HomeMy WebLinkAboutApp-Permit-Compliance No.: BOHDGIS-2055
Commonwealth of Massachusetts Fee
$55.00
Board of Health, Yarmouth, MA
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMTT
Application for a Permit to:Repairvminor-Individaal Component(s)
Location: 35 GENERAL LAWRENCE RD, SOUTH YARMOUTH, MA Owner:
02664 TIERNEY EDWARD D
Map/Parcel#: 078285 TIERNEY MEGCAN M
35 GF.NERAL LAWRENCE RD
SOUTH YARMOUTH,MA 02664
Phone:
Septic System Installer Designer
ROBERT B.OUR
P.O. BOX 1539 HARWICH, MA 02643
Phone:
Type of Building:Dwelling Lot Size: 16,552.80 Acres
Dwelling-No.of Bedrooms:3 Garbage Grinder:
Other Type of Building: No.of persons: Showers:
Other Fixtures:
Plan Date: Number of Sheets:
Cafeteria:
Title: Revision Date:
Design Flow(min.required):330 gpd Calculated design ilow:330 gpd Design Oow provided:330 gpd
Description of Soils:
Soil Evalua[or Porm No.: Name of Soil Evaluator: Date oF Evalua[ioo:
DESCRIPTION OF RF,PAIRS OR ALTERATIONS:MINOR REPAIR-REPLACE ORANGEBURG PIPE FROM FOUNDATION TO
SEPTIC TANK .
The undereigned agrees to install the above described Intlivitlual Sewage Disposal System in accortlance with the provisions of
TITLE 5 and further aarees not to olace in ooeration until a Certificate of Comolianee has heen issued hv the eoard of Health.
Signed Date
Inspections
Commonwealth of Massachusetts
Board of Health, Yarmouth, MA Fee
DISPOSAL SYSTEM CONSTRUCTION PERMIT $55.00
Permission is herby granted to;
ROBERT B. OUR COMPANY INC., P.O. BOX 1539, HARWICH, MA 02643
To perform:Repair-minor an individual sewage disposal system.
Owner. TIERNEYEDWARDD
TIHRNEY MEGGAN M
35 GENERAL LAWRENCE RD
SOUTH YARMOUTH,MA 02664
Location: 35 GENERAL LAWRENCE RD, SOOTH YARMOUTH,MA 02664
Disposal System Construction Permit No.: BOHDC-15-2055, Dated: May O8,2015
Provided: Constmction shall be completed within six months of the date of this permit. All Iocal conditions must be met.
Conditions
1. MINOR REPALR-REPLACE ORANGEBURG PIPE FROM FOUNDATION TO SEPTIC TANK
���� ��
Bruce G. Murp y, MPH, R.S., CHO/Amy L.von Hone, R.S., CHO
� Health Diredor/Assistant Health Director
The issaance of this permit shall not be construed as a guarantee that the system will function as designed.