HomeMy WebLinkAboutApp-Permit-ComplianceNo. o � pc � 1 i J ! -Tver'q � (70C FEE
COMMONWEALTH LTH ®f MASSACHUSETTS
Board of Health, AfLM D 07* , MA.
APPLICATION FOP, DISPOSAL SYSTEM ��N TRUCTI®N PERMIT
Application for a Permit to Construct( ) Repair( ) Upgrade)/) Abandon() - Complete System ❑Individual Components
Location / ��
Map/Parcel#
Owner's Nam
Address
4/2 e, -T-"!
Lot#
Telephone#
Installer's Namee- - �� ,� m
Designer's Name
acw-G
Address `� r
Address
Telephone#
Telephone#
Type of Building �� . L , Lot Size/ 744sq. ft.
Dwelling - No. of Bedrooms-' Garbage grinder ( )
Other -Type of Building No. of persons Showers ( ), Cafet 'a ( )
Other Fixtures ,�
11
Design Flow ( in. required) %�� gpd Calculated design flow �Z� Design flow provided gpd
Plan: Dat s Number of sheets / Revision Date
Title
Description of Soils)
Soil Evaluator Form No. Name of Soil Evaluator Date of Evaluation
DESCRIPTION OF REPAIRS OR ALTERATIONS ,�/.�4/
The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and
further agr s t of top ce the in in operation until a Certificate of C mpliance has been issued by the Board of Health.
Signed Date
Inspections
No. 'tr
FEE
COMMONWEALTH OF MASSACHUSETTS CASO
Board of Health, YA&d D 01k 111,M. -7
CERTIFICATE Of COMPLIANCE
Description of Work: ❑ Individual Components)JQ omplete System
The and signed hereby certify that the Sewage Disposal System; Constructed ( ), Repaired ( ), Upgraded ), Abandoned (
by: C • �7
at // `
�h e/� .-t L
has been installed ` cor a c th th'�pto sions of 310 CMR 15.00 (Title 5) and the. approved design plans/as-built plans relating to
application Nr�_ -� dated 1 --2-9. Approved De 'gn Flow (gpd)
Installer . L'• TZ/�/f+r Y
Designer: i�ditf %iJG Inspector: Date: 16 "6
The issuance of this permit shall not be construed as a guar ee that the system will function as designed.
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COMMONWEALTH Of MIASSAC14USETTS
Board of Health, — YAJJ 0 t Mk- , MA..
DISPOSAL SYSTEM CONSTRUCTION PERMIT 373/
Permission is hereby granted to; Construct( ) Repair( ) Upgrade�<) Abandon( ) an indii tdual sewage disposal system
at �/%1 �% G as described in the application for
Disposal System Construction Permit No. r �.� dated 7
Provided: Construction shall be come�'d"within tiree ye /the date of this permit. Al cal conditions r st be met.
Form 1255 Rev. 5/96 A.M. Sulkin Co. Chadeslown, MA Date 7 "�i Board of Health t .
L
No.:BOHDC-15-4481
Commonwealth of Massachusetts Fee
$55.00
Board of Health, Yarmouth, MA
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT
Application for a Permit to:Upgrade-Complete System
Location: 8 WIDGEON LN,WEST YARMOUTH, MA 02673 Owner:
WEISS ANNE LIFE EST
Map/Parcel#:058.307 8 WIDGEON LN
WEST YARMOUTH,MA 02673
Phone:
Septic System Installer Designer
R.E.LARRIMORE DOWN CAPE ENGINEERING.INC.
112 MAIN STREET HARWICH, MA 939 ROUTE 6A
02645 YARMOUTHPORT,MA 02675
Phone: 508-362-4541
Type of Building:Dwelling Lot Size: 10,890.00 Acres '
Dwelling-No.of Bedrooms:2 Garbage Grinder: ;'
Other Type of Building: No.of persons: Showers:
Other Fixtures:
Plan Date:08/28/2015 Number of Sheets: 1 Cafeteria•
Tit1e:TITLE 5 SITE PLAN 8 WIDGEON LANE Revision Date: '
Design Flow(min.required):220 gpd Calculated design flow:220 gpd Design flow provided:349 gpd
Description of Soi1s:SEE PLAN
Soil Evaluator Form No.: Name of Soil Evaluator: Date of Evaluation:08/26/2015
DANIEL GONSALVES,SE
DESCRIPTION OF REPAIRS OR ALTERATIONS:SEPTIC DISPOSAL-REPAIR-PROPOSED 1500 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 further aarees not to olace in ooeration until a Certificate of Comuliance has been issued bv the Board of Heakh.
Signed Date
Inspections
I
I
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� Commonwealth of Massachusetts
Board of Health, Yarmouth, MA Fee
DISPOSAL SYSTEM CONSTRUCTION PERMIT sss.00 ;
Permission is herby granted to;
R.E. LARRIMORE, 112 MAIN STREET, HARWICH, MA 02645
To perform:Upgrade an individual sewage disposal system.
Owner: WEISS ANNE LIFE EST
8 WIDGEON LN
WEST YARMOUTH,MA 02673
Location: 8 WIDGEON LN,WEST YARMOUTH,MA 02673
Disposal System Construction Permit No.: BOHDC-15-4481 ,Dated: September 29,2015
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-PROPOSED 1500 GAL SEPTIC TANK, DBOX,2-500 GAL PRECAST
CHAMBERS W/4'STONE:25'X 12.83'X 2'
Bruce G. Murph , M , R.3., CHO/Amy L.von Hone, R.S., CHO
H Ith 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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Commonwealth of Massachusetts
Board of Health, Yarmouth, MA Fee
CERTIFICATE OF COMPLIANCE S55.00
Description of Work:Complete System
The undersigned hereby certify that the Sewage Disposal System; Upgraded
by:R.E.LARRIMORE '
at: 8 WIDGEON LN,WEST YARMOUTH,MA 02673 '
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-15-4481,dated 10/06/2015.
Installer:R.E.LARRIMORE
Address:112 MAIN STREET HARWICH,MA 02645 Inspector:AMY VON HONE,R.S.
Designer:DOWN CAPE ENGINEERING,INC. '
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�
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. '
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