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HomeMy WebLinkAboutApp-Permit-ComplianceNo. N�pC_[,5 �-,73 `I -j r j � � ' I •l ' ��� � � � FEE $5 -5 -ft COMMONWEALTH Of MASSACHUSETT) &A-2ASD Board of Health, YArZ N,00T + , MA. r 4'?e � APPLICATION FOR DISPOSAL SYSTEM[ CONSTRUCTION PERMIT Application for a Permit to Construct( ) Repair( ) Upgrade( AbandonO - 0 Complete System .O'fndividual Components Location 0 -0 " Owner's Name Map/Parcel# /�owo 4 aet e-1 1 .7 o Address 36�90 \,i j J Lot# Telephone# �D� - '7 Installer's Name 7 Designer's Name bo Address 4 b ), Address g3 g QLn'5 Q0� my oa Telephone# ,5 1) - 7 7 - 66 Telephone# - Type of Building &151 CLAD (SIC Lot Size Dwelling - No. of Bedrooms 1-13 Other - Type of Building No. of persons Other Fixtures Design Flow (min. Plan: Date J Title Description of Soils) _ Soil Evaluator Form No. sq. ft. Garbage grinder ( ) Showers ( ), Cafeteria ( ) gpd Calculated design flow : Design flow provided Number of sheets Revision Date Name of Soil Evaluator OF REPAIRS OR ALTERATIONS 1 1d 6 -bo. - Date of Evaluation gpd The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further agree o of to place th=t* ation until a Certificate of Complii ce has been issued by the Board of Health. Signed Date—&I, Inspections I No.f it if ej. 2.-3, / %L 7 i / FEE r ."-''. OU COMMONWEALTH OF MASSACHUSETTS Board of Health,Qcf=�A, MA. r; CERTIFICATE OF COMPLIANCE Description of Work: 0 mlividual Component(s) 0 Complete System The undersigned here- by certify that the Sewage Disposal System; Constructed ( ), Repaired ( ), Upgraded r-"bandoned ( ) by: -7) C / at has been instalQ4-,&0fQe-Wi!)j *4 F 'sionS�of 310 0i 15.00 (Title 5) and the approved design plans/as-built plans relating to application No.dated Approved Design Flow (gpd) Installer- t Designer1�,`.1 Inspector: Date: I / r .� : / r./ /.�/�.r The issuance of this permit all not be c nstrued as a gua tel at the system will function as designed. No.FEE COMMONWEALTH Of MASSACHUSETTS 13 Board of Health, , , MA. DISPOSAL SYSTEM CONSTRUCTION PERMIT Permission is hereby granted to; Construct( ) Repair( ) Upgrade ( Abandon( ) an individual sewage disposal system at as described in the application for Disposal System Construction Permit No: dated r Provided: Construction shall be complefed �ni/eriiliree�a �of the date of this permit. All local conditions must be met. Form 1255 Rev. 5/96 A.M. Sulkin Co. Charlestown, MA Date Boark4iielaith > i No.: BOHDC-15-2347 � Commonwealth of Massachusetts Fee 555.00 Board of Health, Yarmouth, MA APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERNIIT Application for a Permit to:Upgrade-Individual Component(s) Location: 36 BOB-O-LINK LN,WEST YARMOUTH, MA 02673 Owner: AHEARN LORNA J Map/Parcel#: 049.170 36 BOB-O-LINK LN WEST YARMOUTH,MA 02673 Phone: Septic System Installer Designer B&B EXCAVATION DOWN CAPE ENGINEERING,INC. 14 TEABERRY LANE FORESTDALE, 939 ROUTE 6A MA 02644 YARMOUTHPORT,MA 02675 Phone: (5081362-4541 Type of Buildiog:Dwelling Lot Size:9,583.00 Acres Dwelling-No.ot Bedrooms:3 Garbage Grinder: Other Type of Building: No.of persons: Showers: Other Fiztures: Plan Date:0528/2015 Number of Sheets: 1 Cafehrie: TitIe:TITLE 5 SITE PLAN 36 BOBOLINK LANE Revision Date: Design Flow(min.required): gpd Calwlated design/1ow:33 gpd Design flow provided:337.4 gpd Description of Soi1s:SEE PLAN Soil Evaluator Form No.: Name of Soil Evaluator: Date of Evaluation:OS/21/2015 DANIEL GONSALVES,SE DESCRIPTION OF REPAIRS OR ALTERATIONS:REPAIR-EXISTING]000 GAL SEPTIC TANK,DBOX, 19 ARC 36HC UNITS W/OUT STONE:45'X 5.6'0.89' . The undersigned agrees W insUll fhe above described Individual Sewage Dlaposal System In aceordance wkh the provisions of TITLE 5 and further aorees not te olace In ooeration untll a Certificate of Comoliance has heen issued bv the 8oard of Health. Signed Date Inspections � Commonwealth of Massachusetts � Board of Health, Yarmouth, MA F� DISPOSAL SYSTEM CONSTRUCTION PERMIT sss.00 Permission is herby granted to; B&B EXCAVATION, 14 TEABERRY LANE, FORESTDALE,MA 02644 To perform:Upgrade an individual sewage disposal system. Owner: AHEARN LORNA J� 36 BOB-O-LINK LN WEST YARMOUTH,MA 02673 Location:36 BOB-O-LINK LN, WEST YARMOUTH,MA 02673 Disposai System Construction Permit No.: BOHDGIS-2347,Dated:June 09,2015 Provided:Construction shall be completed within six months of the date of this permit. Al] local wndi[ions must be met. Conditions 1. REPAIR-EXISTING 1000 GAL SEPTIC T,9NK, DBOX, 19 ARC 36HC UNTlS W/OUT STONE: 45'X 5.6'0.89' v� Bruce G urp y, MPH, R.S., CHO/Amy L. von Hone, R.S., CHO Health Director/Assistant Health Director 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 ass.00 Description of Work:Iudividual Component(s) The undersigned hereby ceRify that the Sewage Disposal System; Upgraded by:B&B EXCAVATION at:36 BOB-O-LINK 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.: BOHDC-15-2347,dated 06/10/2015. Installer:B&B EXCAVATION , Address:l4 TEABERRY LANE FORESTDALE,MA Inspector:AMY VON HONE,R.S. 02644 Designer:DOWN CAPE ENGINEERING,INC. Conditions 1.REPAIR-EXISTING 1000 GAL SEPTIC TANK,DBOX, 19 ARC 36HC UNITS W/OUT STONE: , 45'X 5.6' 0.89' � Bruce G. u hy,MPH, R.S., CHO/Amy L.von Hone, R.S.,CHO Health Oirector/Assistant Health Diredor The issuance of this permit shall not be construed as a guarantee that the system will function as designed. BO H_Disposal_Construction_CofC.rpt