HomeMy WebLinkAboutApp-Permit-ComplianceNo. RDC— 19`' 1 o �la' 1� -i 6- FEE
COMMONS LT14 OF MASSAC14USETTS 2,0 1
Board of Health, Pn%yi , NlEl. Al
APPLICATI®N FOR DISPOSAL SYSTEM[ ONSTRUCTI®N �RMIT
Application for a Permit to Construct( ) Repair( /upgrade( ) Abandon(7— ❑ Complete System Individual Components
Location
C il:)'j (�
Owner's Name
Map/Parcel#
Address
Lot#
Telephone#
Installer's Name �°„ �� CCA 5�'iC .}?< (°
Designer's Name
Address
, o ' $vK14�6aw
i 4, oq�,
Address
Telephone#
.5 L g - 7N00
Telephone#
Type of Building 14 5 Lot'size sq. ft.
Dwelling - No. of Bedrooms Z- Garbage grinder ( )
Other - Type of Building No. of persons Showers ( ) , Cafeteria ( )
Other Fixtures
Design Flow (min. required) Zy� gpd Calculated design flow Design flow provided s% v 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
Date of Evaluation
The undersign ees to install th above described In*vidual Sewage Disposal System in accordance with the provisions of TITLE 5 and
further agre o of top ce the eration until a Certificate of Compliance has been issued by the Board of Health.
Signed Date
Inspections
a
No. �p�'SPI �7J�H i FEE
COMM ONWEAI.TII OF MIASSACHUSETTS ow �. .- ��� 1
Board of Health, �� ,4�
CERTIFICATE Of COMPLIANCE
Description of Work: Li Individual Component(s) ❑ Complete System
The undersigned hereby certify that the Sewage Disposal Syst m; Constructed ( ), Repaired (V,Upgraded ( ), Abandoned 041
.Cid E' ����` �.v�; V. `Fe
by: � f
at14
'S�.,1� 1t
has been installed in ac�c._o-�r77 an ce with the provision of 3]_Q. CMR 15.00 (Title 5) and the approved design plans/as-built plans relating to
application No. �{7 6� , dated J- Approved Design Flow} (gpd)
Installer�(Cr^.(,�•
Designer: s. -AS (tiel Inspector: Date:
The issuance of this permit shall not be construed as a guarantee that the system will function as designed.
-. No. {� y �-�. � '" 101 Sv11-7 C;w. l ^oo Ser. Tir.. g N Sp" FEE 3
COMMON L114 Of MASSACHUSETTS
Board of Health, Y��V t T� , MA.
DISPOSAL SYSTEM �CONSTRUCTI®N PERM, IT
Permission is hereby granted to; Construct Repair() Upgrade ( ) Abandon (✓) an individual sewage disposal system
at ' i ��'� t ( as described in the application for
Disposal System Construction Permit No. dated
/-�
Provided: Construction shall be completed within dffee-years of the date of this permiX., All local condi, 'ons must be met.
-.'�-- ,
Form 1255 Rev. 5/96 A.M. Sulkin Co. Charlestown, MA Date fG / � 5Board of Health
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i
No.:BOHDGIS-6186 �
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: 40 DEBS HILL RD 3B,YARMOUTH PORT, MA 02675 Owner:
LOWENTHAL ARLINE TR '
Maq/Parcel#: 108.43C3B TI�ARILINE LOWENTHAL TRUST
Lot#: C36 40 DEBS HILL RD iJNIT 3B :
YARMOUTH PORT,MA 02675-2530 '
Phone:
Septic System Installer Designer
BEFORE SUNSET LLC
P.O. BOX 1466 HARWICH, MA 02645
Phone: '
5082402500
`
Type of Building:Dwelling Lot Size:0.00 Sq.Ft.
Dwelling-No.of Bedrooms:2 Garbage Grinder: ';
i
Other Type of Building:CONDOMINIUM No.of persons: Showers: i
Other Fiatures:
Plan Date: Number of Sheets: Cafeteria• '
• i
Title: Revision Date: !
„ Design Flow(min.required):220 gpd Calculated design flow:220 gpd Design flow provided:220 gpd
Description of Soils: '
. Soil Evaluator Form No.: Name of Soil Evaluator: Date of Evaluation:
DESCRIPTION OF REPAIRS OR ALTERATIONS:SEPTIC DISPOSAL-MINOR REPAIR-PROPOSED PLASTIC 1500 GAL SEPTIC
TANK,DBOX TO EXISTING 6'X 8'LEACH PIT
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 oueration 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 555.00
Permission is herby granted to;
BEFORE SUNSET LLC, P.O. BOX 1466, HARWICH, MA 02645
To perform:Upgrade an individual sewage disposal system.
Owner: LOWENTHAL ARLINE TR
THE ARILINE LOWENTHAL TRUST
40 DEBS HILL RD UNIT 3B
YARMOUTH PORT,MA 02675-2530
Location:40 DEBS HILL RD UNIT 3B,YARMOUTH PORT,MA 02675
Disposal System Construction Permit No.: BOHDGIS-6186,Dated:December 14,2015
Provided:Construction shall be completed within six months of the date of this permit. All local conditions must be met.
CONDITIONS:
SEPTIC DISPOSAL-MINOR REPAIR-PROPOSED PLASTIC 1500 GAL SEPTIC TANK, DBOX TO EXISTING 6' '
X 8'LEACH PIT
Bruce G. Murp ,M , R.S., CHO/Amy L.von Hone, R.S., CHO
alth Director/Assistant Health Director
The issuance of this permit shall not be construed as a guarantee that the system will function as designed.