HomeMy WebLinkAboutApp-Permit-ComplianceNo. 1304De-t5'- 2D33 6LD P--/6-- 005Z/55 FEE
Uj Uj /!�--7 / COMMONWEALTH .ILTH ®f 1` ASSAC1L4USETTS ck4l/72.
Board of Health, T (ilrM , MA.
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APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTI®N PERMIT
Ap lication for a Permit to Construct Repair( ) UpgradeQQ Abandon) - 14 Complete System ❑ Individual Components
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Location 031.
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Owner's Name l N�E:- CVV_(Z,:W c -rp U9T
Map/Parcel#
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Address k65' +'- Se Ll
Lot#
Telephone#
Installer's Name
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Designer's Name ZSC, 6?4lJ'? IMC -
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Address
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Address 349 C a$.. UDR 1) W, Y PAd
Telephone#
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Telephone# C 5-0$ -7'-7 6 - 8 9 19
Type of Building 1jT l A i . Lot Size
Dwelling - No. of Bedrooms iD Garbage grinder ( )
Other - Type of Building No. of persons Showers ( ) , Cafeteria ( )
Other Fixtures
Design Flow (min. required) (O gpd Calculated design flow WOO Design flow provided gpd
Plan: Date t k"��� 3 Number of sheets Revision Date 1J ON E�
Title SewtiCS� 6S?QS;AL S YS T El\ U1�6P AQC, LACI iyl '-(AiL.N\6014 09:7:
Description of Soil(s) _
Soil Evaluator Form No.
Name of Soil Evaluator YALjtjj YIEVAIAW Date of Evaluation
DESCRIPTION OF REPAIRS OR ALTERATIONS , AAZOJ LS Y M M Cb-PAV61.1i~ 0:S . y e -a" nz-
S E&T tc Teti n uK ► , my, & t t—rw Lu, l e.6 Pi—,LY) r -A tJS iS--t1.,J 4- OV- (i 5m-6AL1-,&n1 PVZC AST
The undersigied abz6es to install
furtheragr s ng"
/ ��oA lace
Signed e!
Individual Sewage Di
until a Certificate of
Date -Si
X/
S1 DT=.- J
System in accordance with the provisions of TITLE 5 and
kance�as been issued by the Board of Health.
No. 60 05 20331 /l E —4—"0166
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77 COMMONWEALT14 OF MASSACHUSETTS �� �- %'� Cj,4 lI ?7
Board of Health, Y P -H 0 k1 4
CERTIFICATE OF COMPLIANCE
Description of Work: ❑ Individual Component(s) X Complete System
The undersigned hereby certify that the Sewage Disposal System; Constructed*, Repaired ( ), Upgraded"0,0, Abandoned X
by: 6166S C'005MV2702 INC
at 6 OS -
has been installed a"c�ord nce-V�' t�I'i the provisions of 310 CMR 15.00 (Title 5) and the approved design plans/as-built plans relating to
application No. /'�-` 72 , dated �' /. Approved Design Flow WOO (gpd)
Installer .TAM 11; r --n R P� S
Designer: Inspector: X�f Date:, G -
The issuance of this permit shall not be construed as a guarajZe that the system will function as designed.
No. 60 Rb r- — I5 -7,0,93 61&j6,5 C 0A35Tl2t1M 0rQ FEE
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-77 C®MMON 4LTH Of MASSACHUSETTS C k4 7 2 -
Board of Health, RQ.MVin\j� T j- , MA.
DISPOSAL SYSTEM CONSTRUCTION PERMIT
Permission is hereby granted to; ConstructW Repair( ) Upgrade Abandon.(><l an individual sewage disposal system
at k No LQ.:iiO&F-9-IY' LA N E as described in the application for
Disposal System Construction Permit No. / L / , dated
Provided: Construction shall be completed within t"hr�y_ 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—/ lBoard of Health /
No.: BOHDGIS-2033
Commonwealth of Massachusetts Fee _
E»o.00 �
Board of Health, Yarmouth, MA
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT
, Application for a Permit to:New Construction-Complete System
. Location: 186 CRANBERRY�N,YARMOUTH, MA 02675 Owner:
BURKE LUCY L TRS
Map/ParceW: 128.14.1 THE CRANBERRY COVE TRUST
� 5 TIMBER LANE APT 304
EXETER,NH 03833
Phone:
Septic System Installer Designer
GIBBS CONSTRUCTION, BSC GROUP,INC.
