HomeMy WebLinkAboutApp-Permit-ComplianceNo. 950"01 t5 -1-77q FEE
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COMMONWEALTH OF M SAC SETTS 12
Board of Health, ym:t. um , MA. �5 � �
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APPLICATION FOR DISPOSAL SYSTLM CONSTRUCTION PERMIT
Application for a Permit to Construct( ) Repaira4"Upgrade( ) Abandon( ) - Ll Complete System 44ndividual Components
Location LA
Owner's Name T,,-4
Map/Parcel# 90Z 9,
Address W lal 1-212 tAA 9,7/26
1Z
Lot#
Telephone# q y, I - 6-
Installer's Name C-
Designer's Name
Address 9 8kpog-
Address
Telephone# 5-V&/J
Telephone#
Type of Building
Lot Size
sq. ft.
Dwelling - No. of Bedrooms -1 A/ *540,6 n 15 Garbage grinder k�
Other - Type of Building No. Of persons Showers Cafeteria
Other Fixtures
Design Flow (min. required) 1141) gpd Calculated design flow Design flow provided3� gpd
Plan: Date Number of sheets Revision Date
Title
Description of Soil(s) Al - � t4
Soil Evaluator Form No. Name of Soil Evaluator &do( Date of Evaluation
DESCRIPTION OF REPAIRS OR ALTERATIONS o e 6.sT- (bt4t!j�Tg4ukT 4-,vj
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 thyptem Ui operation until a Certificate of Compliance has been issued by the Board of Health.
Signed &4o -L4 Date
Inspections LL
No. 130"M -15- 1 -7"9 FEE
COMMONWEALTH OF MASSACHUSETTS
Board of Health, V&9,M6Un MA. plc( �, �%
CERTIFICATE Of COMPLIANCE��//Yi, x6z,
Description of Work: Individual Component(s) 0 Complete System
The undersigned hereby certify that the Sewage Disposal System; Constructed Repaired Upgraded Abandoned(
by: 0 kL 1< tA-JV*, Q, e- Z & 1vv t ovr efm
at /I ce Logy f -. I, J /7=
has been installee,n�ckr-da./ce it—wt�PpFoqslons, 6 10 CMR 15.06 (Title 5) and the approved design plans/as-built plans relating to
application No. /!' -- C ) Flow
-dated Approved Design -?A'n*0 (gpd)
Installer.. -,e
U We
Designer: Inspector: Date:
The issuance of this permit shall not be construed as a guarantee that the system will function as designed.
D�
No. -0,0 kA - DC 05 -0 C -V- FEE
-2- COMMONWEALTH OF MASSAC14USETTS
Board of Health, VAgMQUni MA.
DISPOSAL SYSTEM, CONSTRUCTION PERMIT
Permission is hereby granted to,; Construct( Repair( ) Upgrade(Vf Abandon( )anindividual sewage disposal system
at4149C- iA). I/ as d6ieribed in the application for
Disposal System Construction Permit No. dated fj
7 '
t
Provided: Construction shall bleocompleted withinhiFv--�of the date of this perm t local conditions must be met.
B ar Xz��
Form 1255 Rev. 5/96 A.M. Sulkin Co. Charlestown, MA Date 4 --/ o 6kol We it h / I'— -
No.:BOHDC-15-1779
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: 11 COLUMBUS AVE,WEST YARMOUTH, MA 02673 Owner:
SARNI JAMES L JR TRS
Map/Parcel#: 0222 SARNI]EANNETTE TRS
ll8 WOODCRESTDR
MELROSE,MA 02176
Phone:
Septic System Installer Designer
B.C.K.GENERAL
97 TOWN BROOK ROAD WEST
YARMOUTH, MA 02673
Phone:
Type of Building:Dwelling Lot Size:8,712.00 Acres
Dwelling-No.of Bedrooms:4 Garbage Grinder:
Other Type o(Building: No.of persons: Showers:
Other Fixtures:
Plan Dah: Number of Sheets: Ca&hria: .
Title: Revision Date:
Design Flow(min.required):440 gpd Calculated design ilow:440 gpd Design flow provided: gpd �
Description ot Soils: �
Soil EvaWator Form No.: Name of Soil Evaluator: Date of Evaluation:
DESCRIPTION OF REPAIRS OR ALTERATIONS:REPAIR-REPLACE EXISTING LEAKING SEPTIC TANK WITH 1500 GAL 5EPTIC
TANK AND DEBOX PER INSPECTION REPORT BY ACCU SEPCHECK DATED 12/13/2014
The undersigned agrees to insfall the above described Individual Sewage Disposal System in accordanee with the provisions of
TITLE 5 and further aarees not W olace in ooeration until a Certlflcate of Comoliance has heen issued bv the Board of Heakh.
Signed Date
Inspections
Commonwealth of Massachusetts
Board of Health, Yarmouth, MA FeB
DISPOSAL SYSTEM CONSTRUCTION PERMIT sss•oo
Permissio�is herby gra�ted to;
B.C.K. GENERAL CONTRACTOR,97 TOWN BROOK ROAD,WEST YARMOUTH, MA 02673
To perform:Upgrade an individual sewage disposal system.
Owner. SARNI JAMES L JR TRS
SARNI JEAIVNETTE TRS
118 WOODCREST DR �
MELROSE,MA 02176
Location: ll COLUMBUS AVE,WEST YARMOUTH,MA 02673
Disposal System Construction Permit No.: BOHDC-1S1779,Dated: April 17,2015
Provided:Construction shall be wmpleted within six months of[he da[e of this permit. All local condi[ions must be met.
Conditions
1. REPAIR-REPLACE EXISTING LEAKING SEPTIC TANK WITH I500 GAL SEPTIC TANK AND
DEBOX PER INSPECTION REPORT BYACCU SEPCHECK DAT �/13/2014
v
Bruce G. rph , MPH, R.S., CHO/Amy L.von Hone, R.S.,CHO
Health Diredor/Assistant Health Diredor
The issuance of this permit shall not be construed as a guarantee that the system will function as designed.
Commonwealth of Massachusetts
Board of Health, Yarmouth, MA Fee
CERTIFICATE OF COMPLIANCE 555.00
� Description of Work:Individual Component(s)
i
The undersigned hereby certify that the Sewage Disposal System; Upgraded
by: B.C.K. GENERAL CONTRACTOR
at: ll COLUMBUS AVE,WEST YARMOUTH,MA 02673
Has been installed in accordaoce with the provisions of 310 CMR 15.00(Title 5)and the approved
design plans or as-built plans relating to application No.: BOHDC-15-1779,dated OS/06/2015.
IInstaller:B.C.K.GENERAL CONTRACTOR
� Address:97 TOWN BROOK ROAD WEST Inspector:
YARMOUTH,MA 02673
Designer:
Conditions
1.REPAIR-REPLACE EXISTING LEAHING SEPTIC TANK WITH 1500 GAL SEPTIC TANK
AND DEBOX PER INSPECTION REPORT BY ACCU SEPCH TED 12/13
, �/ C�/ o
Bruce G. Mu[phy,TN1PH, R.S., CHO/Amy L.von Hone, R.S.,CHO
� Health Director/Assistant Health Diredor
T6e issuance of this permit shall not be construed as a guarantee that the system will functiou as designed.
BOH_D isposal_Construction_CofC.rpt