HomeMy WebLinkAboutApp-Permit-ComplianceNo. t3� I�1�C-� I e —4 LA � %� FEE S�rOO
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?-,,,,*,,APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT
Application for a Permit to Construct( ) Repair (If, Upgrade( ) Abandon( - ❑ Complete System f -t ividual Components
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Location 110� loe Ae:)
Owner'sf-
Map/Parcel# t ,0 �!� �,yj��i
AddressJrtr
Lot#
Telephone# c.�-
Installer's Namel� ,0;7/ `E%��"
Designer's Nam ,W-:�7
Address e3
Address
Telephone# d�
Telephone# cr;O .5'06�7
Type of Building C;e
Dwelling - No. of Bedrooms
Other - Type of Building
No. of persons
Lot Size
sq. ft.
Garbage grinder ( )
Showers ( ), Cafeteria ( )
Other Fixtures
Design Flow (min. required)® gpd Calculated design flow Design flow provided z�R gpd
Plan: Date oZ �`'�-�� Number of sheets ooO� Revision Date
Title
Description of Soil(s) _
Soil Evaluator Form No.
Name of Soil Evaluator
DESCRIPTION OF REPAIRS OR ALTERATIONS
Date of Evaluation
The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and
further agr not to place the system in operation until a Certificate of Compliance has been issued by the Board of Health.
Signed lszz Date
Inspections
No. 150k�"Df-' (c7"�� L� j.FEE ��
�®MM®NIT/�I�l�� MASSACHUSETTS
of Health,/ myT� " �, MA. c14 3131, /
CERTIFICATE Of COMPLIANCE % 61V 5 40al
Description of Work.' A Individual Component(s) ❑ Complete System
The undersigned hereby certify that the Sewage Disposal System; Constructed ( ), Repaired e,'Upgraded( ), Abandoned ( )
at .�d� alp' F./V �iVI'p `/�' ' ✓'j
has been installed m accordance with t erovisions of 3t1t9-CMR 15.00 (Title 5) and the approved design plans/as-built plans relating to
application No. �S �/ ,dated r� �l Approved Design Flow(gpd)
Installer,�J�rW •'e'e�,�® �i�.r !'1
Designer: 40-10"`10 ems% ol" XV' Inspector: Y®)l y yVl Date:
The issuance of this permit shall not be construed as a guarantee that.the system will function as designed.
No. 13olt�C–t$-��z� V ttM � PU1G�F FEE 00
COMMONWEALTH OF MASSACHUSETTS c #-3 8((o
Board of Health, MA.
DISPOSAL SYSTEM[ CONSTRUCTION PERMIT
Permission is hereb granted to; Construct( j Repair( Upgrade ( ) Abandon ( ) an individual sewage disposal system
at -/e,�'�,��i'1��" � • P as described in the application for
Disposal System Construction Permit No. / ��, dated
Provided: Construction shall be complete d within gars of the date of this permit. All local condi' s must be met.
Form 1255 Rev. 5/96 A.M. Sulkin Co. Chale awn, MA D to 1 ! Board of Health
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No.:BOHDC-15-4423
• Commonwealth of Massachusetts Fee
$55.00
Board of Health, Yarmouth, MA
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT
Application for a Permit to:Upgrade-Individual Component(s)
Location: 16 VENUS RD, SOUTH YARMOUTH, MA 02664 Owner:
WILLIAMS COURTNEY E
Map/Parcel#: 050.70 WILLIAMS ANTHONY J
16 VENIJS RD
SOUTH YARMOUTH,MA 02664
Phone:
Septic System Installer Designer
JIM LEBOEUF SEPTIC DAVID B.MASON,R.S.
55 BODICK ROAD HYANNIS, MA 02601 4 GLACIER PATH
Phone: EAST SANDWICH,MA 02537
508-833-2177
Type of Building:Dwelling Lot Size:8,712.00 Acres
Dwelling-No.of Bedrooms:3 Garbage Grinder:
Other Type of Building: No.of persons: Showers:
Other Fixtures:
Plan Date:08/27/2015 Number of Sheets: 1
Cafeteria:
Tit1e:SITE&SEWAGE PLAN 16 VENiJS ROAD Revision Date:09/21/2015
Design Flow(min.required):330 gpd Calculated design flow:330 gpd Design flow provided:349 gpd
Description of Soils:SEE PLAN
Soil Evaluator Form No.: Name of Soil Evaluator: Date of Evatuation:08/26/2015
DAVID B.MASON,R.S.
� DESCRIPTION OF REPAIRS OR ALTERATIONS:SEPTIC DISPOSAL-REPAIR-EXISTING 1000 GAL SEPTIC TANK,DBOX,2-500
GAL PRECAST CHAMBERS W/4'STONE:25'X 12.83'X 2'
, The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of
TITLE 5 and furtner aarees not to olace in ooeration until a Certificate of Comoliance has heen issued bv the Board of Heakh.
Signed Date
Inspections
,'
.
Commonwealth of Massachusetts
' Board of Health, Yarmouth, MA Fee
DISPOSAL SYSTEM CONSTRUCTION PERMIT 555.00
� Permission is herby granted to;
; JIM LEBOEUF SEPTIC SERVICE, 55 BODICK ROAD, HYANNIS, MA 02601
To perform:Upgrade an individual sewage disposal system.
Owner: WILLIAMS COURTNEY E
WILLIAMS ANTHONY J
16 VENiJS RD
SOUTH YARMOUTH,MA 02664
�
Location: 16 VENUS RD,SOUTH YARMOUTH,MA 02664
Disposal System Construction Permit No.: BOHDC-15-4423,Dated: September 24,2015
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, DBOX,2-500 GAL PRECAST
CHAMBERS W/4'STONE:25'X 12.83'X 2'
2. BOH TO INSPECT REMOVAL OF FAILED LEACH FACILITY SOILS WITHIN 5'OF P POSED SYSTEM
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Bruce G. Murp ,M H, .S., CHO!Amy L.von Hone, R.S.,CHO
ealth Director/Assistant Health Director
The issuance of this permit shall not be construed as a guarantee that the system will function as designed.
.
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i
' Commonwealth of Massachusetts
Board of Health, Yarmouth, MA Fee
CERTIFICATE OF COMPLIANCE $55.00
Description of Work:Individual Component(s)
The undersigned hereby certify that the Sewage Disposal System; Upgraded
by:JIM LEBOEUF SEPTIC SERVICE
at: 16 VENUS 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-15-4423,dated 09/25/2015.
Installer:JIM LEBOEUF SEPTIC SERVICE
Address:55 BODICK ROAD HYANNIS,MA 02601 Inspector:BRUCE MURPHY,R.S.
Designer:DAVID B.MASON,R.S.
' ��
B�Gce G. Murphy,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