONE:25'X 12.8'X 2' 2.ZONE II MAXIMUM 3 BEDROOM ����� � Bruce G. 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. i I ,f � , � ; { i r I I