HomeMy WebLinkAboutApp-Permit-ComplianceNo. 60
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Board of Health, l , MA.
APPLICATION FOR DISPOSAL SYSTEM[ CONSTRUCTION PERMIT
Application for a Permit to Construct( ) Repair( ) Upgrade(>,<bandon() - JUComplete System ❑ Individual Components
Location 12
Owner's Name ��✓
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Map/Parcel#
Address J
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Lot#
Telephone# os/ —
Installer's Name
Designer's Name
Address
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Address
Telephone# MOO
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Telephone# fzk S�OZ Co
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Type of Building R�s'GN-� Lot Size sq. ft.
Dwelling - No. of Bedrooms Garbage grinder ( )
Other - Type of Building No. of persons Showers ( ) , Cafeteria ( )
Other Fixtures `
Design Flow (min. required) gpd Calculated design flow Design flow provided gpd
Plan: Date Number of sheets Revision Date
Title
Description of Soil(s) _
Soil Evaluator Form No.
Name of Soil Evaluator
Date of Evaluation
DESCRIPTION OF REPAIRS OR ALTERATIONS /yli7 k/ / r /7/ Sof' VIY7 1-- SNP"
The undersigned agrees to install a above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and
further agrees to n ace system in operation until a Certificate of Compliance has been issued by the Board of Health.
Signed Date
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Inspections
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No. DC_5-a (�Z 2 COMMONWEALT14 OF MASSAC14USETTS FEE --5 06
Board of Health, 3 AW 11 O OT -H , MA.
CERTIFICATE Of COMPLIANCE
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Description of Work: ❑ Individual Component(s) 0 Complete System ff
The undersigned hereby certify thate.Sewage Disposal System; Constructed ( ), Repaired (V), Upgraded ( ), Abandoned ( )
by:�}i;i .S 4�
at
has been installeTiri Oc rd6ncct witK tliie'provisions of 310 CMR 15.00 (Title 5) and the approved design plans/as-built plans relating to
application No.�- 1,0 , dated FS 1 < % Approved Design Flow -,i' s C- (gpd)
Installer
Designer: ` i l > Inspector: 1 l ' / Date:
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The issuance of this permit shall not be construed as a guarantee that the system will function as designed.
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Board of Health, YA9 0 tf 7* , MA.
DISPOSAL SYSTEM CONSTRUCTION PERMIT
Permission is hereby granted to; Construct( ) Repair( i)' Upgrade( ) Abandon( ) an individual sewage disposal system
at C.� �,i>f as described in the application for
Disposal System Construction Permit No. A —4/ , dated S',2 /
Provided: Construction shall be comple"tedxn the �fdte of this permit. A11/cal conditions must be met.
Form 1255 Rev. 5/96 A.M. Sulkin Co. Chadestown. MA Date) Board of Health
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' No.:BOHDG 15-4212 '
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: 18 WEST RD,WEST YARMOUTH, MA 02673 Owner:
BASHIAN ROBERT W
Map/Parcel#: 022.316 BASHIAN ELEANOR L
P O BOX 442
WEST HYANNISPORT,MA 02672
Phone:
Septic System Installer Designer
RODNEY FISHER EAS SURVEY,INC.
440 MAIN STREET HARWICH, MA P.O.BOX 1729
02645 SANDWICH,MA 02563
Phone: 508-888-3619 '
Type of Building:Dwelling Lot Size: 13,068.00 Acres
Dwelling-No.of Bedrooms:3 Garbage Grinder:
Other Type of Building: No.of persons: Showers: :
Other Fixtures:
Plan Date:06/18/2015 Number of Sheets:2 Cafeteria:
Tit1e:SITE&SEWAGE REPAIR PLAN 18 WEST ROAD Revision Date:
Design Flow(miarequired):330 gpd Calculated design flow:330 gpd Design flow provided:336 gpd
Description of Soi1s:SEE PLAN
Soil Evaluator Form No.: Name of Soil Evaluator: Date of Evaluation:06/04/2015
EDWARD STONE,PLS
DESCRIPTION OF REPAIRS OR ALTERATIONS:SEPTIC DISPOSAL-REPAIR-PROPOSED 1500 GAL SEPTIC TANK,DBOX,24 ,
QUICK 4 STANDARD INFILTRATORS W/OUT STONE: 16'X 17'X 8"
� 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 Comuliance has been issued bv the Board of Heakh.
Signed Date I
Inspections
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. Commonwealth of Massachusetts
Board of Health, Yarmouth, MA Fee :
' DISPOSAL SYSTEM CONSTRUCTION PERMIT �55.00
Permission is hereby granted to;
RODNEY FISHER SEPTIC SERVICE,440 MAIN STREET, HARWICH, MA 02645
To perform: Upgrade an individual sewage disposal system. '
Owner: BASHIAN ROBERT W '
BASHIAN ELEANOR L
P O BOX 442
WEST HYANNISPORT,MA 02672
Location: 18 WEST RD, WEST YARMOUTH, MA 02673
Disposal System Construction Permit No.: BOHDC-15-4212 , Dated: August 25,2015
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-PROPOSED 1500 GAL SEPTIC TANK, DBOX, 24 QUICK 4
STANDARD INFILTRATORS W/OUT STONE: 16'X 17'X 8"
2. PLUMBING PERMIT REQUIRED
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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.