HomeMy WebLinkAboutApp-Permit-ComplianceNo. 80wor -1,5-4435
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COMMONWEALTH LTH ®F M ASSAC14USETTS
Board of Health, QTj+ , MA.
FEE $ 5-5' 00
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APPLICATION F®I, DISPOSAL SYSTEM CONSTRUCTION PERMIT
Application for a Permit to Construct( ) Repair( ) Upgrade/,) Abandon() - 6 Complete System ❑ Individual Components
Location
Owner's Name
Map/Parcel;
Address
Lot#
Telephone# 9 7S- 5-9 —', O
�j��
Installer's Name%
Designer's Name
Addressy�
Address !�
Telephone#
Telephone#
Type of Building �oalen/`fL/ Lot Size z .S� 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
i
Plan: Date 2 Zot 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 -� &
The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and
further a > es oft place the tem in operation until a Certificate of C mpliance has been issued by the Board of Health.
Signed,/ l? Date O "
c
Inspections
No. " 'H C - i _ ; FEE
COMMONWEALTH LTH OF M ASSACHUSETTS„Ci H-15- � �z
Board of Health, 461?—fyl 0 U l A , MA.
CERTIFICATE Of COMPLIANCE
Description of Work: ❑ Individual Component(s) - 0 Complete System
The
by:
at
;ned hereby certify that the Sewage Disposal System; Constructed ( ), Repaired ( ), Upgraded;(" ), Abandoned ( )
Ute_
has been installed in'accordance with the provisions of 310 CMR 15.00 (Title 5) and the approved design plans/as-built plans
application No. f dated % Approved Design Flow > ”` (gpd)
Installer
Designer: Inspector:
The issuance of this permit shall not be construed as a guara
Date:
that the system will function as designed.
FEE C
COMMONWEALTH OF MASSACHUSETTS -
Board of Health, y�� rvtO l�il- , MA.
DISPOSAL SYSTLM[ CONSTRUCTION PERMIT
Permission is hereby granted to; Construct( ) Repair( ) Upgrade,(?) Abandon( ) an indhideal sewage disposal system
at i as described in the application for
Disposal System Construction Permit No. / , dated
Provided: Construction shall be completed within threee�rs of the date of this permit. All local conditions must be met.
Form 1255 Rev. 5/96 A.M. Sulkin Co. Chadestmvn, MA Date % %%� ! Board of Health - =
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No.: BOHDC-15-4435
• Commonwealth of Massachusetts FaB
us.00
Board of Health, Yarmouth, MA
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT
Application for a Permit to:Upgrade-Complete System
Location: 31 MAINEAVE,WESTYARMOUTH, MA02673 Owner:
PLAUSKY ROBERT J
Map/Parcel#: 022.370 PLAUSKY KAREN J
PO BOX 776
SOUTH YARMOUTH,MA 02664
Phone:
Septic System Installer Designer
R.E.LARRIMORE RONALD J.CADILLAC.PLS.RS,PC
112 MAIN STREET HARWICH, MA P.O.BOX 258
02645 WEST YARMOUTH,MA 02673
Phone: 508-775-9700
Type of Budding:Dwelling Lot Size:6,534.00 Acres
Dwelliog-No.of Bedrooms:3 Garbage Grioder:
Other Type of Building: No.of persons: Showers:
Other Fixtures:
Plao Date:OS/24/2015 Number of Sheets: 1
Cafekria:
Tit1e:SITE PLAN FOR 31 MAINE AVENUE Revisioo Date:
Design Flow(min.required):330 gpd Calculated design Flow:330 gpd Design flow provided:355 gpd
Descriptioo of SoiIs:SEE PLAN
Soil Evaluator Form No.: Name o[Soil Evaluaror: Date of Evaluatioo:08/20/2015
RONALD J.CADILLAC,RS
DESCRIPTION OF REPAIRS OR ALTERATIONS:SEPTIC DISPOSAL-REPAIR-PROPOSED 1500 GAL SEPTTC TANK,DBOX,20
ADS ACR 36HC UNITS W/OUT STONE:25'X 11.5'X 0.89'
� The undersigned agrees W insfall the above described Intlivitlual Sewage Disposal System In aeeordance wkh the provisions of
TITLE 5 antl furfher aarees not W olace in ooeratlon until a Certlflcafe of Comoliance has heen issued 6v the Board of FleaRh.
Signed Date
Inspections
Commonwealth of Massachusetts
Board of Health, Yarmouth, MA Fee
DISPOSAL Y sss.00
S STEM CONSTRUCTION PERMIT
Permission is herby granted to;
R.E. LARRIMORE, 112 MAIN STREET, HARWICH, MA 02645
To perform:Upgrade an individual sewage disposal system.
Owner. PLAUSKY ROBERT 1
PLAUSKY KAREN J
PO BOX 776
SOUTH YARMOUTH,MA 02664
Location:31 MAINE AVE,WEST YARMOUTH,MA 02673
Disposal System Construction Permit No.: BOHDC-15-4435,Dated: September 11,2015
Provided: ConsWction shall be completed within six mon[hs of the date of this permi[. All local condi[ions must be met.
CONDITIONS:
1. SEPTIC DISPOSAL-REPAIR-PROPOSED 1500 GAL SEPTIC TANK, DBOX,20 ADS ACR 36HC UNITS
W/OUT STONE:25'X 11.5'X 0.89'
2. MFC VARIANCE APPROVAL: a. SETBACKS
1 V i
Bruce G. u y, MPH, 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 wi0 function as designed.
i
Commonwealth of Massachusetts
Board of Health, Yarmouth, MA Fee
CERTIFICATE OF COMPLIANCE ass.00
Descriprion of Work:Complete System
The undersigned hereby certify that the Sewage Disposal System; Upgraded
by:R.E.LARRIMORE
at: 3] MAINE 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.: BOHDG1S4435,dated 09/14/ZO15.
Installer:R.E.LARRIMORE
Address:112 MAIN STREET HARWICH,MA 02645 Inspector:AMY VON HONE,R.S.
Designer:RONALD J.CADILLAC,PLS,RS,PC
��- ,
Bruce G. Murphy P , 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 guarantee that the system will function as designed.
BO H_Disposal_ConsVuction_CofC.rpt