HomeMy WebLinkAboutBHDC-254-71 N G 2-I+ k___ ��
FEE
COMMONWEALTH OF MASSACHUSETTS
07_7 Board of Health, Yarmouth, MA RECEIVED
U APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERM( U i 2024
Application for a Permit to Construct()Repair()Upgrade()Abandon()-❑Complete S,ystem4Individual Componegtye A LTH DEPT.
Location a; rk Vt j a tL, Owner's Name ( ®1^ -HEALTH
Map/Parcel# /2 Ty-6 I Address c J
Lot# Telephone# �7?— 3 G 27.'
Installer's Name .�p fprfri� J ractik t� Designer's Name
.Address l r ` �l r� t I1LQyr Address
Telephone# Telephone#
Type of Building Lot Size sq.ft.
Dwelling—No.of Bedrooms Garbage grinder( )
Other—Typc of Building No.of persons Showers O,Cafeteria()
Other Fixtures
Design Flow(min,required) gpd Calculated design Clow 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 ALTERATIONS ,/9I eO_ b(,c77e r kohq It
(97
.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 peration until a Certificate of Compliance has been issued by the Board of health.
/,( —/`r-�21
Signed
./V� Date _�
Inspections 7
No. w•24.7 I ------.-_._---_-FEE 55
COMMONWEALTH OF MASSACHUSETTS
Board of Health, Yarmouth,MA
CERTIFICATE OF COMPLIANCE
Description of Work: ❑Complete System O Individual Components
The undersigned hereby certify that the Sewage Disposal System;Constructed(•Repaired() Upgraded() Abandoned()
by: 3.7..c ar v
aC C .
s�j I y�
has been installed in✓accordance ,with the provisions of 310 CMR 15.00(Title 5)and the apprgved design plans/as-built plans relating to
application No. ./c !��- dated c;"v.a�/ . A r ign Flow r-/ (gpd)•
Installer: TT )
Designer: /i -4 Inspector I -- Date: �--/O-
The issuance of this permit shall nut be constro a gun ee that the system will function as designed.
\ Sc
No. FEE
COMMONWEALTH OF MASSACHUSETTS
Board of Health,Yarmouth,MA
DISPOSAL SYSTEM CONSTRUCTION PERMIT
Permission herepy granted to; Construct(,,),(repair() Upgrade() Abandon() an individual sewage disposal syste at
((, nbtra--� ( as described i system at
the application for
Disposal SystemConstruction Permit No., a-- • ted • 7`'I
Provided:Construction of shall be completed wit '� - • -o'-the date of this permit.All local conditions must be met.
Date 5."-: -T'c1"1 Board of Health
Town of Yarmouth
Subsurface Sewage Disposal System As-Built Information
Street Address: 85 Freeman Road Map: 106 Parcel: 40
Owner Name: Cheryl Margcson Permit#: BHDC-24-36
Date Installed: 3/13/2024 New: X Repair:
C.C.Construction Inc. 508-398-1811
Installer Name: Installer Phone:
Installation of(list all components,both newly installed and existing to remain in use):
Schedule 40 4'PVC,Re-Using Existing 1500 GAL Septic Tank
Leach Capacity(gpd): 330 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)
House
A B
5 2
1 '
6 Inspection Port
I '
' l
RECEIVES K
I ,
MAY 0 2 2024
HEALTH OFF
4 3
A B C D E F G
1 35' 24'
2 32' 18'6"
3 41' 32'
4 29'6" 36'
S 12'6" 24'6"
6 20" 19'6"
.. 0 ?
cc
.V' <f) %
ILI 'j 00
z.71 /
tre 0 V •
O < �1. 1 •
• . ::1:::), n
.
g v a •f 0 a
? z o F z1