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HomeMy WebLinkAboutApp-Permit-ComplianceR MY.-�Vt� }1� ���`T'I SIJ /j��""`�( � � ✓� FEE $S OJA 115---110 COM O LTH Of MASSACHUSETTS c'3�q5 3 Board of Health, Y .aurw , M. APPLICATION FOP DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to Construct( ) Repair(Xl Upgrade( ) Abandon( ) - ❑ Complete System kIndividual Components Location 30 c"Amr-JEy Owner's Name &'t N sot-pmo Map/Parcel# Address x IrVI wifr We�prDtkj M Lot# Telephone# Installer's Name CAS ALsegL.. Designer's Name WIA Address5 � t ST ,41>e- Telephone# ..2 Fs 7,7 Address Telephone# Type of Building RAES 6'OQJi'tt4-C... Lot Size Dwelling - No. of Bedrooms Other - Type of Building No. of persons Other Fixtures Design Flow (min, required) Plan: Date Title Description of Soil (s) Soil Evaluator Form No. gpd Calculated design flow Number of sheets Name of Soil Evaluator sq. ft. Garbage grinder ( ) Showers ( ), Cafeteria ( ) Design flow provided gpd Revision Date Date of Evaluation DESCRIPTION OF REPAIRS OR ALTERATIONS' Wj jLA- N-�� torr oX The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further agrees to noVp place the system in operation until a Certificate of Compliance has been issued by the Board of Health. Signed Date Inspections � (r No. C -IS �( /V2.Ir, . FEE 5ob Q COMMONWEALTH LTH OF MASSACHUSETTS Board of Health, © � MA. a� �' //� f CERTIFICATE OF COMPLIANCE Descriptionn / of Work: � Individual Compo ent(s) 0 Complete System The undeAersigned hereby certify that the Sewage Disposal System; Constructed ( ), Repaired ( ), Upgraded ( ), Abandoned ( ) by:n ` �, t 4 6 rte P -A s s� �.LC- at sn eijdIUNE(_„ Pe)txl-r 'Q&1 E has been installedli`acc�� ,-E/ th tlf frl�s$�ns of 310 CMR 15.00 (Title 5) and the approved design plans/as-built plans relating to application No. dated Approved Design Flow (gpa) Installer Designer: i 1A Inspector: (f �[d I Date: The issuance of this permit shall not be construed as a guaranJtee that the system will function as designed. No. 604bC I -4 �5PJ"�Ic ((�f FEE COMMONWEALTH Of MASSACHUSETTS C4 `i / 3 Board of Health, V 1 Wtk , MA. DISPOSAL SYSTEM CONSTRUCTIONPERMIT Permission is hereby granted to; Construct( ) 'Repair(x) Upgrade( ) Abandon( ) an individual sewage disposal system at 3 J CKYLIEi.,. 11 ti2T jVL4-' as described in the application for Disposal System Construction Permit No. , dated -y�s Provided: Construction shall be comAOMirl ZreflMf the date of this per t. All local conditions must be met. i Form 1255 Rev. 5/96 A.M. Sulkin Co. Chadeslown, MA Date Board of Health No.:BOHDGIS-4455 Commonwealth of Massachusetts F� sss.00 Board of Health, Yarmouth, MA APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERNIIT Application for a Permit to:Repairvminor-Individual Component(s) Location: 30 CHANNEL POINT DR,WEST YARMOUTH, MA 02673 Owner: SOLOMONS ANTONY H Map/Parcel#: 014.12 52 WALNUTRD WESTON,MA 02493 Phone: Septic System Installer Designer CAPEWIDE 153 COMMERCIAL STREET MASHPEE, MA 02649 Phone: Type otBuilding:Dwelling Lot Size:29,621.00 Acres Dwelliug-No.of Bedrooms:5 Garbage Grinder: Other Type of Buildiog: No,of persons: Showers: Other Futures: Plan Date: Number of Sheets: Cafeteria: Title: � Revision Date: Design Flow(min.required):550 gpd Calculated design flow:550 gpd Design flow provided:550 gpd DescripHon of Soils: Soil Evaluator Form No.: Name of Soil Evaluator. Date of Evaluation: DESCRIPTION OF REPAIRS OR ALTERATIONS:SEPTIC DISPOSAL-MINOR REPAIR-REPLACE H-]0 DBOX WITH H-20 DBOX IN DRIVEWAY CONNECTED TO EXISTING 1000 GAL SEPTTC TANK AND 4 FLOWDIFFUSORS The untlersigned agrees W insfall the above describetl Intlivitlual Sewage Disposal Syslem in aecordance wkh the provbions of TITLE 5 antl furfher aarees not W olace in oceratlon until a Certlficate of Comollance has been issued W the Board of Heskh. Signed Date Inspections . � , Commonwealth of Massachusetts Board of Health, Yarmouth, MA FeB DISPOSAL SYSTEM CONSTRUCTION PERMIT 555.00 , Permission is herby granted to; CAPEWIDE ENTERPRISES, LLC, 153 COMMERCIAL STREET, MASHPEE, MA 02649 To perform:Repair-minor an individual sewage disposal system. Owner: SOLOMONS ANTONY H 52 WALNUTRD WESTON,MA 02493 Location:30 CHANNEL POINT DR,WEST YARMOUTH,MA 02673 Disposal System Construction Permit No.: BOHDC-1S4455,Dated: September 15,2015 Provided:Cons[ruction shall be comple[ed within six months of the date of this permit. All local conditions must be met. CONDITIONS: 1.SEPTIC DISPOSAL-MINOR REPAIR-REPLACE H-10 DBOX WITH H-20 DBOX IN DRIVEWAY CONNECTED TO EXISTING 1000 GAL SEPTIC TANKAND 4 FLOWDIFFUSORS � � U�� Bruce G. rp y, MPH, R.S., CHO/Amy L.von Hone, R.S.,CHO .�Health Diredor/Assistant Health Director L 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 Fee CERTIFICATE OF COMPLIANCE E55.00 Description of Work:Iodividual Camponent(s) The undersigned hereby certify that the Sewage Disposal System; Repair-minor by:CAPEWIDE ENTERPRISES,LLC at:30 CHANNEL POINT DR, WEST YARMOUTH,MA 02673 Has been installed in accordance with the provisions of 310 CMR I5.00(Title 5)and the approved design plans or as-built plans relating to application No.: BOHDC-15-4455,dated 09/17/2015. Installer:CAPEWIDE ENTERPRISES,LLC Address:153 COMMERCIAL STREET MASHPEE,MA Inspector:AMY VON HONE,R.S. 02649 Designer: �CUC���� Bruce G. Murptiy, MPH,�R.S.,O Amy L.von Hone, R.S., CHO / . Health Director/Assistant Health Diredor The issuance oFthis permit shall not be construed as a guarantee that the system will function as designed. BO H_Disposal_Construction_CofC.rpt