HomeMy WebLinkAboutApp-Permit-ComplianceNo. bo DC--rs �✓c.7 qo ,� -�-03- FEE/Zea
Y COMMONWEALTH OF MASSA C IUSETTS c�
YARMOUTH HEALTH SEPT.
Board of Health, , MA.
f PI.ICATI®N FOR DISP® 'P CTI®N PERMIT
Application for a Permit to Construct( ) Repair( ) Upgrade(V) AbandonO - ❑ Complete System Pndividual Components
Location ''�
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Owner's Name 2i^t 1 Ky/iJ 8
Map/Parcel#
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Address '�j `� L1v 2�" (jp
Lot# Z Le
Telephone#
Installer's Name
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Designer's Name v
Addresst.
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Address (?j (PC OZ._ ZA y
Telephone#
50 3 *-)'77
1 Telephone# S -Of Z ` 711 t!F
Type of Building 2 S f '�d�-1� Lot Size �✓ 6'I ZZ�i sq. ft.
Dwelling - No. of Bedrooms 1 t Garbage grinder( )
Other - Type of Building No. of persons Showers ( ) , Cafeteria ( )
Other Fixtures
Design Flow (min. required) E gpd Calculated design flow Design flow provided gpd
Plan: Date Number of sheets t Revision Date
Title
Descr
Soil I
Date of Evaluation 101 at I I ! f '
DESCRIPTION OF REPAIRS OR ALTERATIONS W 6,TA .-C_ 06-4. W 'W) .OVA %c
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The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and
further agrees to not ) pla a the system in operation until a Certificate of C7 fiance has been issued by the Board of Health.
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Signed /" 1 t r n.y b` ,ems..^ Date 15
" Inspections
No. 6o N D C- l$s Oe 40 FEE S73
COMMONWEALTH Of AC14USETTS
Board of Health, 40-kljs1 , MA.
CERTIFICATE Of COMPLIANCE
Description of Work: C".l Individual Component(s) ❑ Complete System
The undersigned hereby certify that the Sewage Disposal System; Constructed ( ), Repaired ( )> Upgraded (,,(Abandoned
by: r C C At\ 1 id e' lJ f._
at -r.-t L—i ! /a,(- o on f �/Z a �^ rr+^ 0 U,� { j�. !'� -Z 6:117
has been installet'aci"4)�Wcrcfar ce'itXli rhe provisions of 310 CMR 15.00 (Title 5) and the approved design plans/as-built plans relating to
application No. �Ci `� dated 0- ZL >�� Approved Design Flow (gpd)
Installer /7
Designer: 1�)020xdl,- L� Inspector: i Uy 44 Date: 7 /�
The issuance of this permit shall not be construed as a guar a that the system will function as designed.
No. P�OiI DG'/S^C�8�0 OGenNS/ DG- YeT c
COMMONWEALTH Of MASSACHUSETTS
Board of Health, 7A /'/1't 0 ✓tY� MA.
DISPOSAL SYSTEM CONSTRUCTION PERMIT
FEE iD SJ QRZ
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Permission is hereby granted to; Construct( j Repair(/, Upgrade( ) Abandon( ) an individual sewage disposal system
1
at (._.l J x' ✓ P 00 Y ar..Y v: J" Pori- as described in the application for
Disposal System Construction Permit No. %% , dated 11-22-
Provided:
ZZProvided: Construction shall be completed within t of the date of this permit. All local conditions must be met.
`Form 1255 Rev. 5/96 A.M. Sulkin Co. Charlestown, MA Date
� �B-oardof Health
f'%rJ
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' No.:BOHDGIS-0840
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Commonwealth of Massachusetts ee
, $55.00
Board of Health, Yarmouth, MA
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERNIIT
Application for a Permit to:Upgrade-Individual Component(s)
Location: 37 LIVERPOOL DR,YARMOUTH, MA 02675 Owner:
KRUEGER MEREDITH P
Map/Parcel#: 143.63 37 LIVERPOOL DR
YARMOUTHPORT,MA 02675
Phone:
Septic System Installer Designer
OCEANSIDE SEPTIC OCEANSIDE SEPTIC
P.O. BOX 201 BREWSTER, MA 02631 P.O.BOX 201
Phone: BREWSTER,MA 02631
(508)896-1513
Type of Building:Dwelling Lot Size:0.83 Acres
Dwelling-No.of Bedrooms:4 Garbage Grinder:
Other Type of Building: No.of persons: 56owers:
Ot6er Fiatures:
Plae Date: 11/17/2014 Number of Sheets: 1 Cafeteria•
Tit1e:PROPOSED SITE&SEW.4GE DISPOSAL SYSTEM Revision Date:
Design Flow(min.required):440 gpd Calculated design flow:440 gpd Design flow provided:444 gpd
Description of Soi1s:SEE PLAN
Soil Evaluator Form No.: Name of Soil Evaluator: Date of Evaluation: 10/09/2014
LINDA PINTO,PE
� DESCRIPTION OF REPAIRS OR ALTERATIONS:REPAIR FOR ADDITION-EXISTING 1000 GAL SEPTIC TANK,PROPOSED
DBOX,PROPOSED 25 ARC 36HC iJNITS W/OUT STONE:25'X 14.4'X 0.89'
, The undersigned agrees to install the above described Individual Sewage Disposal System in accordance wkh the provisions of
TITLE 5 and further aarees not to olace in ooeration until a Certificate of Comoliance has heen issued bv the Board of Health.
Signed Date
Inspections
1
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I Commonwealth of Massachusetts
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� Board of Health, Yarmouth, MA Fee
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� DISPOSAL SYSTEM CONSTRUCTION PERMIT sss.00
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� Permission is herby granted to;
� OCEANSIDE SEPTIC INC., P.O. BOX 201, BREWSTER, MA 02631
To perform:Upgrade an individual sewage disposal system.
Owner: KRITEGER MEREDITH P
37 LIVERPOOL DR
YARMOUTHPORT,MA 02675
Location:37 LIVERPOOL DR,YARMOUTH,MA 02675
i Disposal System Construction Permit No.: BOHDC-15-0840,Dated:January 22,2015
Provided:Construction shall be completed within six months of the date of this permit. All local conditions must be met.
' Conditions
1. REPAIR FOR ADDITION-EXISTING 1000 GAL SEPTIC TANK, PROPOSED DBOX, PROPOSED 25
ARC 36HC UNITS W/OUT STONE:25'X 14.4'X 0.89'
2. BOH&ENGINEER TO INSPECT&CERTIFY SOIL REMOVAL AND SYSTEM
Bruce . rphy, 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 fhat the system will function as designed.