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HomeMy WebLinkAboutApp-Permit-ComplianceNo. BoydC"(5-%G33 FEE 45em;0,0 COMMONWEALTH OF MASSACHUSETTS Le Board of Health, AR -MO , MA. APPLICATION FOR DISPOSAL SYSTEM[ CONSTRUCTION PERMIT Application for a Permit to Construct( Repair( Upgrade( bandonO - ❑ Complete System -a'I�dividual Components Location L�'IWY Owner's Name l_L Map/Parcel# Address TWL -AMD&VE 5WPAiWICI Lot# LOTTelephone# 506 732 Installer's Name , I i -AC • Designer's Name 1.i 6 , A55m, L I--C- Addressl 60 L I L-L-RD� S , C -HA T 14A � Address p � f � 5 � �M�� 1 G1� A Telephone# 5oe5 :L.{ 2 1 G 55 Telephone# ;�506 2 2-S7 Type of Building R�Sd7Et�►'T/R1 Lot Size mon + sq: ft. Dwelling - No. of Bedrooms 17,51= t>goom Garbage grinder ( ) Other - Type of Building No. of persons Showers ( ), Cafeteria ( ) Other Fixtures Design Flow (min. required) 'J gpd Calculated design flow 3-8 Design flow provided gpd Plan: Date 10 / 1�) 115 Number of sheets I (2 - S i DED) Revision Date Title fi1T1✓ 4 SEWA6E PA-Aii l Description of Soils) t61 15 5h f" PLAN (C -LASS .-C L Ci 4CZ- l.,&YER` ) Soil Evaluator Form No. Name of Soil Evaluator 1R, -TJ ti i Date of Evaluation ie 11 F kt�, DESCRIPTION OF REPAIRS OR ALTERATIONS The undersigned ees tall the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further agrees of to 1 c e te�pera on until a Certificate of Compliance has been issued by the Board of Health. Signed Z Date Inspections No -600C -19-s'633 'Y ��CJ !" FEE t575-00 COMMONWEALTH Of MASSACHUSETTS �V C* -4 Z/ go Board of Health, �&R-m 0 MA z/1Cf CERTIFICATE ©F COMPLIANCE Description of Work: id'Individual Components) ❑ Complete System The undersigned hereby certify that the Sewage Disposal System; Constructed ( ), Repaired ( ), Upgraded Abandoned ( ) by: T W , 01 C KSS 4N, /N C at t_! 2 A be- TR l.A N EC has been installedin acc r anceS;-�rh �1' ons of 310 CMR 15.00 (Title 5) and thea proved design plans/as-built plans relating to application No. /C 2 6 C, dated Approved Design Flow (gpd) Installer ST1 VeW G -A -P -K. Designer: MOR -I N E,yGI1JEF2/N6- Inspector: / I i Date: The issuance of this permit shall not be construed as a guarantee that the system will function as designed. No.#�,ttlF°�7C 1�"�`�o e� %� NIUGEi�.jO/V FEE 66 / 1 COMMONWEALTH Of MASSACHUSETTS cc# V80 Board of Health, YEkR.MO Q-Tl4 , MA. DISPOSAL SYSTEM CONSTRUCTION PERMIT Permission is hereby granted to; Construct( ) Repair( ) Upgrade ( Abandon( ) an individual sewage disposal system at .3 6W ZA b E7Y e.AME / as described in the application for Disposal System Construction Permit No. /�� dated GC/ -/<-7b Provided: Construction shall be co p eed within tLr4e4Le,&t of the date of this permit. All local c ditions must be met. Cr `14a S of Health Form 1255 Rev. 5/96 A.M. Sulkin Co. Chadeslown, MA Date �� ��oard �. � ' No.:BOHDGIS-5633 , Commonwealth of Massachusetts F� ; � $55.00 Board of Health, Yarmouth, MA APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT I Application for a Permit to: Upgrade-Individual Component(s) Location: 3 ELIZABETH LN,WEST YARMOUTH, MA 02673 Owner: REMICK ALLAN E Map/Parcel#: 047.12 OBRYAN LYNN P � 3 ELiZABETH LN I WEST YARMOUTH,MA 02673 I � Phone: ! � Septic System Instalter Designer T.W.NICKERSON, INC. MORAN ENGINEERING ASSOC.,LLC ' 160 MILL HILL ROAD SOUTH P.O.BOX 183 CHATHAM, MA 02659 SOUTH HARWICH,MA 02661 Phone: 508-432-2878 5084321655 � Type of Building:Dwelling Lot Size:24,829.00 Sq.Ft. Dwelling-No.of Bedrooms:3 Garbage Grinder: Other Type of Building: No.of persons: Showers: Other Fixtures: Plan Date: 10/19/2015 Number of Sheets:2 Cafeteria: Title:SITE&SEWAGE PLAN 3 ELIZABETH LANE Revision Date: . Design Flow(min.required):330 gpd Calculated design flow:330 gpd Design flow provided:348.68 gpd � Description of Soi1s:SEE PLAN Soil Evaluator Form No.: Name of Soil Evaluator: Date of Evaluation: 10/08/2015 RICK JUDD,R.S. DESCRIPTION OF REPAIRS OR ALTERATIONS:SEPTIC DISPOSAL-REPAIR-EXISTING 1000 GAL SEPTIC TANK,PROPOSED 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 CertiFcate of Comnliance has been issued bv the Board of Health. Signed Date Inspections i a � � ; � i � , Commonwealth of Massachusetts � Board of Health, Yarmouth, MA Fee DISPOSAL SYSTEM CONSTRUCTION PERMIT $55.00 ; Permission is herby granted to; T.W. NICKERSON, INC., 160 MILL HILL ROAD,SOUTH CHATHAM, MA 02659 To perform: Upgrade an individual sewage disposal system. Owner: REMICK ALLAN E OBRYAN LYNN P 3 ELIZABETH LN WEST YARMOUTH,MA 02673 { Location:3 ELIZABETH LN, WEST YARMOUTH,MA 02673 Disposal System Construction Permit No.: BOHDC-15-5633 ,Dated:November 18,2015 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, PROPOSED DBOX,2-500 GAL PRECAST CHAMBERS W/4'STONE:25'X 12.8'X 2' , l.S� '� Bruce G.Mu h , MPH, 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.