HomeMy WebLinkAboutApp-Permit-Compliance4
/NL1)7`1? -- IS- 0 0 (o V011-411
No. -X35Z, FEE
2— COMMONWEALTH 490MASSACHUSETT
Board of Health, )kmo lr , MA.
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT
Application for a Permit to Construct( ) Repair( ) Upgrade(/) Abandon( ) - Complete System ❑ Individual Components
Location
ltw-
Owner's Name
Map/Parcel#
C16 �
Address
Lot#
Telephone#`il , ,�'� C✓��---
Installer's Name
Z--7
Designer's Name
Address
1
Address u
Telephone#
Telephone# tO7 9— 7-7-�--.
Type of Building
Dwelling - No. of Bedrooms
Other - Type of Building
Other Fixtures
r
Lot Size 2— sq. ft.
Garbage grinder
No. of persons Showers ( ), Cafeteria ( )
6-7 Design Flow (min. required) gpd Calculated design flower Design flow provided gpd
Plan: Date 45-'-7 --� J Number of sheets Revision Date,
Title
Description of Soil (s) V '
Soil Evaluator Form No. Name of Soil Evaluator
OF REPAIRS OR ALTERATIONS
A`Date of Evaluation
The undersigned;no
ree in the above desc 'bed lndivi Sewage Disposal System in accordance with the provisions of TITLE 5 and
further agrees to p ceto tto a Certificate of Compliance has been issued by the Board of Health.
Signed [[�� ,,// Date�-
Y
Inspections
No. FEE , 0
COMMONWEALTH
f OF MASSACHUSETTS � i-�.�-�i -77`
Board of Health, Y �2i1+1t U-11+ , MA. f rC
CERTIFICATE OF COMPLIANCE ,.
Description of Work: ❑ Individual Component(s) 2 Complete System
The undersigned hereby certify that the Sewage Disposal System; Constructed ( ), Repaired ( ), Upgraded 'Abandoned ( )
by: P�, t + t S ir,.� fw i CC rl .►t
at/�� c c, d / - ` C" -i
has been installe ti� cc rAance ih provisions of 310 CMR 15.00 (Title 5) and the approved design plans/as-built plans relating to
application No.,/'C> f Z. dated l Approved Design Flow-5�1!rj(gpd) or
Installer I /1iN Aix ) fr �4i /��J1✓ s° f a �f3%i'ef wG�T r'+'��%G ��
Designer: !!c . ) .�>t s r�, "t` C4. Inspector: ./ 'l �i� Date:
�, =
The issuance of permit shall not be. construed as'a guarant th t the system will function as designed.
_
o o c:; .:c 00 o u 0 e o 6"o o 000c o'"' f+o-<rd000�,i �r�000rc ��'0& o C, � o c o oe'd'oro., c.z"r.,oun-p'000co.,ou co o.00 <.v �oo.o.; .,o.>ooeo:
No. 60WX 45 Z. eW5 i3a-o s , FEE G!5, }
COMMONWEALTH OF MASSACHUSETTS Ck4 1-7
Board of Health, � �} tn% MA
DISPOSAL SYSTEM CONSTRUCTION PERMIT
Permission is hereby granted to; Construct( ) Repair( ) Upgrade( ) Abandon( ) an individual sewage disposal system
at l�6 PV
as described in the application for
Disposal System Construction Permit Np. k"/Z 1._ ,dated 7-
7'
Provided: Cdhstrucnon shall be completed within thx4&4 ears of the date of this permit. All local conditions must�be :met.
