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HomeMy WebLinkAboutApp-Permit-ComplianceNo. Dl�"IJ ! t"� / jC r � � A� FEE 465-,00 z� % COMMONWEALTH LTH OF M SSAC14USEITS t1f�T, E -1% ©v Board of Health, )�gmo 0-1-W , MA. APPLICATION FOR DISPOSAL SYSTLM[ CONSTRUCTION PERMIT Application for a Permit to Construct( ) Repair( ) Upgrade(+ -<Abandon() - ❑ Complete System 6 -An' dividual Components Location a rn�Or >.��Il per; Owner's Name Map/Parcel# © C,J<� Addresses Lot# Telephone# Installer's Name � Designer's Name Address pqb Address F®e ' Telephone# Telephone# Type of Building V,�C'L Dwelling - No. of Bedrooms Other - Type of Building _ No. of persons Lot Size + O'�( Ptr'S soft. Garbage grinder ( ) Showers ( ), Cafeteria ( ) Other Fixtures Design Flow (min. required) gpd Calculated design flow 35�� Design flow provided - y C gpd Plan: Date QO( 5�- Number of sheets Revision Date Title Description of Soil(s) _ Soil Evaluator Form No, Name of Soil Evaluator, � r 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 to not to lace the system operation until a Cert cate of ompltan has been issued by the Board of Health. Signed Date Jam_ Inspections No. /�;%" v"+'aa ep COMMONWEALTH OF I� ASSACHUSETTS Board of Health, V!\;RWonA 11711M. CERTIFICATE Of COMPLIANCE X Description of Work: �xidividual Component(s) ❑ Complete System The undersigned hereby certify that the Sewage Disposal System; Constructed ( ), Repaired ( ), Upgraded (VKAbandoned ( ) by: at rgn� U��� i YC7[alPQ .A.— O has been installedin/ccol'dance' itli a vis`fons of 310 CMR 15.00 Title 5 and the roved design Tans/as-built plans relating to " ( ) PP g P P g application No. dated Approved Design Flow 7(gpd) Installer v,.-.., Designer:1,✓-. tt. y7n G, Inspector: � t % ��/k'�¢ Date: r The issuance of this permit shall not be construed as a guaraute/ that the system will function as designed. No. b%br_ (S 4 CBKj F-�-D4 (ZOO FEE 537- /Is — ) 21COMMONWEALTH OF MASSACHUSETTS %4-Z50`( Board of Health,A -MO UTI-;- , MA. DISPOSAL SYSTEM CONSTRUCTION PERMIT Permission is herebygrantedto; Construct( ) Repair( ) Upgrade( -4 -'Abandon( ) an individual sewage disposal system at �Q \ ` \�C� r , l S] C'��� Q�A� as described in the application for Disposal System Construction Permit No. % Q� `� �, dated Provided: Construction shall be completed within th=_yea4 of the date of this per it. All local conditions must be met. c, � i Form 1255 Rev. 5/96 A.M. Sulkin Co. Chadeslown, MA Date �� �/ �� Board o Health , �V / , No.:BOHDGIS-4486 I Commonwealth of Massachusetts Fee 555.00 � Board of Health, Yarmouth, MA ] APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERNIIT I Application for a Permit to:Upgrade-Individual Component(s) Location: 22 MEADOWBROOK RD,WEST YARMOUTH, MA 02673 Owner: i THOMPSON KENNETH E Map/Parcel#: 049.132 THOMPSON DEBRA L 22 MEADOWBROOK RD WEST YARMOUTH,MA 02673 Phone: Septic System Installer Designer INNOVATIVE MEYER&SONS,INC. 17 JAN SEBASTIAN WAY SANDWICH, P.O.BOX 981 MA 02644 EAST SANDWICH,MA 02537 Phone: 508-360-3311 Type of Building:Dwelling Lot Size: 10,454.00 Acres Dwelling-No.of Bedrooms:3 Garbage Grinder: Other Type of Building: No.of persons: Showers: Other F�tures: Ptan Date:09/27/2015 Nurober of Sheets:2 Cafeteria: Title:SEPTIC SYSTEM REPAIR PLAN 22 MEADOWBROOK ROAD Revision Date: Design Flow(min.required):330 gpd Calculated design flow:330 gpd Design flow provided:350 gpd Description of Soi1s:SEE PLAN ' Soil Evaluator Form No.: Name of Soil Evaluator: Date of Evaluation:09/24/2015 DARREN MEYER,R.S. DESCRIPTION OF REPAIRS OR ALTERATIONS:SEPTIC DISPOSAL-REPAIR-EXISTING 1500 GAL SEPTIC TANK,H-20 DBOX, 16 H-20 HIGH CAPACITY INFILTRATORS W/OUT STONE:25'X 11.32'X 11" , 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 Comoliance has heen issued bv the Board of Health. Signed Date Inspections i � � • Commonwealth of Massachusetts Board of Health, Yarmouth, MA Fee DISPOSAL SYSTEM CONSTRUCTION PERMIT ass.00 I Permission is herby granted to; � INNOVATIVE EARTHWORKS, LLC, 17 JAN SEBASTIAN WAY, SANDWICH, MA 02644 ; To perform:Upgrade an individual sewage disposal system. Owner: THOMPSON KENNETH E THOMPSON DEBRA L 22 MEADOWBROOK RD WEST YARMOUTH,MA 02673 Location:22 MEADOWBROOK RD,WEST YARMOUTH,MA 02673 Disposal System Construction Permit No.: BOHDGIS-4486,Dated: October O5,2015 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 1500 GAL SEPTIC TANK, H-20 DBOX, 16 H-20 HIGH CAPACITY INFILTRATORS W/OUT STONE:25'X 11.32'X 11" �V � Bruce G. Murphy, H, R.S., CHO/Amy L.von Hone, R.S.,CHO He Director/Assistant Health Director The issuance of this permit shall not be construed as a guarantee that the system will function as designed. i Commonwealth of Massachusetts Board of Health, Yarmouth, MA Fee ' CERTIFICATE OF COMPLIANCE $55.00 i � � Description of Work:Individual Component(s) , The undersigned hereby certify that the Sewage Disposal System; Upgraded i by:INNOVATIVE EARTHWORKS,LLC � at:22 MEADOWBROOK RD,WEST YARMOUTH,MA 02673 ; 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-15-4486,dated 10/08/2015. � Installer:INNOVATIVE EARTHWORKS,LLC Address:l7 JAN SEBASTIAN WAY SANDWICH,MA Inspector:AMY VON HONE,R.S. i 02644 Designer:MEYER&SONS,INC. V C� 1I Bruce G. y, MPH, R.S., CHO/A y L.von Hone, R.S.,CHO 1 Health Director/Assistant Health Director 1 3 The issuance of this permit shall not be construed as a guarantee that the system will function as designed. I � BOH_Disposal_Construction_CofC.rpt I i 4 I (