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Home My WebLink AboutApp-Permit-ComplianceNom CTDC—(5CICJ n� FEE COMMONWEALTH OF MASSACHUSETTS Board of Health, SMA USIA , MA. APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to Construct( ) Repairu) Upgrade( ) Abandon( - ❑ Complete System ❑ Individual Components Location Owner's Name ( S Map/Parcel# �� 2"[ Address Lot# Telephone# Installer's Name ac.fs e yoi( Designer's Name Address / 7 &eI fi lal Gf Address Telephone#Y77--Telephone# Type of Building Lot Size Dwelling - No. of Bedrooms Other - Type of Building No. of persons Other Fixtures Design Flow (min. required) Plan: Date Title Description of Soil(s) gpd Calculated design flow Number of sheets sq. ft. Garbage grinder ( ) Showers ( ), Cafeteria ( ) Design flow provided Revision Date Soil Evaluator Form No. Name of Soil Evaluator Date of Evaluation DESCRIPTION OF REPAIRS OR ALTERATIONS ni ZA iLtt-e Yang caP4--L- gpd 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 to place tem in . icate of Compliance has been issued by the Board of Health. Signed Date / /' S-- /J 101, 1 Inspections No. � ��. "'i��'f `t -! � 'i_.®M1`�Y®N �YV' iN.t1tI,T� OF MASSACHUSETTS FEE Board of Health, OTW , MA. i / Ir ' CERTIFICATE Of COMPLIANCE %fl r Description of Work:Individual Component(s) ElComplete System The undersig.-nped herebycertifythat the Sewage Disposal stem; Constructed ( ), Repaired Upgraded ( ), Abandoned ( ) by:RJlili� /l,Ct�-.5 tY6j/(" /*Gct at e o has been installed'iii acct, dame wifh tl application No. " _� � 6 , dated Installer MF4L;7NS risions of 310 CMR 15.00 (Title 5) and the approved design plans/as-built plans relating to �15 � Approved Design Flow (gpd) �V Designer: Inspector: Date: The issuance of this permit shall not be construed as a guarantee that the system will function as designed. No. auk .�t -- l �`� A cc V %S we Ec*�— FEE COMMONWFALT14 Of MASSACHUSETTS `3�3 Board of Health, �*M D i)T4 , MA. DISPOSAL SYSTEM CONSTRUCTION PERMIT Permission is hereby granted to; Construct( ) Repair Y Upgrade( ) Abandon( ) an individual sewage disposal system at f3 1-14 N p A LIG: as described in the application for Disposal System Construction Permit No./< _.2 �, dated rU ( rS Provided: Construction shall be cGmpleted within thxctlears the date of this permit All local conditions must be met. Form 1255 Rev. 5/96 A.M. Sulkin Co. Chadestown, MA Dater e.1, Board o4ge0Mth . � No.:BOHDGIS-4499 Commonwealth of Massachusetts Fee ass.00 Board of Health, Yarmouth, MA APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to:Repair-minor-Individual Component(s) Location: 8 LYNDALE RD, SOUTH YARMOUTH, MA 02664 Owner: PHILLIPS MARY B Map/Parcel#: 025.245 272 LONGHILL ST SPRINGFIELD,MA 01108-1452 Phone: Septic System Installer Designer ACCUSEPCHECK 17 NORTHSIDE DRIVE SOUTH , DENNIS, MA 02660 Phone: Type of Building:Dwelling Lot Size: 11,761.00 Acres Dwetting-No.of Bedrooms: Garbage Grinder: Other Type of Building: No.of persons: Showers: Other Fixtures: Plan Date: Number of Sheets: Cafeteria• Title: Revision Date: Design Flow(min.required): gpd Calculated design flow: gpd Design flow provided: gpd Description of Soils: Soil Evaluator Form No.: Name of Soil Evaluator: Date of Evaluation: DESCRIPTION OF REPAIRS OR ALTERATIONS:SEPTIC DISPOSAL-MINOR REPAIR-REPLACE DBOX,SEPTIC TANK TEE AND COVER PER INSPECTION REPORT 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 Health. Signed Date Inspections . � �. i i Commonwealth of Massachusetts Board of Health, Yarmouth, MA Fee � DISPOSAL SYSTEM CONSTRUCTION PERMIT $55.00 ; i Permission is herby granted to; ACCU SEPCHECK, 17 NORTHSIDE DRIVE,SOUTH DENNIS, MA 02660 To perform:Repair-minor an individual sewage disposal system. Owner: PHILLIPS MARY B 272 LONGHILL ST iSPRINGFIELD,MA 01108-1452 i i i Location: 8 LYNDALE RD,SOUTH YARMOUTH,MA 02664 I Disposal System Construction Permit No.: BOHDC-15-4499,Dated:October 06,2015 Provided: Construction shall be completed within six months of the date of this permit. All local conditions must be met. i CONDITIONS: � 1. SEPTIC DISPOSAL-MINOR REPAIR-REPLACE DBOX, SEPTIC TANK TEE AND COVER PER INSPECTION REPORT V`�"� Bruce G. Murp , M , R.S., CHO/Amy L.von Hone, R.S.,CHO alth Director/Assistant Health Director The issuance of this permit shall not be construed as a guarantee that the system will function as designed. Commonwealth of Massachusetts Board of Health, Yarmouth, MA Fee CERTIFICATE OF COMPLIANCE ass.00 ; Description of Work:Individual Component(s) The undersigned hereby certify that the Sewage Disposal System; Repair-minor by:ACCU SEPCHECK at: 8 LYNDALE RD,SOUTH YARMOUTH,MA 02664 Has been installed in accordance with the provisions of 310 CMR 15.00(Title 5)and the approved design plans or as-built plans relating to application No.: BOHDC-15-4499,dated 10/15/2015. Installer:ACCU SEPCHECK Address:l7 NORTHSIDE DRIVE SOUTH DENNIS, Inspector:PHILIP RENAUD MA 02660 Designer: � V�/ Bruce G. Murphy, H, 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 at the system will function as designed. BOH_Disposal_Construction_CofC.rpt