Loading...
HomeMy WebLinkAboutApp-Permit-Compliance/ O C �� " �� / V O Cj(0<7(0,?�T FEE ; 1 L I/y No. �K � — t Board of Health, 0 0T -U , MA. APPLICATION FOR DISPOSAL SYSTEM[ CONSTRUCTI®N PERMIT Application for a Permit to Construct( ) Repair( ) Upgrade(/KAbandon() - Ja Complete System ❑ Individual Components Location 31 r—,h L Owner's Name Cohvc/kJ Res Map/Parcel# Lt I Address Lot# Telephone# Installer's Name Designer's Name �G✓- 17an iJ.-GA-G�vi Address Address 13 Telephone# Telephone# 1�-- C%'� 3&S-- CP Type of Building Lot Size sq. ft. Dwelling - No. of Bedrooms 3 Garbage grinder ( ) Other - Type of Building No. of persons Showers ( ), Cafeteria ( ) Other Fixtures Design Flow (min. required) gpd Calculated design flow Design flow provided gpd Plan: Date (0 o 1 i S Number of sheets t Revision Date Title Description of Soil(s) &ea SoY1 LGQI Soil Evaluator Form No. Name of Soil Evaluator Date of Evaluation DESCRIPTION OF REPAIRS OR ALTERATIONS The undersigned ees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further agrees of to place the syste in p ration until a Certificateof omplianc has been issued by the Board of Health. Signed Date' a Inspections No. 3o14 DC. —1 s- z,,Lfiq COMMONWEALTH OF MASSACHUSETTS FEE ©0 Board of Health, yd j&MUL TV , MA. CERTIFICATE OF COMPLIANCE Description of Work: ❑ Individual Component(s) 6a"''Complete System The undersigned hereby certify that the Sewage Disposal System; Constructed ( ), Repaired ( ), Upgradedandoned (J`) by: !-` i ! s�k r c -T, T. at has been installedin accoi application No. / Y Installer rvitetim visions of 340 CMR 15.00 (Title 5) and the approved design plans/as-built plans relating to dated `%--'/3'! Approved Design Flow 7-3 (gpd) Designer: 5 e.�_e�1r� 1.a nom,''-¢.-Pliuispector: Date: r% `" ! ✓ The issuance of this permit shall not be construed as a guaragXee that the system will function as designed. 00000000c o o o 0;, c o o o a o 00 c a a 00000 CC0 o c 00 oo 000. ao u coo 000 c a o oo o 000 oocooc-O CIO CC) 00 000 oc o 00 a 0 0-00.0-0.000 bd*000000c 0001000 o-ovoo oco�c�c-co c'o`op No. jA 1) c -A-5 "-Z...9 -1 0 E uA s -bvwn'i 5 FEE % W C®MMON�LTII Of MASSACHUSETTS C4 -i+ Board of Health, YAW 0 UJ -9- , MA. DISPOSAL SYSTEM CONSTRUCTION PERMIT Permission isherebygranted to; Construct( ) Repair( ) Upgrad�'Abandon( ) an individual sewage disposal system at 2l F? l� c h L5 '-� le - tA4 i Y &I ra^,-,,, `l 4 as described in the application for sI� Disposal System Construction Permit No. ,dated l✓� fib(`�'1�-z4% Provided: Construction shall be completed . within t of the date of this perm'". All local conditions must be met. Form 1255 Rev. 5/96 A.M. Sulkin Co. Charlestown, MA Date 7 '2 _. sBoard o �tl > No.: BOHDC-15-2494 '� ' Commonwealth of Massachusetts s55 00 Board of Health, Yarmouth, MA APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to:Upgrade-Complete System Location: 31 FINCH LN,WEST YARMOUTH, MA 02673 Owner: CONVEY DOROTIiY A TR Map/ParceUl:049.180 CONVEY REALTY 1RUST 159 MAIN ST BLDG 19A STONEIIAM,MA 02180 Phone: Septic System Installer Designer ELLIS BROTHERS SWEETSER ENGINEERING PO BOX 59 YARMOUTHPORT,MA P.O.BOX 713 02675 SOUTH DENNIS,MA 02660 Phone: 508-385-6900 Type of Building:Dwelling Lot Size:9,583.00 Acres ���.. DwelGng-No.of Bedrooros:3 Garbage Grinder: '�� Other Type of Building: No.of persons: Showers: ��.. Other F�tures: . Pleo Date:06/10/2015 Number of Shcets: 1 Catehria: . Title:PROPOSED SEPTTC DESIGN 31 FINCH LANE Revision Date: '��. Design Flow(min.required):330 gpd Calculated design tlow:330 gpd Design flow provided:351 gpd ', Description ot SoiIs:SEE PLAN Soil Evaluator Form No.: Name of Soil Evaluator: Date of Evaluation:06/10/20t5 � ROBIN WILCOX,PLS DESCRIPT[ON OF REPAIRS OR ALTERATIONS:REPAIR-PROPOSED 1500 GAL SEPTIC TANK,DBOX,4 HIGH CAPACITY INFILTRATORS W/STONE:36'X 11'X 10" The untlersigned agrees to insfalllhe above deseribetl Indlvidual Sewage Disposal System In accortlance wkh the provislons of TITLE 6 antl fuMer aarees not ta olace in ooeration u�l a Certificate ef Comoliance has heen issuetl 6v the Board of Heakh. Signed Date Inspecdons s Commonwealth of Massachusetts Board of Health, Yarmouth, MA F� DISPOSAL SYSTEM CONSTRUCTION PERMIT E55.00 Permission is herby granted to; ELLIS BROTHERS CONSTRUCTION, PO BOX 59,YARMOUTHPORT, MA 02675 To perform:Upgrade an individual sewage disposal system. Owner: CONVEY DOROTHY A TR CONVEY REALTY TRUST 159 MAIN ST BLDG 19A STONEHAM,MA 02180 Location: 31 FINCH LN,WEST YARMOUTH,MA 02673 Disposal System Construction Permit No.: BOHDC-15-2494,Dated:July 13,2015 Provided:ConsWction shall be completed within six months of the date of this permit. All local condi[ions must be met. Conditions 1. REPAIR-PROPOSED I500 GAL SEPTIC TANK, DBOX, 4 HIGH CAPACITY INFILTRATORS W/ ' STONE. 36'X 11'X 10" 2. MFC VARIANCE APPROVAL:a. SETBACKS ' U l.0 Bruce G. rp y, MPH, R.S., CHO/Amy L.von Hone, R.S., CHO Health Diredor/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 F88 CERTIFICATE OF COMPLIANCE sss.00 Description of Work:Complete System The undersigned hereby cer[ify that the Sewage Disposal System; Upgraded by:ELLIS BROTHERS CONSTRUCTION at:31 FINCH 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-1S2494,dated 07/29/2015. Installer:ELLIS BROTHERS CONSTRUCTION Address:PO BOX 59 YARMOUTHPORT,MA 02675 Inspector:AMY VON HONE,R.S. Designer: S WEETSER ENGINEERING Cooditions 1.REPAIR-PROPOSED 1500 GAL SEPTIC TANK,DBOX,4 HIGH CAPACITY INFILTRATORS W/STONE:36'X 11'X 10" 2.MFC VARIANCE APPROVAL: a.SETBACKS ^ � Bruce G. M hy 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. BO H_Disposal_Conshuction_CofC.rpt