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App-Permit-Compliance
3 liz - ► S 0051-0 a t ' . y� �/ V i1C7 5 {�I `� ©at FEE �. Y rrte(? N i�6 G 15-2✓LF�l� '7r COMMONWEALTH Of MASSACHUSETTS f -�ncvOM �. r Board o Health, , APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT plication for a Permit to Construct( Repair( Upgrade Abandon( ❑ Complete System idividual Components Location V i, l iq e- Owner's Name 7 -OAA flj (Z%1 Map/Parcel# Address Lot# -3 Telephone# a Installer's Name JGC� Q C "� L Designer's Name C- P?,P—)nl Address �j �� `1 V� _ Address Telephone# Telephone# Type of Building Dwelling - No. of Bedrooms Other - Type of Building _ Other Fixtures Design Flow (min. rAL uired) '��j� gpd Calculated design flow Plan: Date r' F Number of sheets Title Description of Soil(s) _ Soil Evaluator Form No. Name of Soil Evaluator No. of persons Lot Size � � OL 0 sq. ft. Garbage grinder ( ) Showers ( ), Cafeteria ( ) Design flow provided Revision Date .lam Date of Evaluation gpd DESCRIPTION OF REPAIRS OR ALTERATIONS Z AS1'Q)'i N 2LJ Z' -10D VL, ( 500 (�!� d CAIQ .� I" be -j o� (L The undersigned agrees to install the ab,94,e described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further agrees to not to plac a cyst operation until a Certificate of Compliance has been issued by the Board of Health. Signed Date Inspections No. tJQqj)C "'c!,"'Z0(4 -7 FEE �'� CMCJ C®MM®�l��,T� OF M�4SSAC�USETTS 6-703 Board of Health, M 0 071 ' 'MA. / / CERTIFICATE OF COMPLIANCE Description of Work: 111fidividual Component(s) ❑ Complete System The undersigned hereb/y certify that the Sewage Disposal System; Constructed ( ), Repaired ( ), Upgraded (Abandoned ( ) by: P-0E�eT' & (a)(z. Co. INC , at 77 \1ILLA L;Ej has been installed Iii aordance with the provisions of 310 CMR 15.00 (Title 5) and the approved design plans/as-built plans relating to application No. /�-� -�� dated .Approved Design Flow ?' 7 (gpd) Installer Designer: 61\!& V_d oyL t-:�,Y-a(1�eyte\1ll inspector: lse. V'.! Date: The issuance of this permit shall not be construed as a guarantee that the system will function as designed. COMMONWEALTH OF MASSAC14USETTS Board of Health, YKaMD ()IR , MA. DISPOSAL SYSTEM CONSTRUCTION PERMIT FEE 06 _ ckji— 0 Permission is hereby granted to; Construct( ) Repair( ) Upgrade (A Abandon( ) an individual sewage disposal system at I LA_AG4--- LAN)�5 as described in the application for Disposal System Construction Permit No. dated >^ -/ � -301,1: � S 7 Provided: Construction shall be completed within thus -of the date of this permit: ,,AllAlocal con itipas must be met. _ Lf Form 1255 Rev. 5/96 A.M. Sulkin Co. Chadeslawn, MA Date "' 1 Icy-/CBoard of Health i ' No.:BOHDC-15-2047 � ' Commonwealth of Massachusetts Fee I ass.00 � � Board of Health, Yarmouth, MA I APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to:Upgrade-Individual Component(s) Location: 7 VILLAGE LN,YARMOUTH, MA 02675 Owner: MARTIN THOMAS J Map/Parcel#: 124.15 MARTIN JANICE C 7 VILLAGE LN YARMOUTH PORT,MA 02675-1944 Phone: Septic System Installer Designer ROBERT B.OUR BASS RIVER ENGINEERING P.O. BOX 1539 HARWICH, MA 02643 P.O.BOX 1163 Phone: EAST DENNIS,MA 02641 (5081385-3426 Type of Building:Dwelling Lot Size: 11,325.60 Acres Dwelling-No.of Bedrooms:3 Garbage Grinder: Other Type of Building: No.of persons: Showers: Other Fixtures: Plan Date:04/27/2015 Number of Sheets: 1 Cafeteria: ' Tit1e:SIT'E PLAN 7 VILLAGE LANE Revision Date: Design Flow(min.required):330 gpd Calculated design tiow:330 gpd Design flow provided:349 gpd Description of Soi1s:SEE PLAN Soil Evaluator Form No.: Name of Soil Evaluator: Date of Evaluation:04/15/2015 THOMAS MCLELLAN,P.E. . DESCRIPTION OF REPAIRS OR ALTERATIONS:REPAIR-EXISTING 1000 GAL SEPTIC TANK,DBOX,2-500 GAL PRECAST H-20 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 further aarees not to olace in ooeration until a Certificate of Comoliance has been issued bv the Board of Health. Signed Date Inspections � � , � � Commonwealth of Massachusetts Board of Health, Yarmouth, MA Fee DISPOSAL SYSTEM CONSTRUCTION PERMIT sss.00 Permission is herby granted to; ROBERT B. OUR COMPANY INC., P.O. BOX 1539, HARWICH, MA 02643 To perform:Upgrade an individual sewage disposal system. Owner: MARTIN THOMAS J MARTIN JANICE C 7 VILLAGE LN YARMOUTH PORT,MA 02675-1944 Location: 7 VILLAGE LN,YARMOUTH,MA 02675 Disposal System Construction Permit No.: BOHDC-15-2047,Dated: May 19,2015 Provided:Construction shali be completed within six months of the date of this permit. All local conditions must be met. Conditions 1.MFC VARIANCE: 1. DEPTH OF LEACH FACILITY 2. REPAIR-EXISTING 1000 GAL SEPTIC TANK, DBOX, 2-S00 GAL PRECAST H-20 CHAMBERS W/ 4'STONE:25'X 12.83'X 2' Bruce G. Mu y, PH, R.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. j i