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HomeMy WebLinkAboutBOHDC-20-4923 Commonwealth of Massachusetts Board of Health, Yarmouth, MA Fee CERTIFICATE OF COMPLIANCE $55.00 Description of Work: Replace DBox& Install Outlet Tee The undersigned hereby certify that the Sewage Disposal System; Repair-minor by: ACCU SEPCHECK at: 30 NAUSET RD, 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-20-4923, dated 01/28/2022. Installer: ACCU SEPCHECK Address:17 NORTHSIDE DRIVE SOUTH DENNIS, MA Inspector: 02660 Designer: NA Bruce G. Murphy, MPH, R.S., CHO Health Director The issuance of this permit shall not be construed as a guarantee that the system will function as designed. S r am( � DP6DX 0►`l�y No.i�� ' A2-3 FEE ✓ 'LO -III COMMONWEALTH OF MASSACHUSETTS 0/4 $ 1 Board of Health, Yarmouth,MA APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to Construct()Repair XUpgrade()Abandon()-0 Complete System Individual Components 30 e € lit.) • Owner's Name As 1 C/b 'P , , lot I Location �� Map/Parcel# 99 Address JQ�aezve f s)eT iltde 6re.AV/- Lot# Ite) Telephone#40 9 0 l b 1'f Q 2434 Installer's Name,foeMay. 1.i.$ 1 At Se fetiect . Designer's Name Address 11-1004Siele bil.. S:D2441.1 0 266 D Address /1/41it Telephone# .SDP.3.05..:FEg,�I Telephone# \��..Type of Building . iN"� Lot Size ©, 0 .4 - Dwelling-No.of Bedrooms_ a -dam-QeSirh _ Garbage grinder( ) Other-Type of Building _No.of persons Showers(),Cafeteria() Other Fixtures Design Flow(min.required) _gpd Calculated design flow_ Design flow provided_ ___gpd Plan: Date Number of sheets Revision Date Title Description of Soil(s) Soil Evaluator Form No. Name of Soil Evaluator Date of Evaluation DESCRIPTION OF REPAIRS OR ALTERATIONSR 1)LS(aLt 1u Oct &* ),J-�ns+4,1 Ocrtle-F&Q .The undersigned agrees to install the above described Individual Sewage Disposal Syst 'n accordance with the provisions of TITLE 5 and further agrees to not to pl a the system in operation until a Certificate of Compliance has been.. by the Board of Health. Signed Date r i0 —ZO L v ___�_ _J 1 Inspections MAY 1D20 HEALTH DEPT. No.VI "--2-O' Ln2 DBog' pNi.,4 F hi- COMMONWEALTH OF MASSACHUSETTS a -V` S3CQl Board of Health, Yarmouth,MA DISPOSAL SYSTEM CONSTRUCTION PERMIT Permission is hereby anted to; Construct() Repair(Upgrade() Abandon() an individual sewage disposal system at 30 '( ou.�t Kd as described,in the application for Disposal SystemConstruction Permit No. 10-I Il , dated S!I$f b? ) . Provided: Construction shall be completed within ee years the date of this permit. All local conditions must be met. Date 5 12111,0,0 Board of Health _ • • 7. • • Town of Yarmouth Subsurface Sewage Disposal System As-Built Information Street Address: 2 4) /Vatic I A/ Map: l q Parcel: ` Owner Name: / # Permit#: Date Installed: >.5"18'/2,0 Ld New: Repair: Installer Name: �� Ai/t✓((4 S 4: 6 �o��e�< Installer Phone: �'"� I 30f-S7tv Installation of(list all components,both newly installed and existing to remain in use): ,e-� '1'dc Leach Capacity(gpd): Ground Water Depth(inches): Health Inspection by: As-built Diagram (Print Clearly in Black/Blue Ink and Use Straight Edge—Label Risers and Zabel Filter) PO reA g C O � i DISTANCES 3 0y Al=17' 81=13' /- . i;' 8,2=/9.r' /3-1V i33 --.c' A4= 7.5' 8Y=22' L11�c.J\ LEJ A B I C D E F G 1 13 2 11 j4•5 v_. . � � � 3 i 13 22,5- 5 6 / .11.,"11 LOT NO. : L-' 14o ADDRESS: 3O Ai0,v s-,- R • OWNERS NAME: 4541,. SEWAGE PERMIT NO. : NEW: / REPAIR: DATE ISSUED: DATE INSTALLED: INSTALLERS NAME: INSTALLATION OF:/aa0 fc..h 19-1.0o,, 2F4,4, 2's+-, WATER TABLE:g,Z.' F428iiL INSPECTION BYIw://:••..,,, DRAWING OF INSTALLATION ON REVERSE SIDE: 1 -..: , I gk \ 1 5., \ )-6.....#23(4:Z 18t 26 �37' Town of Yarmouth Subsurface Sewage Disposal System As-Built Information Street Address: 50 4 41[ e t.41 LA) )Map: ' Parcel: 7 ?1-I '1ti Owner Name: FS-fa iC S Philip p ''A Permit#: "k '23 Date Installed: ti Si �Z" o New: Repair: X Installer Name: çt Ha IrP ws d(, 4 ,i/cci. c-C/14'1 L,C.. Installer Phone:55/7A 3 4/71-7 Installation of(list all components, both newly installedle and existing to remain in use): P Pf$ et � t �#y fee,/'ar f -12?4fTirit- z— -7- rrrI/P ' /nl�' t- Te ortc Cavell /16p/cked Leach Capacity(gpd): Ground Water Depth(inches):_ Health Inspection by: L______T_____pa.CA-1Z l; T 1 1 3 r, . DEC 2 0 2021 _ , . ... HEALTH DEPT A B 1 I- r 13 C D € F G ' 2 1 If 1 ife - 3 t6 22•5".— 4 1?•S.. 2-2 5 1 6 1 1