HomeMy WebLinkAboutApp-Permit-ComplianceNo. O)kto —1 ✓ r z3 IL 8 t 0 TR l S 0 0 3 0- / /
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�-®NIIVI U STH ®l- NIYASSAl-ITUShTTS
Board of Health, ��47P11/l lT , MA.
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT
Application for a Permit to Construct( ) Repair( ) Upgrade�4XAbandon( ) - Complete System U Individual Components
Location 9 SS
Owner's Name
Map/Parcel#
Address SS'
Lot#
Telephone#
Installer's Name `-� G J oly Q6,7 -T-2-
Designer's Name
Address /
Address
Telephone# �'
Telephone# �, g
Type of Building
Dwelling - No. of Bedrooms
Other - Type of Building _
No. of persons
Lot Size /0, 45W sq. ft.
Garbage grinder/(
Showers ( ), Cafeteria ( )
Other Fixtures
Design Flow (min. required) �'� gpd Calculated design flow Design flow provided gpd
Plan: Date 1 la� Number of sheets K-9�- Revision Date
Title
Description of Soil(s) _�
Soil Evaluator Form No,
Name of Soil Evaluator
DESCRIPTION OF REPAIRS OR ALTERATIONS O "
Date of Evaluation
The undersignegAgees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and
further agre not to lac e s on until a Certificate of Compliance has been issued by the Board of Health.
Signed Date
�� ��
Inspections
No.)�
COMMONWEALT14 OF MASSACHUSETTS
Board of Health, Y M.OUTA , MA.
CERTIFICATE OF COMPLIANCE
FEE , . -
7
Description of Work: ❑ Individual Component(s) .W'Complete System
The undersigned hereby certify that the Sewage Disposal System; Constructed ( ), Repaired ( ), Upgraded ( ), Abandoned ( )
by:
at
has been installec'piTi'a.c-cordaiice wi`fti'se provisions of 310 CMR 15.00 (Title 5) and the approved design plans/as-built plans relating to
application No. l�- 5` dated Approved Design Flow 378 (gpd)
Installer ro
'_ �► "�-
Designer: IF AL $ 14 l di, a / Inspector: // 1 Date:
The issuance of this permit shall Zbconstrued as a guarantee thal the system will function as designed.
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No. �ar7 �C'" �j ��. I Z J FEE .�.
COMMONVVEA1.111 OF MASSACHUSETTS aAr -40 2�-
Board of Health, y9-iZM MA.
DISPOSAL SYSTEM[ CONSTRUCTION PERMIT
Permission is hereby granted to; Construct( ) Repair( ) Upgrade( --)-"-Abandon( ) an individual sewage disposal system
at L -C u ��cd 1i t I � � a+ . _ 7'Z as described in the application for
Disposal System Construction Permit No. /y r-�7 V, dated
Provided: Construction shall be completed within t44>r-. exrsof the date of this per it. All local conditions must be met.
Form 1255 Rev. 5/96 A.M. Sulkln Co. Chadeslown. MA Date(, /�— Board of Health C�✓
No.: BOHDC-15-2312
' Commonwealth of Massachusetts Fee
555.00
Board of Health, Yarmouth, MA
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT
, Application for a Permit to:Upgrade-Complete System
I Location:455 LONG POND DR, SOUTH YARMOUTH, MA 02664 Owner:
iKARRAS JOHN M
� Map/Parcel#: 079.121 KARRAS CATHI,EEN C
! 2112 SOUTf�RLAND BLUFF DRIVE
� TOWNSEND,GA 31331
Phone:
Septic System Iustaller Designer
ELLIS BROTHERS EAS SURVEY.INC.
, 23 ENTERPRISE ROAD p,0.BOX 1729
YARMOUTHPORT, MA 02675 SANDWICH,MA 02563
Phone:
(5081888-3619
Type of Building:Dwelling Lot Size: 1Q454.40 Acres
Dwelling-No.of Bedrooms:3 Garbage Grinder.
Other Type of Building: No.of persons: Showers:
Other Fixtures:
Plan Date:02/07/2015 Number of Sheets:2 Cafeteria:
Title:SI1'E&SEWAGE REPAIR PLAN 455 LONG POND DRIVE Revision Date:
Design Flow(min.required):330 gpd Calwlated desigo flow:330 gpd Design Flow provided:378 gpd
Description of Soi1s:SEE PLAN � �
Soil Evaluator Form No.: Name of Soil Evaluator: Date of Evaluation:04/292015
EDWARD STONE,PLS
� DESCRIPTION OF REPAIRS OR ALTERATIONS:REPAIR- 1500 GAL SEPTIC TANK,DBOX,27 QUICK 4 INFILTRATORS W/
STONE:36'X 8S X 8"
7he undersigned agrees to Install the above describetl Individual Sewage Disposal System in accoMance wkh the provislons of
� TITLE 5 and further anrees not to olace in ooeretlon until a Cekifitate of Comoliance has been issuetl bv the 8oard of Fleakh.
Signed Date
Inspections
i
� Commonwealth of Massachusetts
Board of Health, Yarmouth, MA Fae
i DISPOSAL SYSTEM CONSTRUCTION PERMIT ass.00
I
i
i
� Permission is herby granted to;
IELLIS BROTHERS CONSTRUCTION, 23 ENTERPRISE ROAD,YARMOUTHPORT,MA 02675
To perform: Upgrade an individual sewage disposal system.
Owner. KARRAS JOHN M
� KARRAS CATHI.EEN C
2112 SOUTHERLAND BLUFF DRIVE
� TOWNSEND,GA 31331
Location:455 LONG POND DR, SOUTH YARMOUTH,MA 02664
Disposal System Coastruction Permit No.: BOHDC-1S2312 ,Dated:June Ol,2015
i Provided:Construction shall be completed within six months of the date of this permit. All local conditions must be met.
Conditions
, 1. REPAIR-I500 GAL SEPTIC TANK, DBOX, 27 QUICK 4 INFILTRATORS W/STONE: 36'X 8.5 X 8"
2. MFC VAIUANCES: 1. SETBACKS
3. PLUMBING PERMIT REQUIRED
:ll
Bruce G. Murp , M H, R.S., CHO/Amy L. von Hone, R.S.,CHO
ealth Director/Assistant Health Diredor
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 F�
CERTIFICATE OF COMPLIANCE sss.00
Description of Work:Complete System
The undersigned hereby certify that the Sewage Disposal System; Upgraded
by:ELLIS BROTHERS CONSTRUCTION
at:455 LONG POND DR, SOUTH YARMOUTH,MA 02664
Has been installed in accordance with the provisions of 3]0 CMR 15.00(Title 5)and the approved
design plans or as-built plans relating to application No.: BOHDC-15-2312,dated 06/23/2015.
Installer:ELLIS BROTHERS CONSTRUCTION
Address:23 ENTERPRISE ROAD YARMOUTHPORT, Inspector:AMY VON HONE,R.S.
MA 02675
Designer:EAS SURVEY,INC.
Condifio�s
1.REPAIR- 1500 GAL SEPTIC TANK,DBOX,27 QUICK 4 INFILTRATORS W/STONE:36'X
8.5 X 8"
2.MFC VARIANCES: 1.SETBACKS
3.PWMBING PERMIT REQUIRED yJ� �
(
Bruce G. Murphy, H, R.S., CHO/Amy L.von Hone, R.S., CHO
� Health Director/Assistant Health Director
The issuance oF t6is permit shall not be construed as a guarant¢e that the system will functian as designed.
BOH_Disposal_Construction_CofC.rpt