HomeMy WebLinkAboutApp-Permit-ComplianceNo.
` I
FEE 4 5'r00
A L -4 QlqK_
Board of Health, Aguo ono , 111A.
c
APPLICATION F®I, DISPOSAL SYSTEM CONSTRUCTION PERMIT
Application for a Permit to Construct( ) Repair( ) Upgrade Abandon() :-,EComplete System ❑ Individual Components
Location 01
Owner's Namey
Map/Parcel# �yJ {�7 /�07
Address
Lot#
Telephone#
Gj �;
Installer's Name /
- Designer's Name
Address �-'
Address��
�r ✓� y
Telephone#
Telephone#
Type of Building Lot Size sq. ft.
Dwelling - No. of Bedroomst - /V .2 Garbage grinder ( )
Other -Type of Building No. of persons Showers ( ) , Cafeteria ( )
Other Fixtures
Design Flow (min. required) d gpd Calculated design flow �33C Design flow provided gPd
Plan: Date Number of sheets Revision Date
Title
Description of Soil(s) _
Soil Evaluator Form No.
DESCRIPTION OF REPAIRS OR ALTERATIONS
Name of Soil Evaluator
r
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 agrees to not to place the system in operatio til a Certificate of Compliance has been issued by the Board of Health.
Signe �i i v Date � /46L7/2! �
Inspections
No. 60&Dc, 15-57-1 FEE
�'l[�'l[®NI.TII ® I�'1[SSCIIII5ETT5
11
Board of Health, A-(111 V1L)LMA MA. '
CERTIFICATE Of COMPLIANCE '� `
Description of Work: ❑ Individual Component(s) Liedomplete System.
The undersigned hereby certify that the Sewage Disposal System; Constructed ( ), Repaired ( )> Upgraded (a; Abandoned ( )
by: �iat
'f
,✓.�:
has been installed in accordance with the rotn�si 1k3I R 13.d�(i tle 5) the approved design plans/as-built plans relating to
application No. 14--2-V), dated ,�%`'`/Z / Approved Design Flow C�(gpd) ,- Cl w,o — - Q-.-1, (;k � � �^
tr J
Installer
Designer: e 4 - 5Z _ Inspector: Date:
The issuance of this permit shall not be con ued as a guarantee that a system will function as designed.
DOUA0-1 a0_C_OL`-OO CIO 00"' 0 C C -0,00000_x- J O 00 O 0000 O o00000000 OOo00000UC O 0000 o0000.00a 000000 DO.O O O 00c:00000o000.0000000..000000000 OOOt_?00000_QO-CO.O-O
No. 1 r 1 c4m � e_ 4 MEV_,t_`f 'AAJ 7_ FEE JSY, 00
COMMONWEALTH OF MASSACHUSETTS C 9f 5S
Board of Health, n l� , MA.
DISPOSAI. SYSTEM[ CONSTRUCTION PERMIT
Permission is hereby granted to; Construct( ) Repair( ) Upgrade(,.' Abandon( ) an individual sewage disposal system
at
Disposal System Construction
Provided: Construction shall be
Form 1255 Rev. 5/96 A.M. Sulkin Co. Charlestown, MA
as described in the application for
No. A�P�_Ddai'a
,pleted within tllx�rs of the date of this pernlit. All local conditions must be met.
Date fj r/Z�_Bl rad of Health A _
i
' No.:BOHDGIS-5298
. 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
I Location: 14 KENNEDY LN,WEST YARMOUTH, MA 02673 Owner:
MUI,LIGAN THOMAS E
Map/Parcel#: 067.291 14 KENNEDY LN
; WEST YARMOUTH,MA 02673
i
� Phone: 5083982116
Septic System Installer
Designer
CHASE&MERCHANT BASS RIVER ENGINEERING
P.O. BOX 5 DENNISPORT, MA 02639 P.O.BOX 1163
Phone:
5083982116 EAST DENNIS,MA 02641
508-3 85-3426
�
I
Type of Building:Dwelling Lot Size: 12,197.00 Sq.Ft.
Dwelling-No.of Bedrooms:2 Garbage Grinder:
Ot6er Type of Buildin : No.of ersons: Showers:
g P
Other Fixtures:
Plan Date:08/15/2015 Number of Sheets: 1 Cafeteria•
- Title:SIT'E PLAN 14 KENNEDY LANE Revision Date:
Design Flow(min.required):220 gpd Calculated design flow:220 gpd Design flow provided:330 gpd
y Description of Soi1s:SEE PLAN
Soil Evaluator Form No.: Name of Soil Evaluator: Date of Evaluation:08/12/2015
THOMAS MCLELLAN,P.E.
DESCRIPTION OF REPAIRS OR ALTERATIONS:SEPTIC DISPOSAL-REPAIR-PROPOSED 1500 GAL SEPTIC TANK,DBOX,3-
500 GAL PRECAST CHAMBERS W/STONE 2.5'SIDES,2'ENDS:2905'X 9.8'X 2'
The undersigned agrees to install the above described Individual Sewage Disposal System in accoMance with the provisions of
TITLE 5 and further aarees nnt to olace in ooeration until a Certi£cate of Comoliance has been issued bv the Board of Health.
Signed Date
Inspections
r
� Commonwealth of Massachusetts
` Board of Health, Yarmouth, MA Fee
DISPOSAL SYSTEM CONSTRUCTION PERMIT $55.00
Permission is herby granted to;
� CHASE&MERCHANT INC., P.O. BOX 5, DENNISPORT,MA 02639
To perform:Upgrade an individual sewage disposal system.
� Owner: MULLIGAN THOMAS E
14 KENNEDY LN
WEST YARMOUTH,MA 02673
Location: 14 KENNEDY LN,WEST YARMOUTH,MA 02673
Disposal System Construction Permit No.: BOHDC-15-5298,Dated:November 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-PROPOSED 1500 GAL SEPTIC TANK, DBOX,3-500 GAL PRECAST
' CHAMBERS W/STONE 2.5'SIDES,2'ENDS:2905'X 9.8'X 2'
v
Bruce G. rp , 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.