HomeMy WebLinkAboutApp-Permit-ComplianceNo. WkvDc— f5 —2-2qcI r «
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COMMONWFALT14 Of MASSACHU ETTS ,ercr*377/
Board of Health, Y 6UT-V , MA.
APPLICATION FOP, DISPOSAL SYSTEM CONSTRUCTION PERMIT
Application for a Permit to Construct( ) Repair( ) Upgradeo Abandon( ) - ❑ Complete System. Individual Components
Location
Owner's Name
Map/Parcel#
Awee-1
Address
Lot#
Telephone#
Installer's Name
-
Designer's Name i
Address Z
- t
Address G�
Telephone#
Telephone -%"
Type of Building ��!/�i%i� Lot Size ®• � � sq. ft.
Dwelling - No. of Bedrooms Garbage grinder ( )
Other - Type of Building No. of persons Showers ( ) , Cafeteria ( )
Other Fixtures 27
Design Flow (mi/n. required)® gpd Calculated design flow 41 � Design flow provided gpd
Plan: Date `�"� _� Number of sheets Revision Date
Title
Description of Soils) _
Soil Evaluator Form No,
Name of Soil Evaluator
DESCRIPTION OF REPAIRS OR ALTERATIONS %C1�4 A/
Date of Evaluation
The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and
further a o oto lace tem in operation until a Certificate of C m h ce has been issued h the Board of health.
Signed ��^7'�'� p Date y
No. _ CON[MONWEALTH OF M ASSAC14USETTS °,,41� 1150 Rcic�. 377,
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Board of Health, Yagm o ur , MA. /• r'
CERTIFICATE Of COMPLIANCE
Description of Work: individual Component(s) ❑ Complete System
The undersigned hereby certify that the Sewage Disposal System; Constructed ( ), Repaired O6, Upgraded ( ), Abandoned ( f
at s ,�, 4,:
has been installed fn�a�cd�n�e wit th provisions of 310 CMR 15.00 (Title 5) and t e a proved design plans/as-built plans relating to
application leo. 4 9 - dated �', -- � - ,'' �. Approved Design Flow "� �p (gpd)
besigner: eul o % Inspector: l.T n Date: j
The issuance of this permit shall not be construed as a tee at the system will function as designed.
No. 01, D C "i �:'"'' �t,.4 � � �4 , � L -A t+Z,41 m a)iL FEE.'---
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COMMONWEALTH OF MASSACHUSETTS c, I
Board of Health, yAAWt OUT* , MA.
DISPOSAL SYSTEM CONSTRUCTION PERMIT
Permission is hereby granyd to; Construct( ) Repair( ) Upgrade(y) Abandon(
at
an individual sewage disposal system
C
_ as described in the application for
Disposal System Construction Permit No. _ , dated
Provided: Construction shall be completed within thf-G�s of the to of this permit. AlFlocal conditions must be met.
Form 1255 Rev. 5/96 A.M. Sulkin Co. Chadestown, MA Date Board of Health c�
B
No.:BOHDC-15-2244
� 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: 7 AKIN AVE,SOUTH YARMOUTH, MA 02664 Owner:
LEONARD ANN M
Map/Parcel#: 061.6 PO BOX 89
SOUTH YARMOUTH,MA 02664-0089
Phone:
Septic System Installer Designer
R.E.LARRIMORE DOWN CAPE ENGINEERING.INC.
112 MAIN STREET HARWICH, MA 939 ROUTE 6A
02645 YARMOUTHPORT,MA 02675
Phone: (508)362-4541
Type of Buildiog:Dwelling Lot Siu: 13,068.00 Acres
Dwelling-No.of Bedrooms:4 Garbage Grinder.
Other Type of Building: � No.of persons: Showers:
Other Futures:
Plan Date:04/21/2015 Number of Shcets: 1
Catehria•
TitIe:TITLE 5 SITE PLAN FOR 7 AKIN AVENUE Revisioo Dah:OS/29/2015
Design Flow(min.required):440 gpd Calculsted design Flow:440 gpd Design Flow provided:443 gpd
Description of SoiIs:SEE PLAN
Soil Evaluator Form No.: Name o[Soil Evaluator: Date of Evaluation:04/16/2015
DANIEL GONSALVES,SE
' DESCRIPTION OF REPAIRS OR ALTERAT[ONS:REPA[R-ADD 2 FLOW DIFFUSORS WITH 2'STONE TO EXISTING 1000 GAL
SEPTTC TANK,DBOX,3 FLOWDIFFUSORS FOR A MAXIMIJM 4 BEDROOM CAPACITY
The untlersigned agrees to install the above describetl Intlividual Sewage Disposal System in aeeordance with the provisions of
' TITLE 5 and furfher aarees not to elace in ooeration untll a Certificate of Comollance has heen issued 6v the Board of MeaRh.
Signed Date
Inspections
Commonwealth of Massachusetts
� Board of Health, Yarmouth, MA F�
DISPOSAL SYSTEM CONSTRUCTION PERMIT 555.00
Permission is herby granted to;
R.E. LARRIMORE, 112 MAIN STREET, HARWICH, MA 02645
To perform: Upgrade an individual sewage disposal system.
Owner: LEONARD ANN M
PO BOX 89
SOUTH YARMOUTH,MA 02664-0089
Location:7 AKIN AVE,SOUTH YARMOUTH,MA 02664
Disposal System Construction Permit No.: BOHDC-15-2244,Dated:June O5,2015
Provided:Construction shall be completed within six months of the date of this permit. All local conditions must be met.
Conditions
1. REPAIR-ADD 2 FLOW DIFFUSORS WTlH 2'STONE TO EXISTING 1000 GAL SEPTIC TANK,
DBOX, 3 FLOWDIFFUSORS FOR A MAXIMUM 4 BEDROOM C �CTIY
U
Bruce . Mu y, MPH, R.S., CHO/Amy L. von Hone, R.S., CHO
Health Diredor/Assistant Health Director
The issuance of t6is permit shall not be construed as a guarantee that the system wiil function as designed.
Commonwealth of Massachusetts
Board of Health, Yarmouth, MA FBe
CERTIFICATE OF COMPLIANCE $55.00
Description of Work: Individual Componeut(s)
The undersigned hereby certify that the Sewage Disposal System; Upgraded
by:R.E.LARRIMORE
at:7 AKIN AVE, SOUTH YARMOUTH,MA 02664
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.: BOHDGIS2244,dated 07/06/2015.
Installer:R.E.LARRIMORE
Address:112 MAIN STREET HARWICH,MA 02645 Inspector.AMY VON HONE,R.S.
Designer:DOWN CAPE ENGINEERING,INC.
Conditions
1.REPAIR-ADD 2 FLOW DIFFUSORS WITH 2' STONE TO EXISTING 1000 GAL SEPTIC
TANK,DBOX,3 FLOWDIFFUSORS FOR A MAXIMUM 4 B O`MnC' A TY
Cl�c
Bruce G. rphy, 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 t6at the system will function as designed.
BO H_Disposal_Construction_CofC.rpt