HomeMy WebLinkAboutApp-Permit-ComplianceNo. Q c- 5-2 5-7 i `0 08 -0 �� Ft � FEE
COMMONWULTII Of MASSACHUSEfff'
Board of Health, �/k Q -i , MA.
PPI.ICATI®N FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT
Wplication for a Perrmit to Construct( ) Repair (Vppgrade(Vrbandon() - El Complete System-J"individual Components
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Location ej '� US 7-
Owner's Name
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Map/Parcel#6 Ig -1
Address ' -7f�
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Lot#
Telephone#
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Installer's Name 141 Ice
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Designer's Name
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Address (ZS
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Address 19,)��.N/S,
Telephone# 50S- '?
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Telephone# Ej^p
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Type of Building
Dwelling - No. of Bedrooms
Other - Type of Building _
Other Fixtures
Design Flow (min. required
Plan: Date (0 IV
Title fid pd L t c
Description of Soil (s)
Soil Evaluator Form No.
Lot Size 0 •39 A' s s�
Garbage grinder ( )
No. of persons Showers ( ), Cafeteria ( )
gpd Calculated design flow 3 Jr Design flow provided gpd
Number of sheets A Revision Date
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Name of Soil Evaluator L. t eJ A- t Date of Evaluation
DESCRIPTION OF REPAIRS OR ALTERATIONS f N 5 1 -Ai, L AI -W -2-650v- Pr eJ S A 5
The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and
further agrees to pot to place the tem in operation until a Cert'if'icate of Compliance has been issued by the Board of Health.
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Signed Z ° �.t�^� Date
Inspec
COMMONWEALTH Of MASSAC14USEITS . A eo
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Board of Health, Yk9-MC1Q tj , MA.
CERTIFICATE Of COMPLIANCE ��y �
Description of Work: 6 Individual Component(s) ❑ Complete System
The undersigned hereby certify that the Sewage Disposal System; Constructed ( ), Repaired (`} Upgraded ( ), Abandoned ( )
by: 0-A.1 'tit
at
has been installed in acco ae with the provisions of 10 CMR 15.00 (Title 5) and t e..proved design plans/as-built plans relating to
application No. rte dated Approved Design Flow (gpd)
Installer V\A L kCf AM. C P
Designer: LLP -01 A f%; � L4 Inspector: � ����� Date:
The issuance of this permit shall not be construed as a guaranthat the system will function as designed.
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FEE
COMMONWEALTH Of MASSACHUSETTS p 55 0
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Board of Health, Yarz.rv►aV-n-k , MA.
DISPOSAL SYSTEM CONSTRUCTION PERMIT
Permission is hereby granted to; Construct( "T' Repair( J' Upgrade ( Abandon( ) an individual sewage disposal system
at �� r t� ( �` as described in the application for
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Disposal System Construction Permit No. 1 AF dated 6
,oe>," 'C- i4;"--.2 =3 -?/
Provided: Construction shall be completed within the e --jjjj/ �A6f the date of this per 't. All local conditions must be met.
�' ��Sc—Board of Health
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Form 1255 Rev. 5/96 A.M. Sulkin Co. Chatlestow�n, MDate �A ,fir ,p
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No.:BOHDGIS-2371 ��
' 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: 9 FROST AVE,WEST YARMOUTH, MA 02673 Owner:
RUSTER BRIAN
Map/Parcel#: 066.81 175 JOHN xEZZA DR
NORTH ATTLEBORO,MA 02763
Phone:
Septic System Installer Designer
OCEANSIDE SEPTIC OCEANSIDE SEPTIC
P.O. BOX 201 BREWSTER, MA 02631 P.O. BOX 201
Phone: BREWSTER,MA 02631
(5081896-1513
Type of Buildiog:Dwelling Lot Size: 16,988.00 Acres �.
Dwelling-No.of Bedrooms:2 Garbage Grinder:
Other Type of Building: No.of persons: S6owers:
Other Fiatures:
Plan Date:06/OS/2015 Number of Sheets: l Cafeteria: ���
Title:PROPOSED SEWAGE DISPOSAL SYSTEM 9 FROST AVENiJE Revision Date: I
Desigo Flow(min.required):220 gpd Calculahd desigo flow:220 gpd Desigo flow provided:355 gpd '
Description of SoiIs:SEE PLAN
Soil Evaluator Form No.: Name of Soil Evaluatar: Date of Evaluatian:06/02/2015 i
LINDA PINTO,PE I.
DESCRIPTION OF REPAIRS OR ALTERATIONS:REPAIR-EXISTING]000 GAL SEPTTC TANK,H-20 DBOX,20 ADS ARC 36HC
UNITS W/OUT STONE:25'X 11.5'X 0.89'
� The unde�signed agrees to insfall the above described Intlividual Sewage Disposal System in aeeordanee with the provisions of
T1TLE 5 antl furfher aarees not W olace in ooeration until a Cerfifitate of Comoliance has been issued bv the Baard of Health. '�.
Signed Date ,
Inspections
- Commonwealth of Massachusetts II
Board of Health, Yarmouth, MA Fee
DISPOSAL SYSTEM CONSTRUCTION PERMIT su.00
Permission is herby granted to;
OCEANSIDE SEPTIC INC., P.O. BOX 201, BREWSTER, MA 02631 �!
To perform:Upgrade an individual sewage disposal system. ',
Owner. RUSTER BR[AN
175 JOH1V REZZA DR
NORTH ATTLEBORO,MA 02763
Location: 9 FROST AVE,WEST YARMOUTH,MA 02673
Disposal System Construction Permit No.: BOHDG1S2371 ,Dated:June 11,2015
Provided: Cons[ruction shall be wmpleted within six mon[hs of the date of this permit. All local conditions must be met.
Conditions
1. REPAIR-EXISTING 1000 GAL SEPTIC TANK, H-20 DBOX, 20 ADSARC 36HC UNITS W/OUT
STONE: 25'X 11.5'X 0.89'
2. BOH TO CONFIRM 4'SUITABLE SOILS BELOW LEACH FIELD
3. ENGINEER TD INSPECT AND CERTIFY PER PLANNOTE
GC�i
Bruce G. Mu y, PH, R.S., CHO/Amy L. von Hone, R.S., CHO
ealth Director/Assistant Health Direc[or
The issuance of this permit shall oot be construed as a guarantee that the system will fuuction as designed.