HomeMy WebLinkAboutApp-Permit-ComplianceNo. $oWDC-15 J 13S ii`"QFEE j 00
COMMONWEALTH Of MASSACHUSETTS
Board of Health, MA.
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AFFLJILAIWIN 1 -UH. lU►;7NF'l1ZAL NYMEM LIJINZ51RULIIUIN FEi IVIII
pplicatiori for a Permit to Construct( Repair( Upgrade,(/AbandonO - ❑ Complete System ndividual Components
Location
Owner's Name j
Map/Parcel#
Address
cla V4
Lot# '
Telephone#
Installer's Name „)
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Designer's Name
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Address
Address L{I
Telephone*
Telephone#
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Type of Building 1 Lot Size '� sq. ft.
Dwelling - No. of Bedrooms Garbage grinder( )
Other - Type of Building No. of persons Showers ( ), Cafeteria ( )
Other Fixtures
Design Flow (minregquii end)) � gpd Calculated design
• flowPlan: Date --� `��e 1 1�-- Number of sheets i Fvtk
Title
Description of Soil (s) _
Soil Evaluator Form No.
Design flow provided gpd
Revision Date
The undersigned a es to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and
further agr s o o place the system in operation until a Certificate o Compliance has been issued by the Board of Health.
Signed Date
Inspections
No. 8014 COMMONWEALTH OF MASSACHUSETTS/Gzzo
Board of Health, � 8 , MA. 2 •
CERTIFICATE OF COMPLIANCE
Description of Work: O4"dividual Component(s) ❑ Complete System
The un igned hereby y that the Sewage Disposal System; Constructed ( ), Repaired e/upgraded ( ), Abandoned ( )
by: d��\� A f 5 c -o G-
at pp
has been installed irfc o dan :e wit the ovisi , of 310 CMR 15.00 (Title 5) and the approved design plans/as-built plans relating to
application No. dated;. p Approved Design Flow (gpd)
Installer�''�� r _rte
Designer:. nspector: Date:
The issuance of this permit shall n t be construed a guarantee that the system will function as designed.
No. �15io♦ C —1 3� A f 5 FEE
COMMONWEALTH OF MASSACHUSETTS
Board (f Health, V" M 1) Y }� , MA.
DISPOSAL SYSTEM CONSTRUCTION PERMIT
Permission is hereby granted to; Construct( ) Repair( ) Upgradep Abandon( ) an individual sewage disposal system
at ZZ S V I iZ 1 12-01Q as described in the application for
Disposal System Construction Permit No. 2k 3, dated 12 _ `l- //(j�
Provided: Construction shall be coi5lpyeted within of the date of this permit. All local condi 'ons must be met.
Form 1255 Rev, 5/96 A.M. Sulkin Co. Chadeslown, MA Date - oafd of Health -
No.:BOHDC-15-5933
� Commonwealth of Massachusetts Fee
ass.ao
Board of Health, Yarmouth, MA
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT
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Application for a Permit to:Upgrade-Individual Component(s)
Location: 22 SQUIRREL RUN,YARMOUTH PORT, MA 02675 Owner:
SPARKS LILLIAN
Map/Parcel#: 123J3 22 SQUIRREL RiJN
YARMOUTH PORT,MA 02675-1834
Phone:
Septic System Installer Designer
A&S CONSTRUCTION MORAN ENGINEERING ASSOC.,LLC
P.O. BOX 1396 ORLEANS, MA 02653 941 ROUTE 28
Phone: HARWICH,MA 02645
5082463068 508-432-2878
Type of Building:Dwelling Lot Size: 13,939.00 Sq.Ft.
Dwelling-No.of Bedrooms:2 Garbage Grinder:
Other Type of Building: No.of persons: Showers:
Other Fistures:
Plan Date: 10/30/2015 Number of 56eets:2 Cafeteria•
Tit1e:SEPTIC SYSTEM DESIGN PLAN 22 SQUIRREL Ri1N Revision Date:
• Design Flow(min.required):220 gpd Calculated design flow:220 gpd Design flow provided:347 gpd
Description of Soils:SEE PLAN
' Soil Evaluator Form No.: Name of Soil Evaluator: Date of Evaluation: 10/29/2015 :
RICK NDD,R.S.
DESCRIPTION OF REPAIRS OR ALTERATIONS:SEPTIC DISPOSAL-REPAIR-EXISTING 1000 GAL SEPTIC TANK,PROPOSED
DBOX,2-500 GAL PRECAST CHAMBERS W/4'STONE:25'X 12.8'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 Heakh.
Signed Date
Inspections
, Commonwealth of Massachusetts
Board of Health, Yarmouth, MA Fee
DISPOSAL SYSTEM CONSTRUCTION PERMIT S55.00
Permission is herby granted to;
A&S CONSTRUCTION, P.O. BOX 1396, ORLEANS, MA 02653
To perform:Upgrade an individual sewage disposal system.
Owner: SPARKS LILLIAN
22 SQUIRREL RLJN
YARMOUTH PORT,MA 02675-1834
Location:22 SQUIRREL RLTN,YARMOUTH PORT,MA 02675 i
Disposal System Construction Permit No.: BOHDC-15-5933,Dated:December 04,2015 ;
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 1000 GAL SEPTIC TANK, PROPOSED DBOX,2-500 GAL j
PRECAST CHAMBERS W/4'STONE:25'X 12.8'X 2' �
2. BOH AND ENGINEER TO INSPECT SOIL REMOVAL AND FINAL INSTALLATION �
� i
�� �
Bruce G. Mu hy, PH, R.S., CHO/Amy L.von Hone, R.S.,CHO �
ealth Director/Assistant Health Director
i
The issuance of this permit shall not be construed as a guarantee that the system will function as designed.
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