HomeMy WebLinkAboutApp-Permit-ComplianceNo.r �L / Z FEE 01' ®e
COMMONWEALTH LTH OF MASSACHUSETTS
4.;
7 �j� Board of Health, Z A MO 0114, MA.
APPLICATION FOP, DISPOSAL SYSTEM CONSTRUCTION PERMIT
Application for a Permit to Construct( Repair( ) Upgrade( ) Abandon( EffComplete System ❑ Individual Components
Location
Owner's Name
GaryS
Map/Parcel# � e
Address a T
Lot#
Telephone#
Installer's Name a L X v
Designer's Name
M j q SQ ar
Address(� �'� r S
Address j g G�
Telephone# p _
Telephone#
Type of Building I S i d Qw CO n Skoch 61 _ _ 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) 4 y U gpd Calculated design flow
Plan: Date
10125.114 Number of sheets
Title
Description of Soil(s)
Soil Evaluator Form No.
Name of Soil Evaluator
DESCRIPTION OF REPAIRS OR ALTERATIONS D .ROX - LCct c I ► it O
Design flow provided
Revision Date
Date of Evaluation
gpd
The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and
further agrees to not to place,the system in operation until a Certificate of Compliance has been issued by the Board of Health.
Signed , Date Pi' -zg ^ j S
No. '> ,f�� �' S L'7 ( FEE 114) d7,
COMMONWEALT14 OF MASSACHUSETTS
Board of Health, Pc (—Mo 01-H , MA. /
CERTIFICATE Of COMPLIANCE
Description of Work: ❑ Individual Component(s) O Complete System t
The undersigned hereby certify that the Sewage Disposal System; Constructed (vl ), Repaired ( ), Upgraded ( ), Abandoned ( )
by:
at 2 -" );
has been installed in acc' df a -n6 vitlfthe pr
application No. �i / dated �-
Installer P)
is of 310 CMR 15.00 (Title 5) and the apPr,oved design plans/as-built plans relating to
/ Approved Design Flow �f'7 �� /(gpd)
Designer: S(iaC-n45 Inspector: g:C Date: f 7�
The issuance of this permit shall not be construed as a guara,,d that the system will function as designed.
No. 4��/����� FEE
y iT
COMMONWEALTH OF MASSACHUSETTS w
r
Board of Health, YPr(ZM O lTl 4 , MA.
DISPOSAL SYSTEM CONSTRUCTION PERMIT
Permission is hereby granted to; Construct Repair( ) Upgrade( ) Abandon( ) an individual sewage disposal system
at pinc wvc Dr, as described in the application for
Disposal System Construction Permit No. dated
Provided: Construction shall be completed withinCl a s pf the date �- of this permi�. All,local conditions must be met.
_ b .
Form 1255 Rev. 5/966 A.M. Sulkikin Co. Chade5lown,MA D�te 7 �/' 7 Board of Health
No.:BOHDGIS-2308
Commonwealth of Massachusetts Fee
f110.00�
Board of Health, Yarmouth, MA
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT
Application for a Permit to:New Construction-Complete System
Location: 2 PINE CONE DR,WEST YARMOUTH, MA 02673 Owner:
ASWAD GARY
Map/Parcel#: 023.100 ASWAD TINA
952 SALEM RD
DRACUT,MA 01826
Phone:
SepHc System Installer Designer
B&B EXCAVATION WILLIAMS&SPARAGES
14 TEABERRY LANE FORESTDALE, 189 NORTH MAIN STREET,SUITE 101
MA 02644 MIDDLETON,MA 01949
Phone: 978-539-8088
Type of Building:Dwelling Lot Siu: 13,939.00 Acres
Dwelling-No.of Bedrooms:4 Garbage Grinder:
Other Type of Building: No.of persons: Showers:
Other Futures:
Plan Date:09/25/2014 Number of Sheets:2 Cafeteria:
Tit1e:SEPT'[C SYSTEM DESIGN PLAN 2 PINE CONE DRIVE Revision Date: 10/]0/2014
Design Flow(min.required):440 gpd Calculated design flow:440 gpd Design ilow provided:452.9 gpd
DescripNon of Soi1s:SEE PLAN
Soil Evaluator Form No.: Name of Soil Evaluator. Date of Evaluatioo:06/27/2014
DANIEL GONSALVES,SE
DESCRIPTION OF REPAIRS OR ALTERATIONS:SEPTIC DISPOSAL-NEW-PROPOSED 1500 GAL SEPTIC TANK,DBOX,3-2'X
2'X 34'TRENCHES(PIPE AND STONE) ,
The undeisigned agrees W insfall the above deseribed Individual Sewage Disposal System in accortlance wkh the provlslons of
TITLE S and furfher aarees not to olace in ooeration until a Certifitate of Comolianee has heen issuetl hv the Boartl of Neakh.
Signed Date
Inspections
Commonwealth of Massachusetts
Board of Health, Yarmouth, MA Fee �
DISPOSAL SYSTEM CONSTRUCTION PERMIT $110.00
Permission is hereby granted to;
B& B EXCAVATION, 14 TEABERRY LANE, FORESTDALE, MA 02644
To perform: New Construction an individual sewage disposal system.
Owner: ASWAD GARY
ASWAD TINA
952 SALEM RD
DRACUT,MA 01826
Location: 2 PINE CONE DR, WEST YARMOUTH, MA 02673
Disposal System Construction Permit No.: BOHDGIS-2308 , Dated: July 30,2015
Provided: Construction shall be completed within six months of the date of this permit. All local conditions must be met.
CONDITIONS:
1. SEPTIC DISPOSAL- NEW- PROPOSED 1500 GAL SEPTIC TANK, DBOX, 3-2'X 2'X 34'
TRENCHES(PIPE AND STONE)
2. BOH TO INSPECT SOIL REMOVAL
�V /
Bruce G. Mu y, PH, R.S., CHO/Amy L. von Hone, R.S., CHO
ealth Director/Assistant Health Director
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 F8a
CERTIFICATE OF COMPLIANCE s++o.00
Description of Work: Complete System
The undersigned hereby certify that the Sewage Disposal System; New Construction
by:B&B EXCAVATION
at:2 PINE CONE 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-1S2308,dated 09/22/2015.
Installer:B&B EXCAVATION
Address:l4 TEABERRY LANE FORESTDALE,MA Inspector:AMY VON HONE,R.S.
02644
Designer: WILLIAMS& SPARAGES
� �JC1(�
Bruce G: u hy,MPH, R.S., CHO/Amy L. von Hone, R.S.,CHO
G/� Health Director/Assistant Health Diredor
The issuance of this permit shall not be construed as a guarantee that the system will function as designed.
BOH_Disposal_Construction_CofC.rpt