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HomeMy WebLinkAboutApp-Permit-ComplianceNo. t` /! '—%/Nq 11itG"l FEE //d, d3 S- ca y 1-18% -07 Z C® [® LTH ®F MASSAC14USETTS `p Board of Health, )ila'2A'l un+ , MA. APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTI®N PERMIT Application for a Permit to Construct] O Repair( ) Upgrade( ) Abandon( ) - Complete System ❑ Individual Components Location 21 Acorn Hill Drive Yarmouth o fhmer'sName L liane Bower Map/Parcel# 134 17 Address 15 Acorn Hill Drive, Yarmov (-A Lot# 17 Telephone# 36207799/Paul Tardiff Installer'sName Barrows Excavation Designer's Name Eastbound Land Surv0_ Address Queen Ann Road, Harwich Address p,O.Box 442,Forestdale,M4/ L Telephone# 508-400-6347 Telephone# 508-477-4511 Type of Building Single family hoyse I.otSize 24,000 sq. ft. Dwelling - No. of Bedrooms Garbage grinder ( ) Other - Type of Building-� No. of persons Showers ( ) , Cafeyrj'a ( ) Other Fixtures Design Flow (min. required) T77 gpd Calculated design flow 7 7- V Design flow provided gpd Plan: Date 1/25/15 Number of sheets 2 Revision Date Title Proposed dwelling site sewage plan located @ 21 Acorn Hill DrivSZ Description of Soil(s) see plan 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 not to place tem in oper tion until a Certificate of Compliance I as beersued by the Board of Health. _Signed Date—Z-4 Inspections No. FEE %/ 6 �. FEE C®MMONWEA .TII OF MASSACHUSETTS }' Boa feath, Ci1TI FICATE ©f COMPLIANCE N �.. Descripti, n.oi'V,Al' ❑ Individual Components) C Momplete System J The undersigned hereby certify that the Sewage Disposal System; Constructed (X, Repaired ( ),Upgraded.( ;Abandoned at has been installed in accordance with the provisions of 310 CMR 15.00 (Title 5) and the approved desiplans relating to application No.l7.Z+fflY dated 'f i � . Approved Design Flo (gpd) Installer1� `©L� SgP1lteOG'! l i Designer: L=/'--'1V0Z1M7 7f��'iInspector: 1 V" i Date: Wi I The issuance of this permit shall not be construed as a guarantee that the system will function as designed. ,tea-`�� x.�,c �.v <<.�a 7nrc »�v' �c ., ��.,_oo�a"in u�(» .ic>.. ��y-r�• e r� %/t? f &)el/ I FEE s� �%/ COMMONWEALTH Of MASSACHUSETTS j>G•f �1, ' Board of Health, Vae-w D in4- , MA. DISPOSAL SYSTEM CONSTRUCTION PERMIT Permission isherebygranted to; Construct(,\e.j Repair( ) Upgrade( ) Abandon( ) an individual sewage disposal system at -�/ �T <4y�'% �y/�� i�f%(/`Z° as described in the application for Disposal System Construction Permit No. —6, dated / Provided: Construction shall be completed within th_refe date of this per -mi All local conditions must be met. Form 1255 Rev. 5196 A.M. Sulkin Co. Chadeslown, MA Date `7 _ r / Board of Health l` r 1 � � , . No.:BOHDGIS-1169 Commonwealth of Massachusetts Fee ' • So.00 Board of Health, Yarmouth, MA '; APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERNIIT ' Application for a Permit to:New Construction-Complete System ' Location: 21 ACORN HILL DR,YARMOUTH, MA 02675 Owner: BOWER ARCHIE F Map/Parcel#: 134.3.3 BOWER LYLIANE 15 ACORN HILL DR YARMOUTH PORT,MA 02675-1402 Phone: Septic System Installer Designer , BARROWS EASTBOUND LAND SURVEYING 2 VINEYARD LANE HARWICH, MA P.O.BOX 442 02645 FORESTDALE,MA 02644 Phone: (508)477-4511 Type of Building:Dwelling Lot Size:0.55 Acres Dwelling-No.of Bedrooms:4 Garbage Grinder: Other Type of Building: No.of persons: Showers: Other Fixtures: Plan Date:O1/25/2015 Number of Sheets:2 Cafeteria• Title:PROPOSED DWELLING SITE AND SEWAGE PLAN 21 ACORN HILL Revision Date:03/04/2015 DRNE Design Flow(min.required):440 gpd Calcutated design flow:440 gpd Design flow provided:444 gpd Description of Soils:SEE PLAN ' � Soil Evaluator Form No.: Name of Soil Evaluator: Date of Evaluation:O1/07/2015 DARREN MEYER,R.S. ' � • DESCRIPTION OF REPAIRS OR ALTERATIONS:PROPOSED 1500 GAL SEPTIC TANK,H-20 DBOX,4-500 GAL PRECAST CHAMBERS W/STONE 2.25'ENDS,2.5'SIDES:40'X 10'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 oneration unt11 a Certificate of Comoliance has been issued hv the Board of Heakh. Signed Date Inspections � i Commonwealth of Massachusetts _ • Board of Health, Yarmouth, MA Fee DISPOSAL SYSTEM CONSTRUCTION PERMIT $o.00 Permission is herby granted to; BARROWS EXCAVATING,2 VINEYARD LANE, HARWICH, MA 02645 To perform:New Construction an individual sewage disposal system. Owner: BOWER ARCHIE F BOWER LYLIANE 15 ACORN HILL DR YARMOUTH PORT,MA 02675-1402 Location:21 ACORN HILL DR,YARMOUTH,MA 02675 Disposal System Construction Permit No.: BOHDC-15-1169,Dated: March O5,2015 Provided:Construction shall be completed within six months of the date of this permit. All local conditions must be met. Conditions 1.NEW CONSTRUCTION-1 S00 GAL SEPTIC TANK, H-20 DBOX, 4-S00 GAL PRECAST CHAMBERS W/STONE 2.25'SIDES, 2.S'ENDS: 40'X 10'X 2' 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. j 6