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Home My WebLink AboutApp-Permit-ComplianceNo. e)0WDc_ t,5— FEE ZC C®NINI® I.TH I NI SSXCI1IJ TTS Board of Health, LA-je_ 0Q -n4 , MA. APPLICATION FOR DISPOSAL SYSTEM[ CONSTRUCTION PERMI1 Application for a Permit to Construct( ) Repairk-l'-Upgrade( ) Abandon( ) - ❑ Complete System Olidividual Components Location Owner's Name Map/Parcel# S_4kr L/ Address Lot# Telephone# Installer's Name Jr qCI eewj Designer's Name Address 7 f/ �� r dress Telephone# 0'2 0," 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) _ Soil Evaluator Form No, gpd Calculated design flow Number of sheets Name of Soil Evaluator DESCRIPTION OF REPAIRS OR ALTERATIONS .1--k I sq. ft. Garbage grinder ( ) Showers ( ), Cafeteria ( ) Design flow provided Revision Date Date of Evaluation 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 t lace th tem in operation until a Certificate of Compliance has been issued by the Board of Health. Signed Date InspectionsI r' k�� e <,& i Tit, 1, No. 601+1. c 11584 st d 00 COMMONWEALTH OF MASSACHUSETTS dA(a00.o Board of Health, Yui e mo_0 7N , MA. CERTIFICATE Of COMPLIANCE r�k, Description of Work: ❑ Individual Component(s) ❑ Complete System The undersigned hereb certify that the Sewage Disposal Systemonsnucted ( ),RepairedUpgraded ( ),Abandoned( ) by: at', has been installEd' i aceordai e with' a provisions of 310 CMR 15.00 (Title 5) and the app ved design plans/as-built plans relating to application No. dated 4 4-9 / 1i. Approved Design Flow (gpd) Installer Zoe t4A-,2--n N 5 Designer: "` Inspector: //eeC Z �� Dater The issuance of this permit shall not be construed as a guaradfee that the system will function as designed. ,- ., I'll Its —r (�,... ,. �, ;>*-o .> �, , o �� No.'E "ir CG1J FEE 5� COMMONWEALTH LTH ®E MASSACHUSETTS ck -- �6 so Board of Health, _TA9=tM n (Mi, MA. .r ➢DISE®SAI. SYSTEM[ CONSTRUCTION PERMIT Permission is herebygranted to; Construct( ) Repair( Upgrade( ) Abandon( ) an individual sewage disposal system at 6 �2 � V 1 Oki j/� as described in the application for Disposal System Construction Permit No. dated �_ -41 /r Provided: Construction shall be completed within three cArs.of the date of this permit. All local conditions must be met. Form 1255 Rev. 5/96 A.M. Sulkin Co. Chadeslown, MA Date Board of Health 1_9 '— r � i � No.:BOHDC-15-1584 Commonwealth of Massachusetts F� $55.00 Board of Health, Yarmouth, MA APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERNIIT Application for a Permit to:Repair-minor-Individual Component(s) Location: 83 SEAVIEW AVE, SOUTH YARMOUTH, MA 02664 Owner: JAY STEVEN L Map/Parcel#:025.80 JAY ROBIN M 465 COMMERCE DR FORT WASHINGTON,PA 19034 Phone: Septic System Installer Designer ACCU SEPCHECK 17 NORTHSIDE DRIVE SOUTH DENNIS, MA 02660 Phone: Type of Building:Dwelling Lot Size:6,969.60 Acres Dwelling-No.of Bedrooms: Garbage Grinder• Other Type of Building: No.of persons: S6owers: 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 SATTITARY TEE AND DBOX WITH RISER PER INSPECTION REPORT BY ACCUSEPCHECK 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�lace in ooeration until a Certificate of Comoliance 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 ass.00 Permission is herby granted to; ACCU SEPCHECK, 17 NORTHSIDE DRIVE, SOUTH DENNIS, MA 02660 To perform:Repair-minor an individual sewage disposal system. Owner: JAY STEVEN L JAY ROBIN M 465 COMMERCE DR FORT WASHINGTON,PA 19034 Location: 83 SEAVIEW AVE, SOUTH YARMOUTH,MA 02664 Disposal System Construction Permit No.: BOHDGIS-1584,Dated:Apri106,2015 Provided:Construction shall be completed within six months of the date of this permit. All local conditions must be met. Conditions I.SEPTIC DISPOSAL-MINOR REPAIR-REPLACE SANITARY TEE AND DBOX WITH RISER PER INSPECTION REPORT BYACCUSEPCHECK C� Bruce G. 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 that the system will function as designed.