HomeMy WebLinkAboutApp-Permit-CompliancenF I' Dc-( Sy��? / ` K.�' /'� /l�G- G % // r� 11( �4� FEE
No. `�J� /� �v19�/ / ll I r
IMMONWEALTH Of MASSACHUSETTS 2-- �—H)rll
Board of Health, UrA , MA.
APPLICATION FOR DST
SS ®SAI. SYSTEM[ CONSTRUCTI®N PERMIT
Application for a Permit to Construct( ) Repair Upgrade( ) Abandon() - ❑ Complete System individual Components
Location (
1q-10it
Owner's Name I'V iD A- c tear 1
Map/Parcel#
t1qrieej l
Address (J S Lyv
Lot#
Telephone#
Installer's Name
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Designer's Name
Address I
`
Address
Telephone#
- —
Telephone#
Type of Building Lot Size sq. ft.
Dwelling - No. of Bedrooms __ Garbage grinder ( )
Other - Type of Building No. of persons Showers ( ), Cafeteria ( )
Other Fixtures ,y
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,
OF REPAIRS
Name of Soil Evaluator
Date of Evaluation
C%1Di;U Iv 1 rV li e�f�DQt�
The undersi990Aagrees to ins a above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and
further afire lace a tem in operation until a Certificate of Compliance has een issued by the Board of Health.
Signed9tc Date :� �� 1
Inspections
No. 604,DC-15 457( r FEE
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COMMONWEALTJR OF MASSACHUSETTS �t 1// -2f4
Board of Health, YA9MOTIal , MA.
CERTIFICATE OF COMPLIANCE
Description of Work: ❑ Individual Component(s) ❑ Complete System
The undersigned hereby certify that the Sewage Disposal System; Constructed ( ), Repaired 0, Upgraded ( ),Abandoned( )
by: 1r^i. r) r C s w P &21/Z V r C..c�-
at ?, U Aryv bras 4 (,x),y Aaywna WA ii,,)1 0
has been installed in acco
application No. P7
Installer G:,%�e
with the provisions of1310 CMR 15.00 (Title 5) and the approved design plans/as-built plans relating to
dated 4—/—/ �— . Approved Design Flow _ Q(gpd)
Designer: " Inspector �� b6zl / Date:
The issuance of this permit shall not be construed as a guar /ntee//that the system will function as designed.
J..J_-i. ,c..._0[in.!
No.�p/�DClS-1�v7/ (� '�'� �% FEEU (/
�®tel[®NLTH ..Of NNE44S?A
C1IUSETTSWe-tl -)PV
Board of Health, Y�72M0 (�1"�i , MA.
DISPOSAL'SYSTEM CONSTRUCTION PERMIT
Permission is herebygranted air U rade Abandon an individual sewage disposal system
j' g %d to; Construct( ) Re P pgrade ( n
) g P Y
at ( ' Lkv i w r -v as described in the application for;'.
Disposal System Construction Permit No. ` , dated
Provided: Construction shall be completed within tlrrl�,-gears o&e date of this permi . All local conditions must be met.
Form 1255 Rev. 5/96 A.M. Sulkin Co. Charlestown, MA Date / Board of Health / �� L-11
No.:BOHDC-15-1571
Commonwealth of Massachusetts F�
sss.00
Board of Health, Yarmouth, MA
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERNIIT
Application for a Permit to:Repair-minor-Individual Component(s)
Location:6 ANDY LN,WEST YARMOUTH, MA 02673 Owner: �,
CARROLL LINDA TR '
Map/ParceW:031.121 THE LINDA CARROLL 1RUST �
82 CRESTVIEW RD
NEEDIIAM,MA 02192
Phone:
Septic System Installer Des�g°er
CAPE EXCAVATING '
13 CHARLENE LANE HARWICH, MA '�..
02645 �
Phone:
Type of Buildiog:Dwelling Lot Size: 13,068.00 Acres
Dwelling-No.of Bedrooms:4 GarAage Grinder: �
Ot6er Type of Building: No.of persons: Showers:
Other Fiatures:
Plan Date: Number of Sheets: Cafeteria:
Title: Revision Date:
Design Flow(min.required):440 gpd Calculahd design ilow:440 gpd Desigo flow provided:440 gpd
DescripNon of Soils:
Soil Evaluator Form No.: Name of Soil Evaluator: Date of Evaluation:
DESCRIPTION OF REPAIRS OR ALTERATIONS:REPLACE BLOCK IN CESSPOOL 1,REPLACE SADIITARY TEE IN CESSPOOL 2
PER INSPECTION REPORT DATED 12/08/2014.
The unde�sig�red agrees W install the above deseAbetl Intlivitlual Sewsge Dlsposal System In aceordanee wifh the provisio,n of
TITLE 5 and furfher aorees not to olace in ooera[ion until a CertiHcate of Comoliance has heen issuetl bv flie Board of Flrakh.
Signed Date
Inspections I�
I
I
i
Commonwealth of Massachusetts
Board of Health, Yarmouth, MA F�
DISPOSAL SYSTEM CONSTRUCTION PERMIT ass.oa
Permission is herby granted to;
CAPE EXCAVATING SERVICE, 13 CHARLENE LANE, HARWICH, MA 02645
To perform:Repair-minor an individual sewage disposal system.
Owner. CARROLL LINDA TR
THE LINDA CARROLL TRUST
82 CRESTVIEW RD
NEEDI-IAM,MA 02192
Location:6 ANDY LN,WEST YARMOUTH,MA 02673
Disposal System Construction Permit No.: BOHDGIS-1571 ,Dated:Apri103,2015
Provided:Construction shall be completed within six months of the date of this permit. All local wnditions must be met.
Conditions
1.REPLACE BLOCK IN CESSPOOL 1, REPLACE SANTIARY TEE IN CESSPOOL 2 PER INSPECTION
REPORT DATED 12/OS/2014.
�V �
Bruce G. M rphy, MPH, R.S., CHO/Amy L.von Hone, R.S.,CHO �
Health Director/Assistant Health Di2dor 'i
The issuaoce of this permit shall not be construed as a guarantee that the system will function as designed. !�
i
Commonwealth of Massachusetts
Board of Health, Yarmouth, MA Fee
CERTIFICATE OF COMPLIANCE sss.00
Description of Work: Individual Component(s)
The undersigned hereby certify that the Sewage Disposal System; Repair-minor
by:CAPE EXCAVATING SERVICE
at:6 ANDY 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.: BOHDGIS-1571,dated 04/Ol/2015.
Insta7ler:CAPE EXCAVATING SERVICE
Address:l3 CHARLENE LANE HARWICH,MA 02645 Inspector:AMY VON HONE,R.S.
Designer:
Conditions
1.REPLACE BLOCK IN CESSPOOL 1,REPLACE SANITARY TEE IN CESSPOOL 2 PER
INSPECTION REPORT DATED 12/08/2014.
Bruce G. Murphy PH, R.S., CHO/Amy .van Hone, R.S.,CHO
Health Director/AssistaM Health Diredor
I
The issuance of this permit s6a11 oot be construed as a guarantee that the system will function as designed. II
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BOH_Dispasal_Construction_CofC.rpt