HomeMy WebLinkAboutApp-Permit-ComplianceNo. 804tc-[ 5-4 l Zq Al,;4, /54 V
COMMONWEALTH LTH ®F MASSACHUSETTS
Board of Health, ), Ai@jL10 t H , MA.
FEE $ 5-5-- no
dt4 33-3 LN
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT
Application for a Permit to Construct( ) Repair grade( ) Abandon( - ❑ Complete System 4Individual Components
Location 48
OPREWS CK ROA
Owner'sName Atmj - P A;4 Amos
Map/Parcel#-L3
2Address
i D TLiZz _ 0
Lot#
Telephone#
Installer's Name e4Pz
Designer's Name
Address j 3
�D, �,_ MA.iPeLs-
Address
Telephone#
5 d 8- 4-7'1 _ VS7
Telephone#
Type of Building Rest b6&)TiA-C. Lot Size sq. ft.
Dwelling - No. of Bedrooms Garbage grinder ( )
Other - Type of Building - No. of persons Showers ( ) , Cafeteria ( )
Other Fixtures
Design Flow (min. required)
Plan: Date
Title
Description of Soils)
Soil Evaluator Form No.
gpd Calculated design flow
Number of sheets
Design flow provided
Revision Date
Name of Soil Evaluator Date of Evaluation
DESCRIPTION OF REPAIRS OR ALTERATIONS���
gpd
The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and
further agreSsAo not to place the system in operation until a Certificate of Compliance has been issued by the Board of Health.
Signed Date 9 e ZrS-.26 Z 5
Inspections
COMMONWEALTH Of MASSACHUSETTS
Board of Health, 1A(Li' ou-na , MA.
�?
CERTIFICATE OF COMPLIANCE
Description of Work: X Individual Component(s) ❑ Complete System
The undersigned hereby certify that the Sewage Disposal System; Constructed ( ),Repaired Upgraded ( ), Abandoned ( )
by: C 62L --CEJ IClGjjp09 $ % LLC
at
has been installedV'0a9Mnc'e"'w1t—ht1Tegrovistons of 310 CMR 35.00 (Title 5) and the approved design plans/as-built plans relating to
application No. /qd , dated 1' / . Approved Design Flow (gpd)
It
Installer+
Designer: Inspector: Date:
The issuance of this permit shall not be construed as a guarante that the system will function as designed.
No. O - iS -�t ZT CA PQA) I'D C- FEE cJ 00
C® ON LTU -OF MASSAC14USETTS c, 33-�614`I
Board of Health, Ymnmour - , MA.
DISPOSAL SYSTEM[ CONSTRUCTION PERMIT
Permission is hereby granted to; Construct( ) Repain(.,�Ijpgrade( ) Abandon( ) an individual sewage disposal system
at
+LW�as described in the application for
QQ
Disposal System Construction Permit No. -/7�, dated
Provided: Construction shall be completed within threeyeW o the date of this permit. All local conditions must be met
Form 1255 Rev. 5/96 A.M. Sulkin Co. Charlestown, MA Date 9-4 Board of Healthy
No.:BOHDGIS-4424
Commonwealth of Massachusetts Fee
sss.00
Board of Health, Yarmouth, MA
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT
I
Application for a Permit to:Repairminor-Individual Component(s) ;
Location:48 BREWSTER RD,WEST YARMOUTH, MA 02673 Owner: I
I
PARIANOS MICHAEL ���.
Map/Parcedl: 029238 PARIANOS ADRIANA
10 TURTLEBACK RD
� ESSEX,MA 01929 j
{
Phone: �
Septic System Installer
Designer �
CAPEWIDE RJ O'HEARN
153 COMMERCIAL STREET 1348 ROUTE 134
MASHPEE, MA 02649 EAST DENNIS,MA
Phone:
Type of Buildiog:Dwelling Lot Size: 11,326.00 Acres
Dwelliog-No.of Bedrooms:3 Garbage Grinder:
Other Type of Building: No.of persoos: Showers: ;,
Other Fiatures:
Plan Date:04/12/1984 Number of Sheets: 1 Cafeteris: �'
Title: Revisioo Date:OS/22/1984
Design Flow(min.required):330 gpd Calculated design ilow:330 gpd Desigo flow provided:420 gpd
Descripfioo of Soi1s:SITE PLAN LOTS 87/89 BREWSTER,YARMOUTH ��.
Soil Evaluator Form No.: Name of Soil Evaluator: Date of Evaluation: �
DESCRIPTION OF REPAIRS OR ALTERATIONS:SEPTIC DISPOSAL-MINOR REPAIR-REPLACE DBOX TO EXISTING 1500 GAL
SEPTIC TANK,30'LEACH TRENCH
7he undersignetl agrees to install the above tlescrlbed Intlividual Sewage Dlaposal System in accoNanee wkh the provislons of
TITLE 6 and further aarees not tn olate in oceration untll a Cerfificate of Comoliance has heen issued hv the Bosrd of HeaHh.
Signed Date
Inspections
I'
Commonwealth of Massachusetts
Board of Health, Yarmouth, MA F�
DISPOSAL SYSTEM CONSTRUCTION PERMIT ass.00
Permission is herby granted to;
CAPEWIDE ENTERPRISES, LLC, 153 COMMERCIAL STREET, MASHPEE,MA 02649
To perform:Repair-minor an individual sewage disposal system.
Owner: PARIANOS MICHAEL ��
PARIANOS ADRIANA �
]0 NRTLEBACK RD '.
ESSEX,MA 01929 �
Location:48 BREWSTER RD,WEST YARMOUTH,MA 02673
Disposal System Construcrion Pernut No.:BOHDG1S4424,Dated: September 04,2015
Provided:Construction shall be completed within six months of the date of this peani[. All local conditions must be met.
CONDITIONS:
1. SEPTIC DISPOSAL-MINOR REPAIR-REPLACE DBOX TO EXISTING 1500 GAL SEPTIC TANK,30'LEACH
TRENCH
` �/LL�O /l
Br�uce C�'ulu hy,MPH, R.S., CHO/A y L.von Hone, R.S.,CHO
� Heatth Director/Assistant Health Diredor
�
The issuance of this permit shall not be construed as a guarantee that the system will fuoMion as designed.
Commonwealth of Massachusetts
Board of Health, Yarmouth, MA Faa
CERTIFICATE OF COMPLIANCE sss.00
Description of Work:Individual Component(s)
The undersigned hereby certify that the Sewage Disposal System; Repair-minor
by:CAPEWIDE ENTERPRISES,LLC
at:48 BREWSTER RD,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-1S4424,dated 09/04/2015.
Installer:CAPEWIDE ENTERPffiSES,LLC
Address:153 COMMERCIAL STREET MASHPEE,MA Inspector:AMY VON HONE,R.S.
02649
Designer:RJ O'HEARN
V��
Bruce G. M h ,MPH, R.S., CHO/Amy L.von Hone, R.S.,CHO
Health Diredor/AssistaM Health Diredor
The issuance ot this permit shall not be construed as a guarantee that the system will function as designed. ',
BO H_Disposal_Construction_CofC.rpt