HomeMy WebLinkAboutApp-Permit-ComplianceNo. N�pC_[,5
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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