Form 1255 Rev. 5/96 A.M. Sulkin Co. Charlestown, MA Date , ✓°/� % Board of Health
(•"
No.:BOHDC-IS-2352
� Commonwealth of Massachusetts Fee
$55.00
Board of Health, Yarmouth, MA
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERNIIT
Application for a Permit to:Upgrade-Complete 5ystem
LocaHon: 47 PAMET RD,WEST YARMOUTH, MA 02673 Owner:
BROWN RAYMOND J JR
Map/Parcel#: 024.98 BROWN ELIZABETH S
10 ANDREWS DR
UXBRIDGE,MA 01569
Phone:
Septic System Installer Designer
ELLIS BROTHERS RONALD J.CADILLAC.PLS,RS,PC
23 ENTERPRISE ROAD P.O.BOX 258
YARMOUTHPORT, MA 02675 WEST YARMOUTH,MA 02673
Phone: 508-775-9700
Type of Building:Dwelling Lot Siu: 13,068.00 Acres
Dwelliog-No.of Bedrooms:2 Garbage Grinder:
Other Type of Building: No.of persons: Showers:
Other Fixtures:
Plan Date:OS/07/2015 Number of Sheets: 1 Cafeteria:
Tit1e:SITE PLAN 47 PAMET ROAD Revision Date:
Design Flow(min.required):220 gpd Calculated design Flow:220 gpd Design Flow provided:367 gpd
Description of SoiIs:SEE PLAN
Soil Evaluator Form No.: Name of Soil Evaluator: Date of Evaluation:04/22/2015
RONALD J.CADILLAC,RS .
DESCRIPTION OF REPAIRS OR ALTERATIONS REPAIR-PROPOSED 1500 GAL SEPTIC TANK,DBOX,21 ADS ARC 36LP
CHAMBERS W/OUT STONE:8.5'X 36'X 3.8"
, The undersigned agrees to install the above described Individual Sewage Disposal System in accordance wMh the provisions of
TITLE b and further aarees not to olace in ooeration until a Cert'rfitate of Comoliance has heen issued 6v the 8oard of FleaHh.
Signed Date
Inspections
Commonwealth of Massachusetts
� Board of Health, Yarmouth, MA Fee
DISPOSAL SYSTEM CONSTRUCTION PERMIT 555.00
Permission is herby granted to;
ELLIS BROTHERS CONSTRUCTION, 23 ENTERPRISE ROAD,YARMOUTHPORT, MA 02675
To perform:Upgrade an individual sewage disposal system.
Owner: BROWN RAYMOND J JR
BROWN ELIZABETH S
]0 ANDREWS DR
UXBRIDGE,MA 01569
Location:47 PAMET RD,WEST YARMOUTH,MA 02673
Disposal System Consuuction Permit No.: BOHDGIS-2352,Dated:June 30,2015
Provided:Cons[ruction shall be completed within six months of the date of this permit. All local conditions must be met.
Conditions
1. REPAIR-PROPOSED I500 GAL SEPTIC TANK, DBOX, 21 ADS ARC 36LP CHAMBERS W/OUT
STONE: 8.S'X 36'X 3.8"
2. MFC VARIANCE:a. GROUNDWATER SEPARATION
3. MAXIMUM2 BEDRODMDEED RESTRICTION
v
Bruce G. urp y, MPH, R.S., CHO/Amy L. von Hone, R.S.,CHO
Health Director/Assistant Health Diredor
The issuance of this permit shall not be coustrued as a guarantee that the system will function as designed.
Commonwealth of Massachusetts
Board of Health, Yarmouth, MA F�
CERTIFICATE OF COMPLIANCE 555.00
Description of Work:Complete System
The undersigned hereby certify that the Sewage Disposal System; Upgraded
by:ELLIS BROTHERS CONSTRUCTION
at:47 PAMET 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.: BOHDGIS-2352,dated 07/21/2015.
Installer:ELLIS BROTHERS CONSTRUCTION
Address:23 ENTERPRISE ROAD YARMOUTHPORT, Inspector:AMY VON HONE,R.S.
MA 02675
Designer:RONALD J.CADILLAC,PLS,RS,PC
Conditions
1.REPAIR-PROPOSED 1500 GAL SEPTIC TANK,DBOX,21 ADS ARC 36LP CHAMBERS
W/OUT STONE: 8.5' X 36' X 3.8"
2.MFC VARIANCE: a.GROUNDWATER SEPARATION
3.MAXIMUM 2 BEDROOM DEED RESTRICTION
C-QQ
Bruce G. M hy, PH, 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 funMion as designed.
BOH_Disposal_Construdion_CofC.rpt