87 SMITH CORNER ROAD NEWTOWN, 349 ROUTE 28 UNIT D
NH 03858 WEST YARMOUTH,MA 02673
Phone: (508)778-8919
iType of Building:Dwelling . Lot Siu:87,555.60 Acres
Dwelling-No.of Bedrooros:6 Garbage Grinder:
. Other Type of Building: No.of persons: Showers:
Other Fixtures:
� PlanDate: ll/08/2013 NumberofSheets: l
Cafeteria:
Tit1e:SEWAGE DISPOSAL SYSTEM UPGRADE 186 CRANBERRY LANE Revision Date: I 1/18/2013
Design Flow(mimrequired):660 gpd Calculated design flow:660 gpd Design tlow provided:679 gpd
� Descripfion of Soi1s:SEE PLAN
Soii Evaluaror Form No.: Name of Soil Evaluator: Date of Evaluation: 10/17/2013 -
BRIAN YERGATIAN,P.E.BSC GROUP
DESCRIPTION OF REPAIRS OR ALTERATIONS:NEW-1500 GAL SEPTIC TANK,DBOX,6•500 GAL PRECAST CHAMBERS W/ .
STONE 4'ENDS,3'SIDES:59'X 10.83'X 2'
7he undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of
TITLE 5 and fuMher aorees not to oWce in ooe`alion until a Certificate of Comoliance has heen issued 6v the Board of Meakh.
. Signed Date
Inspections
Commonwealth of Massachusetts
Board of Health, Yarmouth, MA Fee '
DISPOSAL SYSTEM CONSTRUCTION PERMIT 5770.00
' Permission is herby granted to;
GIBBS CONSTRUCTION, INC., 87 SMITH CORNER ROAD, NEWTOWN, NH 03858
To perform:New Construction an individual sewage disposal system.
Owner: BURKE LUCY L TRS
. THE CRANBERRY COVE TRUST
S TIMBER LANE APT 304
EXETER,NH 03833
Location: 186 CRANBERRY LN,YARMOUTH,MA 02675
� Disposal System Construction Permit No.: BOHDC-15-2033,Dated: May 07,2015
! Provided: Construction shall be completed within six months of the date of this permit. All local conditions must be met.
I Conditions
1. NEW- I500 GAL SEPTIC TANK, DBOX, 6-S00 GAL PRECAST CHAMBERS W/STONE 4'ENDS, 3'
� SIDES: 59'X 10.83'X 2'
�(. I �� �
. Bru . Murphy, MPH, R.S., CHO/Amy L. von Hone, R.S., CHO
� Health Director/Assistant Health Diredor
� The issuance of this permit shall uot be construed as a guarantee that the system will function as designed.
i
Commonwealth of Massachusetts
Board of Health, Yarmouth, MA F�
CERTIFICATE OF COMPLIANCE s��o.00
Description of Work: Complete System
The undersigned hereby certify that the Sewage Disposal System; New Construction
by:GIBBS CONSTRUCTION,INC.
at: 186 CRANBERRY LN,YARMOUTH,MA 02675
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-1S2033,dated 06/23/ZO15.
Installer:GIBBS CONSTRUCTION,INC.
Address:87 SMITH CORNER ROAD NEWTOWN,NH Inspector:AMY VON HONE,R.S.
03858
Designer.BSC GROUP, INC.
Conditions
1.NEW- 1500 GAL SEPTIC TANK,DBOX,6-500 GAL PRECAST CHAMBERS W/STONE 4'
ENDS,3' SIDES: 59' X 10.83' X 2' ���,,9,, �CS�[J�
UGC
Bruce G. Murph ;M , R.S., CHO/Amy L.von Hone, R.S.,CHO
� Health Director/Assistant Health Diredor
l�
The issuance of this permit shall not be construed as a guarantee t6at t6e system will function as designed.
BOH_Disposal_Construdion_CofC.rpt