HomeMy WebLinkAboutApp-Permit-ComplianceNo. F7E7 e`-11� ' 179 l�l-� �G —000 9 1 � FEE 4$ 5v(D()
COMMONWEALTH OF MASSACHUSETTS
Board of Health, — gwOTU , MA•
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT
Application for a Permit to Construct( ) Repair( ) Upgrade Abandon() - Complete System ❑ Individual Components
LocationOwner's
Name SS
Map/Parcel# C\ r
V
Address S- /� "("k3
S
Lot# CA
Telephone#
Installer's Name M ���
Designer's Name
Address
Telephone# SoC.y C)dwl
Address a7 � eO-, L
Telephone#
W
Type of Building h ��� Lot Size :D Q i T sq. ft.
Dwelling - No. of Bedrooms Garbage grinder (�
Other -Type of Building No. of persons Showers( ) , Cafeteria ( )
Other Fixtures
Design Flow (min. (required) _ � � � gpd Calculated design flow�� Design flow provided � � gpd
Plan: Date Number of sheets Revision Date
Title
Description of Soil(s) _
Soil Evaluator Form No.
Name of Soil Evaluator
Date of Evaluation
DESCRIPTION OF REPAIRS OR ALTERATIONS X
The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TrfLE 5 and
further agree o not to place the system in operation until a Certificate of Compliance has been issued by the Board of Health.
Signed Date 7�
Inspections
00
No. tlkp 9 J' FEE
t
j- - commoNwEALTH ®f MASSACHUSETTS
Board of Health, ! ( i1nOl��' , MA.
CERTIFICATE Of COMPLIANCE
Description of Work: ❑ Individual Component(s) GKComplete System
The undersigned hereby certify that the Sewage Disposal System; Constructed ( ), Repaired drUpgraded ( ), Abandoned ( )
by:
at
0
has been insta?,- in &49h e 1 tli-11ro�isions��o��f310 CMR 15.00 (Title 5) and the approved design plans/as-built plans relating to
application No. /'ri / �� dated Approved Approved Design Flow(gpd)
^ � s
FInstaller
Designed -t �� ��� Inspector: i./ Dater
The issuance of this permit shall not be construed as a guar4n ee that the system will function as designed
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No. & R DC - C?" 3 759 C.Gi"['(. k" V— FEE 1 1
7,� COMMONWEALTH OF MASSACHUSETTS
Board of Health,— i IYO 0714 , Am -
DISPOSAL SYSTEM CONSTRUCTION PERMIT
Permission is hereby granted to; Construct( ) Repairy Upgrade( ) Abandon( ) an individual sewage disposal system
at ;�V o AS--, as described in the application for
Disposal System Construction Permit No. dated
i� ", 3
Provided: Construction shall be corn eted within of the ate of this permit. Al cal conditions st be met.
Form 1255 Rev. 5/96 A.M. Sulkin Co. Charlestown, MA Date � �- ��Board of Health
f
No.:BOHDC-15-3939 ��.
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
Locafion: 1 DENISE LN, SOUTH YARMOUTH,MA 02664 Ow°er' 'I
WALSH JESSICA L
Map/Parcel#:069.168 1 DENISE LN i
SOU1'H YARMOUTH,MA 02664 �
Phone:
Septic System Installer Designer
STEP i
� 113 OLD YARMOUTH ROAD HYANNIS, P.O.BOX 16
MA 02601 SOUTH DENTIIS,MA 02660
Phone: '
�
Type of Butlding:Dwelling Lot Size:7,405.00 Acres �
Dwelling-No.of Bedrooms:3 Garbage Grioder. I
I
Other Type of Building: No.of persons: Showers: �
Other Fiactures:
Plao Date:07/28/2015 Number of Sheets: 1 Cafeteria: :
TiUe:SETPIC SYSTEM DESIGN 1 DENISE LANE Revision Date: �-
Design Flow(min.required):330 gpd Calculated design flow:330 gpd Design ilow provided:348 gpd :
Description of Soi1s:SEE PLAN I
Soil Evaluator Form No.: Name of Soil Evaluator: Date of Evaluatioo:07/23/2015 '�,
STEPHEN HAAS,PE I
DESCRIPTION OF REPAIRS OR ALTERATIONS:SEPTIC DISPOSAL-REPAIR-PROPOSED 1500 GAL SEPTIC TANK,H-20 DBOX, I,�
2-500 GAL H-20 PRECAST CHAMBERS W/4'STONE:25'X 12.8'X 2' .�
.. The unAersigned agreea to install the above describetl Individual Sewage Disposal System in aeeordance wkh the provisions of '
TITLE 6 antl turther aarees not W olace in ooeradon until a Certlflcate of Comolianee has heen insuad W the Board of Fleakh.
Signed Date
Inspections
'
. Commonwealth of Massachusetts
Board of Health, Yarmouth, MA Fee
' DISPOSAL SYSTEM CONSTRUCTION PERMIT sss.00
i
Permission is hereby granted to;
Gd L
To perform: Upgrade an individual sewage disposal system. '
Owner: WALSH JESSICA L
1 DENISE LN
SOUTH YARMOUTH,MA 02664
I.ocation: 1 DENISE LN, SOUTH YARMOUTH, MA 02664 ;
Disposal System Construction Permit No.: BOHDC-15-3939 , Dated: August 25,2015
Provided: Construction shall be completed within six months of the date of this permit. All local conditions must be met.
CONDTIONS: �
1. SEPTIC DISPOSAL- REPAIR- PROPOSED 1500 GAL SEPTIC TANK, H-20 DBOX, 2-500 GAL j
H-20 PRECAST CHAMBERS W/4'STONE:25'X 12.8'X 2'
2. MFC VARIANCE APPROVALS: a. FOUNDATION SETBACKS b. DRAINAGE SETACKS c.
PROPERTY LINE SETBACKS
i l
�i '
Bruce G. Mu hy, PH, R.S., CHO Amy L. von Hone, R.S., CHO
Health Director/Assistant Health Director
� he issuance of this permit shall not be construed as a guarantee that the system will function as design
Commonwealth of Massachusetts
� Board of Health, Yarmouth, MA FeB
' CERTIFICATE OF COMPLIANCE sss.00
;
I
; Description of Work:Complete System
IThe undersigned hereby certify that the Sewage Disposal System; Upgraded
by:
at: 1 DENISE LN,SOUTH YARMOUTH,MA 02664
Has been installed in accordance with the pmvisions of 310 CMR 15.00(Title 5)and the approved
design plans or as-built plans relating to application No.: BOHDC-1S3939,dated 09/03/2015.
Installer:
Address:113 OLD YARMOUTH ROAD HYANNIS, Inspector:AMY VON HONE,R.S.
MA 02601
Designer: STEP
UCS�'
' Bruce G. Murp ,M H, 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 functioo as designed.
BOH_Disposal_Construcction_CofC.rpt