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HomeMy WebLinkAboutApp-Permit-ComplianceNo. 1/� C®MM® I,TII M" AS ACHUSETTS Board of Health, MA. FEE % APPLICATION FOR DISPOSAL SYSTEM[ CONSTRUCTION PERMIT Application for a Permit to Construct( ) RepairX Upgrade( ) Abandon( ) - ® Complete SystemXIIndividual Components Location Lj k 117—t el N Owner's Name r.51 y., IGI Map/Parcel# 616 /) 2,0 Address } Lot# 2 Telephone# Installer's Namer l An -r Designer's Name Address -1 ���1Address L Telephone# 60q _-1 -7 _ 0:6 S Telephone# 1501 - 329 - 4L C1 2 Type of Building :. Dwelling - No. of Bedrooms Other - Type of Building _ No. of persons Other Fixtures Design Flow (min. required) 1 a gpd Calculated design flow 330 Plan: Date t4 /g4 Z /4 Number of sheets Title Description of Soil(s) _ Soil Evaluator Form No. Name of Soil Evaluator Lot Size 10, 00 0 sq. ft. Garbage grinder ( ) Showers ( ), Cafeteria ( ) Design flow provided 4,5 °) - 47 gpd Revision Date Date of Evaluation DESCRIPTION OF REPAIRS OR ALTERATIONS �t �O �h c L L'x ( 000 �c..��vr+ _ _ 11' \,+ V b r.. 33 • S ' X 13 1��,1_ 11._.1,1 ��NL 3 9;0,0 The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further agrees ton the sVstem in operation until a Certificate of Complia�c as been issued by the Board of Health. Signed Dated �i JI y Inspections No.FEE bo p f �- I COMMONWEALTH OF MASSACHUSETTS , (/ Board of Health, Y&/2.n4 0 V MA. v O 4 CERTIFICATE ©f COMPLIANCE 64-* 1735 Description of Work: Individual Component(s) U Complete System The undersigned hereby certify that the Sewage Disposal System; Constructed ( ), Repaired (x), Upgraded ( ), Abandoned ( ) by: !fD-e a n L. r1 ,,% ^\) - has been installed}c ore�arlce wifli/fhe p'rovisior.4_s9f 10 CMR 15.00 (Title 5) and the pproved design plans/as-built plans relating to application No. J J/ 7 ,dated - % / Approved Design Flow (gpd) �, n Installer 'jE�E!,►'�/ / Designer: �� l�t; S > - Inspector: ! Date: B L The issuance of this permit shall not be construed as a guaranee that the system will function as designed. No. FEE cJ� COMMONWEALTHU MASSACHUSETTS Board of Health, rZAD , MA. 1 O DISPOSAL SYSTEM CONSTRUCTION PERMIT Permissionishereby granted to; Construct( ) Repair(`) Upgrade( ) Abandon( ) an individual sewage disposal system at—6 J j Q S �o ,l.L \/1 11111 -L. as described in the application for Disposal System Construction Permit No. % , dated — r/4-- . —/S Provided: Construction shall be completed withinars o the date of this per, ;nit. fAll local conditions must be met. Form 1255 Rev. 5/96 A.M. Sulkin Co. Charlestown, MA Date 7-/- /4' Board of Healthz%,�' i No.:BOHDGIS-1711 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: 6 LAKEFIELD RD, SOUTH YARMOUTH, MA 02664 Owner: �: SKEHILL PATRICK S TRS Map/PBCceI#: 068.137 SKEHII,L ELLEN M TRS 8 PAULMAN CIR j � WEST ROXBURY,MA 02132 Phone: Septic System Installer Designer SEAN ENRIGHT WELLER&ASSOCIATES 70 LONGFELLOW DRIVE P.O. BOX 417 i YARMOUTHPORT, MA 02675 CENTERVII,LE, MA 02632 Phone: (5081328-4692 i , �� Type of Building:Dwelling Lot Size: 10,018.80 S.F. i �� Dweting-No.of Bedrooms:3 Garbage Grinder: Ot6er Type of Building: No.of persons: S6owers: . Other Fixtures: ; Plan Date:04/24/2014 - Number of Sheets: 1 Cafeteria: Title:SITE&SEWAGE PLAN 6 LAKEFIELD ROAD Revision Date: Desigu F7ow(min.required):330 gpd Calwlated design flow:330 gpd Design flow provided:459.9 gpd Descripdon of Soi1s:SEE PLAN � Soil Evaluator Form No.: Name of So0 Evaluator: Date of Evaluadon:04/16/2014 DARREN MEYER,R.S. DESCRIPTION OF REPAIRS OR ALTERATIONS:REPAIR-EXISTING 1000 GAL POLY SEPTIC TANK,H-20 DBOX,3-500 GAL � PRECAST CHAMBERS W/4'STONE:33.5'X 13'X 2' . The undersigned agrees to insWll the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further agrees not to place in operation until a Certificate of Compliance has been issued by the Board of Health. Signed Date Inspections Commonwealth of Massachusetts Board of Health, Yarmouth, MA Fee DISPOSAL SYSTEM CONSTRUCTION PERMIT sss.00 Permission is hereby granted to: SEAN ENRIGHT, 70 LONGFELLOW DRIVE, YARMOUTHPORT, MA 02675 To perform: Upgrade an individual sewage disposal system. Ownec SKEHILL PATRICK S TRS SKEHILI,ELLEN M TRS 8 PAOLMAN CIR � WEST ROXBURY,MA 02132 Location: 6 LAKEFIELD RD, SOUTH YARMOUTH, MA 02664 Disposal System Construction Permit No.: BOHDGIS-1711 , Dated: April 14,2015 � Provided: Construction shall be completed within six months of the date of this permit. All local conditions must be met. � Conditions ' 1. REPAIR-EXISTING 1000 GAL POLY SEPTIC TANK, H-20 DBOX, 3 - 500 GAL PRECAST CHAMBERS W/4'STONE: 33.5'X 13'X 2' 2. ZONE77MAXIMUM3 BEDROOMS � � � Bruce G. Murphy, PH, R.S., CHO/Amy L. von Hone, R.S., CHO Hea Director/Assistant Health Director i � i 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 $55.00 Description of Work: Individual Component(s) The undersigned hereby certify that the Sewage Disposal System; Upgraded by: at:6 LAKEFIELD RD,SOUTH YARMOUTH,MA 02664 Has been installed in accordance with the provisions of 3l0 CMR 15.00(Title 5)and the approved desig�plans or as-built plans relating to application No.: BOHDG1S1711,dated OS/12/2015. Installer: Address:70 LONGFELLOW DRIVE Inspector:AMY VON HONE,R.S. YARMOUTHPORT,MA 02675 Designer: WELLER&ASSOCIATES Conditions 1.REPAIR-EXISTING 1000 GAL POLY SEPTIC TANK,H-20 DBOX,3-500 GAL PRECAST CHAMBERS W/4' STONE: 33.5' X 13' X 2' 2.ZONE II MAXIMUM 3 BEDROOMS So l� � Bruce G. ur 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 desigoed. BOH_Disposal_Construdion_CofC.rpt