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Home My WebLink AboutApp-Permit-ComplianceNo. COMMONWEALTH OF MASSACHUSETTS Board of Health, YA(LM(Ol , MA. FEEt��V T)e# '6 .7o 00 APPLICATION FOR DISPOSAL SYSTEM��N TRUCTI®N PERMIT Application for a Permit to Construct( ) Repair( ) Upgrade Abandon() - Complete System 0 Individual Components Location )- Owner's Name A V) Map/Parcel# ©50, Z Address / l Lot# Telephone# �� G 100 Installer's Name -f Designer's Name Address Address q37 CW S t—v- Telephone#-417 Telephone# Type of Building k � Dwelling - No. of Bedrooms Other - Type of Building _ No. of persons Lot Size sq. ft. _ Garbage grinder ( ) Showers ( ), Cafeteria ( ) Other Fixtures ��pp Design Flow (min. required) V gpd Calculated design flow Design flow provided �% gpd Plan: Date IZ� ��i Number of sheets 1 Revision Date Title Description of Soils) _ Soil Evaluator Form No. Name of Soil Evaluator Date of Evaluation DESCRIPTION OF REPAIRS OR ALTERATIONS I s-oo qlal Hlo Q (Z / b Lm&j4 kea Gh l n Q The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further agre to of to place th !3tem ' o eration until a Certificate of Cox pli ce �as been issued by the Board of health. Signed Date �% Inspections No. C®N][MONWEALT14®F MASSAC14USETTS Board of Health, ) A� CERTIFICATE Of COMPLIANCE Description of Work: 0 Individual Component(s) 0 mplete System FEE r�2 3 G-7 The undersigned hereby certify that the Sewage Disposal System; Constructed ( ), Repaired ( ),,Upgraded ( ), Abandoned ( ) by: / J/— has been inst-IlediiiJ2(eWdaii�e.;vi l��p-oAsions of 3lrCMR 15.00 (Title 5) and the approved design plans/as-built plans relating to application No. dated T—� T� Approved Design Flow (gpd) Installer -,CT bv ot.4 i Z5i A , Designer:`- l _ Inspector:` %/��rr �. �_ Date: :!Z. - L -1 ?. tJuke ( cif >► The issuance of this permit shill not be co ued as a gu p"tee at the system will function as designed. No. -be`ei') C 15-01.36 6-1 GxCiVA-nof FEE�Co COMMONWEALTH Of MASSAC14USETTS Board of Health, , MA. DISPOSAL SYSTEM CONSTRUCTION PERMIT Permission is hereby granted to; Construct( ) Repair( ) Upgrade (/,��bandon( ) an individual sewage disposal system at i'U \ � , r _�_.{_- -1 , : . as described in the application for Disposal System Construction Permit No. ' dated —J Provided: Construction shall be comp%tt dd, `A fhke y' �si&he date of this permit i l local conditions must be met. Form 1255 Rev. 5/96 A.M. Sulkin Co. Chadestown, MA Date 2_, t�$Ua OI I aliri _ i i ;;Z% a � ' No.:BOHDGIS-0136 ' ! Commonwealth of Massachusetts Fee ass.00 Board of Health, Yarmouth, MA APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT i { � Application for a Permit to:Upgrade-Complete System i � Location: 22 SATURN LN, SOUTH YARMOUTH, MA 02664 Owner: I MCAVINNUE ELIZABETH Map/Parcel#• 050.52 19 CHELMSFORD ST APT 114B � CHELMSFORD,MA 01854-1509 Phone: Septic System Installer Designer B&B EXCAVATION DOWN CAPE ENGINEERING,INC. 14 TEABERRY LANE FORESTDALE, 939 ROUTE 6A MA 02644 YARMOUTHPORT,MA 02675 Phone: 508-362-4541 � Type of Building:Dwelling Lot Size: 11,761.00 Acres Dwelling-No.of Bedrooms:4 Garbage Grinder: � I Other Type of Building: No.of persons: Showers: Other Fixtures: Plan Date:06/24/2015 Number of Sheets: 1 Cafeteria: i I Tit1e:TITLE 5 SITE PLAN 22 SATURN LANE Revision Date: Design Flow(min.required):440 gpd Calculated design flow:440 gpd Design tlow provided:476 gpd Description of Soi1s:SEE PLAN Soil Evaluator Form No.: Name of Soil Evaluator: Date of Evaluation:06/24/2015 DAN ' DESCRIPTION OF REPAIRS OR ALTERATIONS:REPAIR-PROPOSED 1500 GAL SEPTIC TANK,DBOX,2 TRENCHES-43'X 3'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 Certificate of Comoliance has been issued bv the Board of Health. Signed Date Inspections i � ; - Commonwealth of Massachusetts Board of Health, Yarmouth, MA Fee ; DISPOSAL SYSTEM CONSTRUCTION PERMIT $55.00 � � I � Permission is herby granted to; i B&B EXCAVATION, 14 TEABERRY LANE, FORESTDALE, MA 02644 To perform:Upgrade an individual sewage disposal system. Owner: MCAVINNUE ELIZABETH 19 CHELMSFORD ST APT 114B CHELMSFORD,MA 01854-1509 Location:22 SATURN LN, SOUTH YARMOUTH,MA 02664 Disposal System Construction Permit No.: BOHDC-15-0136,Dated:July 09,2015 Provided: Construction shall be completed within six months of the date of this permit. All local conditions must be met. Conditions 1. REPAIR-PROPOSED 1500 GAL SEPTIC TANK, DBOX, 2 TRENCHES-43'X 3'X 2' 2.MFC VARIANCE APPROVAL:a. SETBACKS J� / � ��C� Bruce G. Mu y, PH, R.S., CHO/Amy L.von Hone, R.S., CHO ealth Director/Assistant Heaith 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 F� CERTIFICATE OF COMPLIANCE ass.00 Description of Work:Complete System The undersigned hereby certify that the Sewage Disposal System; Upgraded by:B&B EXCAVATION at:22 SATURN LN,SOUTH YARMOUTH,MA 02664 Has been installed in accardance with the provisions of 310 CMR 15.00(Title 5)and the approved design plans or as-built plans relating to application No.: BOHDC-15-0136,dated 07/27/2015. Installer:B&B EXCAVATION Address:l4 TEABERRY LANE FORESTDALE,MA Inspector:AMY VON HONE,R.S. 02644 Designer:DOWN CAPE ENGINEERING,INC. Conditions 1.REPAIR-PROPOSED 1500 GAL SEPTIC TANK,DBOX,2 TRENCHES-43'X 3'X 2' 2.MFC VARIANCE APPROVAL: a.SETBACKS : Bruce G. M h ,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. BOH_Disposal_Construction_CofC.rpt f i