HomeMy WebLinkAboutApp-Permit-ComplianceNo. a/Vri �C ' �'bc7�o ✓<�!! "'^� �1 / ®,lt� Gt %� EGOt'6,2,
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COMMONWEALTH OF MASSAC14USETTS
1
Board of Health, MA.
APPLICATION FOP, DISPOSAL SYSTEM[ CONSTRUCTION PERMIT
Application for a Permit to Construct( ) Repair (V Upgrade( ) Abandon() - Complete System ❑ Individual Components
Location 38
Owner's Name j' Leo
Map/Parcel#11
Address �'
Lot# 83A
Telephone# 32 �L X29
Installer's Name Mirml A.
Designer's Names' Lh '
Address P0. So
Address 20.,3 SLEtickel RA, So �n
Telephone#
Telephone# JE,2 _
Type of Building Lot Size /5- 6 Ifo sq. ft.
Dwelling - No. of Bedrooms 3 Garbage grinder ( )
Other - Type of Building �l ��p ��l®a9 i ��/ No. of persons Showers ( ) , Cafeteria ( )
Other Fixtures
Design Flow (min. required) gpd Calculated design flow Design flow provided gpd
Plan: Date O Number of sheets _ / Revision Date &A �'�, 20 /s'
Title !'
Description of Soil (s)
Soil Evaluator Form No.
Name of Soil Evaluator
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 to not to place the system in operation until a Certificate 7of Compliance has been issued by the Board of Health. J./
Signed Date Z0457
N
Inspections
9
No. 500C,
16 *3(04
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COMMONWEALTH OFMASSAC1IUSETT$k,7-,)-/-k/
Board of Health, YA(L(kj®(j]}j , MA.
CERTIFICATE Of COMPLIANCE
Description of Work: ❑ Individual Component(s) $Complete System
The undersigned hereby certify that the Sewage Disposal System; Constructed ( ), Repaired ( ), Upgraded, andoned ( )
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by: f ,G�
at Ss tlwcaw,
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has been installe'crijnacc danFe 71tovisions of 310 CMR 15.00 (Title 5) and the
approved design plans/as-built plans relating to
application No. /rI %'�� dated "?� % Approved Design Flow-,'7,�- (gpd)
Installer N mywq A • P v
Designer: �5 A)&--, T C-mo*(rRfInspector: i (✓CJ: Date:
The -issuance of this permit shall not be construed as a guar ee that the system will function as designed.
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No. °'irj !E-(�PS . �t C FEE
Board of Health, VAP-molnnl MA.
DISPOSAL SYSTEM CONSTRUCTION PERMIT
Permission is hereby granted to; Construct( ) Repair( ) Upgrade�-<Abandon( ) an individual sewage disposal system
at 39 J ; A{c:loodyeatze as described in the application for.
�3 _ �_..
Disposal System Construction Permit No. % � _, d ated
Provided: Construction shall be co leted within —s of the date of this perm't. l local condi ' ns must be met.
6
Form 1255 Rev. 5/96 A.M. Sulkin Co. Chadestown, MA Date Z— Board of Health t✓
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No.:BOHDGIS-0364
� Commonwealth of Massachusetts F�
Sss.00
Board of Health, Yarmouth, MA
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT
Application for a Permit to:Upgrade-Complete System
Location: 38 LINCOLN AVE,WEST YARMOUTH, MA 02673 Owner:
LASTELLA BETTIE A
Map/Parcel#: 054.11 GALLON B A&SCIABARRASI B A
395 GRANT AVE
SATELLITE BEACH,FL 32937
Phone:
Septic System Installer Designer
PHELP INC. S WEETSER ENGINEERING
P.O. BOX 1084 SOUTH YARMOUTH, P.O.BOX 713
MA 02664 SOUTH DENNIS,MA 02660
Phone: 508-385-6900
Type of Building:Dwelling Lot Size: 15,682.00 Acres
Dwelling-No.of Bedrooms:3 Garbage Grinder.
Other Type of Building: No.of persoos: Showers:
Other Fixtures:
Plan Date:OS/18/2015 Number of Sheets: 1 Cafeteria:
Tit1e:PROPOSED SEPTIC DESIGN 38 LINCOLN AVENUE Revision Date:06/18/2015
Design Flow(min.required):330 gpd Calculated design Flow:330 gpd Design Flow provided:351 gpd
Description of Soi1s:SEE PLAN
Soil Evaluator Form No.: Name of Soil Evaluator: Date of Evaluatioo:05/14/2015
, ROBIN WILCOX,PLS
DESCRIPTION OF REPAIRS OR ALTERATIONS:REPAIR-PROPOSED 1500 GAL SEPTIC TANK,DBOX,4 HIGH CAPACITY
INFILTRATORS W/STONE:36'X 11'X 10"
The undersigned agrees to insfall the above described Individual Sewage Disposal System in accordance wkh the provisions of
TITLE 5 and further aarees not to olace in ooeration until a Cerfifieate of Comoliance has 6een issued bv the Board of Heakh.
Signed Date
Inspections
Commonwealth of Massachusetts
` Board of Health, Yarmouth, MA F�
DISPOSAL SYSTEM CONSTRUCTION PERMIT ass.ao
Permission is herby granted to;
PHELP INC., P.O. BOX 1084, SOUTH YARMOUTH, MA 02664
To perform: Upgrade an individual sewage disposal system.
Owner. LASTELLA BETTIE A
GALLON B A&SCIABARRASI B A
395 GRANT AVE
SATELLITE BEACH,FL 32937
Location: 38 LINCOLN AVE, WEST YARMOUTH,MA 02673
Disposal System Construction Permit No.: BOHDC-1�0364,Dated:July 09,2015
Provided:ConsWction shall be completed within six mon[hs of the date of this permit. All local conditions must be met.
CondiHons
I. REPAIR-PROPOSED I500 GAL SEPTIC T.91VK, DBOX, 4 HIGH CAPACITY INFILTR4TORS W/
STONE: 36'X 11'X 10"
2. MFC VARIANCE APPROVAL: a. GROUNDWATER ADJUSTMENT
3. ZONE II MAXIMIJM 3 BEDROOMS
'���/U�/�%��
Bruce G. Murphq, PH, R.S., CHO/Amy L. von Hone, R.S., CHO
Health Diredor/Assistant Health Diredor
/
The issuance of this permit shall not be conshued as a guarantce that the system will function as designed.
Commonwealth of Massachusetts
Board of Health, Yarmouth, MA Fee
CERTIFICATE OF COMPLIANCE ass.00
Description of Work:Complete System
The undersigned hereby certify that the Sewage Disposal System; Upgraded
by:PHELP INC.
at:38 LINCOLN AVE,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-1S0364,dated 07/23/2015.
Installer:PHELP INC.
Address:P.O.BOX 1084 SOUTH YARMOUTH,MA Inspector:AMY VON HONE,R.S.
02664
Designer: S WEETSER ENGINEERING
Conditions
1.REPAIR-PROPOSED 1500 GAL SEPTIC TANK,DBOX,4 HIGH CAPACITY INFILTRATORS
W/STONE:36'X 11' X 10"
2.MFC VARIANCE APPROVAL:a.GROUNDWATER ADNSTMENT
3.ZONE II MAXIMUM 3 BEDROOMS ��'��/;'�L/,C���"1
(X,e 'l
Bruce G. Murph , PH, R.S., CHO/Amy L. von Hone, R.S.,CHO
Health Director/Assistant Health Diredor
The issuance of this permit shall not be construed as a guarSntee that the system will function as designed.
BOH_Disposal_ConsW dion_CofC.rpt