HomeMy WebLinkAboutApp-Permit-ComplianceNo.
4
APl
j
��� 29 "7 � Lam'/ L!'(, FEE
COMMONWEALT14 OF
Board of Health, fUCniO h MA.
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT
for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) - ❑ Complete System ❑ Individual Components
L
cation w
Owner's Name
Map/Parcel#
Address i p
Lot#rAfe CO"Il
Telephone#5 Ob .'77' –13'i�'"
Installer's Name t V; i�in
Designer's Name C Q ;
M my kin cnceAddress
) C
Address `'1 9'k 1 C
Telephone# "� g_ _
Telephone#Jo
Type of Building i�rSti(�tl��Q� Lot Size �r / � >
Dwelling - No. of Bedrooms Garbage grinder ( )
Other - Type of Building No. of persons Showers ( ) , Cafeteria ( )
Other Fixtures
Design Flow (min. required) "NDQ) gpd Calculated design flow Design flow provided gpd
Plan: Date au, dols Number of sheets Revision Date
Title
Description of Soil(s)
Soil Evaluator Form No.
Name of Soil Evaluator
DESCRIPTION OF REPAIRS OR ALTERATIONS
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 agrees t pplace the syste tion until a Certificate of Compliance has been issued by the Board of Health.
' Signed ®�'�Date :5 %zm: ' 9
No. 66N''DC-'� 1
'k" ' I%/ FEE
COMMONWEALTH OF --,MASSACHUSETTS
Board of Health,
CERTIFICATE OF COMPLIANCE
b�� r�
Description of Work: ❑ Individual Component(s) ❑ Complete System
The undersigned hereby certify that the Sewage Disposal System; Constructed ( ), Repaired graded( ), Abandoned ( )
by: ��-�c MC �,• rAPIF GOD SemG SVGS
at ck'o lt7C
has been instafl'eciin ac`corcfalice with &( rovisiRns of CMR 15.00 (Title 5) and thee design plans/as-built plans relating to
application No. �p dated l6 Approved Desi n Flow (gpd)
Installer _
-it�.+ito�C. (- El, � W"(JG– inspector:
Designer: p
CSG.! Date:
The issuance of this permit shall not be construed as a guarV a that the system will function as designed.
No. '..15-2Z91 CAFC— COD v ETT)c SKS FEE
7 COMMONWEALT14 OF MASSACHUSETTS
7(Rct�C��?�1 �.
Board of Health, ,
DISPOSAL SYSTEM CONSTRUCTION PERMIT
Permission is hereby granted to; Construct( ) RepairUpgrade ( ) Abandon( ) an individual sewage disposal system
at 1 1 �1t+Ct �J ��, as described in the application for
Disposal System Construction Permit No. , dated S" SrS V
Provided: Construction shall be completed within t tr �'' -aL ..^f the e of this lpermit. A1Nocal conditions must be met.
` L l
Form 1255 Rev. 5/96 A.M. Sulkin Co. Boston, MA Date% ��! Board of Health
J� No.:BOHDC-15-2897
' Commonwealth of Massachusetts F�
S55.00
Board of Health, Yarmouth, MA
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERNIIT
� Application for a Permit to:Upgrade-Individual Component(s)
Location: 10 BAYVIEW ST,WEST YARMOUTH, MA 02673 Owner:
BAXTER ELIZABETH F 1R
Mep/Parcel#: 036.4 ELIZABETH F BAX1'ER TRUST
I 149 PLEASANT ST
i HYANNIS,MA 02601
' Phone:
f SepHc System Installer Designer
CAPE COD SEPTIC DOWN CAPE ENGINEERING,INC.
350 ROUTE 28 WEST YARMOUTH, MA 939 ROUTE 6A
02673
Phone: 1'f1RMOUTHPORT,MA 02675
508-362-4541
i Type of BuOdiog:Dwelling Lot Siu:4Q075.00 Acres
iDwelling-No.of Bedrooms:3 Garbage Grinder:
Other Type ot Building: No.of persons: Showers:
Other Fictures:
Plao Date:06/26/2015 � Number otSheets: 1
Cateteria:
Title:7'ITLE 5 SITE PLAN 10 BAYVIEW STREET Revisioo Date:
Design Flow(mio.required):330 gpd Calculated design flow:330 gpd Design ttow provided:349 gpd
Descriptioo of SoOs:SEE PLAN
, Soil Evaluator Form No.: Name of Soil Evaluator. Dah of Evaluation:06/24/2015 '�
Dr1NIEL GONSALVES,SE '
DESCRIPTION OF REPAIRS OR ALTERATIONS:SEPTIC DISPOSAL-REPAIR-EX[STING 1500 GAL SEPTIC TANK,H-20 DBOX,2
-500 GAL H-20 PRECAST LEACH CHAMBERS W/4'STONE:25'X 12.83'X 2'
The undersigned agrees W Insfalllhe above deseribetl IndWitlual Sewage Dbpoaal Syatem in accordanee wkh the provisbna of
TIttE 5 anA further aarees not tn olace in ooerotion unfil a Certificate of Comoliance has heen issued hv the Board of Heslth.
Signed Date
[nspec[ions �,
i
�
I
' Commonwealth of Massachusetts
� Board of Health, Yarmouth, MA Fee
DISPOSAL SYSTEM CONSTRUCTION PERMIT sss.00
Permission is hereby granted to;
CAPE COD SEPTIC SERVICES, 350 ROUTE 28,WEST YARMOUTH, MA 02673
To perform: Upgrade an individual sewage disposal system.
Owner. BAXTER ELIZABETH F TR
I ELIZABETH F BAXTER TRUST
149 PLEASANT ST
HYANNIS,MA 02601
Location: 10 BAYVIEW ST, WEST YARMOUTH, MA 02673
Disposal System Construction Permit No.: BOHDGIS-2897 , Dated:August 18,2015
Provided: Construction shall be completed within six months of the date of this permit. All bcal conditions must be met.
CONDITIONS:
1. SEPTIC DISPOSAL-REPAIR- EXISTING 1500 GAL SEPTIC TANK, H-20 DBOX, 2-500
GAL H-20 PRECAST LEACH CHAMBERS W/4'STONE:25'X 12.83'X 2'
2. ZONE II MAXIMUM 3 BEDROOM PLUS OFFICE(0.92 ACRE PARCEL)
�' �V�'l
Bruce G. Mu y, PH, R.S., CHO/Amy L.von Hone, R.S., CHO
ealth Director/Assistant Health Director
The issuance of this permit shall not be construed as a uarantee that the system will function as designed.
I