HomeMy WebLinkAboutApp-Permit-ComplianceNo.
a W111" WHIM
FEE 00
Board of Health, MA.
1, �7rd�teAPPI,ICATI®N FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT
)Applicat' ion for a Permit to Construct( ) Repair( ) Upgrade„( Abandon( 3'6omplete System ❑ Individual Components
Location jrj(tj ��
Owner's Name OQo i)z>4-P{-t
Map/Parcel# h1APL 5
Address 17 Oue-tomo 4, Lext �-'8&1 A ex,
Lot# Lo -r ;ko I
Telephone#
Installer's Name CA
Designer's Name J C �U iV R Mme,
Address15, D T
Address k5 14&j y E. (,4P-Q(�
Telephone# 7%
Telephone#
Type of Building S W Fi LA5 Ffk([ Ly RAS [bE�JT IA -Ce Lot Size �J i 3 fe ( 'r'— sq. ft.
Dwelling - No. of Bedrooms Garbage grinder ( )
Other - Type of Building No. of persons Showers ( ) , Cafeteria ( )
Other Fixtures
Design Flow (min. required) 330 gpd Calculated design flow Design flow provided 3570 _ gpd
Plan: Date 1 (' t t "e1®i 4 Number of sheets Revision Date
Title 1-1:3 P(riC L-iZVC✓ WtQ
Description of Soil (s) S<-1= PC A4
Soil Evaluator Form No. Name of Soil Evaluator Date of Evaluation t O "1 5 - zO l
DESCRIPTION OF REPAIRS OR ALTERATIONS P&O0054 D 1509 SCD a 6(3KijP,(-14- (o
SG�reC, -rev ,p 4t� @-z. TO . [pLrrL&-T" l)&y- Lei a.o Aec ate CP C44wO§e --
10'A Fly 4-00EI&OkAml-toj)
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 l Date 0 I-3:! .Ah%C
59
r
_ COMMONWEALT14 Of MASSACHUSETTS12 t
co—
Board of Health, rA9&0VTff ,MA.
CERTIFICATE Of COMPLIANCE `� 6-2q
r �
- Description of Work: ❑ Individual Component(s) $-Complete System
The undersigned hereby certify that the Sewage Disposal System; Constructed ( ), Repaired ( ), Upgraded Abandoned ( )
by:C0T &P&1&&-5 u -c.
at l 13 l� t N(Q.O u i'cD
has been installed' ' accord nce with the provisi ns of 10 CMR 15.00 (Title 5) and the a roved design plans/as-built plans relating to
application No. dated //- AV Approved Design Flow (gpd)
Installer <—'AQ& W L d Q7 4 -rG0tPiu LL5..
J _ 49
VaWl
Designer:'Inspector: ! {. Date:
The issuance of this permit shall not be construed as a garant6e tha the system will function as designed.
FEE�,t�(;.,
C-91 COMMONWEALTH OF MASSAC14USETTS
Board of Health, i�fLIYYlO IrT , AM.
➢FISP®SAI. SYSTEM CONSTRUCTION PERMIT
Permission is hereby granted to; Construct( ) Repair( ) Upgrade (✓f Abandon ( ) an individual sewage disposal system
at 6'7 3 I)t &JC G—z o-ov e ?,o,+r> as described in the application for
Disposal System Construction Permit No. hf �` ✓� , dated
Provided: Construction shall be completed within-&ree-Ke w.,,of the d of this pegmtt. All local conditions must be met.
Form 1255 Rev. 5/96 A.M. Sulkin Co. Charlestown, MA Date % I� Board offH�Health L t✓' .�i'
/r 7 ice.. _.��` lro�....; YZ LI 1w'.141
No.: BOHDC-14-0612
Commonwealth of Massachusetts F�
$55.00 �
Board of Health, Yarmouth, MA.
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT
Application for a Permit to:Upgrade-Complete System
Location: 173 PINE GROVE RD, SOUTH YARMOUTH, MA 02664 Owner
Map/Parcel#: 025.201 Name:
ADOLPH JOAN E
7 BUCKMAN DR LEXINGTON, MA 02173
Phone:
Septic System Installer
Name:
CAPEWIDE ENTERPRISES, LLC
Address:
153 COMMERCIAL STREET �
MASHPEE, MA 02649 �
Phone:
Type of Building:Dwelling Lot Size:0.11 Acres
Dwelling-No.of Bedrooms:3 Garbage Grinder:
Other Type of Buildiog: No.of persons: Showers: Cafehria:
Other Futures:
Plan Date: 11/11/2014 Number ofSheets: 1
TitIe:PROPOSED SEPT[C SYSTEM UPGRADE l73 PINE GROVE ROAD Revision Date:
Design Flow(min.required):330 gpd Calculated design Flow:330 gpd Desigo flow provided:350 gpd
Description of Soi1s:SEE PLAN
Soil Evaluator Form No.: Name of Soil Evaluator: Date oP Evaluation: 10/IS/2014
JOHN CII[JRCHILL,P.E.
DESCRIPTION OF REPAIRS OR ALTERATIONS: 1500 GAL SEPTIC TANK/500 GAL PUMP CIfAMBER TWO COMPARI'MENT �
TANK,DBOX,20 ARC 36LP UNITS W/OUT STONE:25'X ll 3'X 3.8"
The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of
TITLE 5 antl further aoreea not to olace in ooeretion undl a CertHitate of Comoliance has been issued hv the 8oartl of Health.
Signed Date
Inspections
Commonwealth of Massachusetts
Board of Health, Yarmouth, MA. F�
DISPOSAL SYSTEM CONSTRUCTION PERMTT 555.00
Permission is herby granted to;RICHARD CAPEN Address: 153 COMMERCIAL STREET
MASHPEE,MA 02649
To perform:Upgrade an individual sewage disposal system.
Owner: ADOLPH JOAN E
7 BUCKMAN DR
LEXINGTON,M.4 02173
Location: 173 PINE GROVE RD,SOUTH YARMOUTH,MA 02664
Disposal System Construction Permit No.: BOHDC-14-0612 ,Dated: November 18,2014
Provided: Construction shall be completed within six months of[he date of this permit. All local wnditions must be met.
Conditions
1. BOHto inspectsoil removal.
2. Electrical Permit required.
3. MFC Yariance: l. Groundwater Separation
4. Propased 1500 gal Septic Tank/500 gal Pump Chamber Two Compartment Tank, DBox, 20 ARC 36
Low Profile Units w/out Stone:25'x 11.2'x 3.8"
� l.�-(
Br G. urphy,MPH, R.S., CHO/Amy L.van 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.
Commonwealth of Massachusetts
Board of Health, Yarmouth, MA F�
CERTIFICATE OF COMPLIANCE sss.00
Description of Work:Complete System
The undersigned hereby certify that the Sewage Disposal System; Upgraded
by:CAPEWIDE ENTERPRISES,LLC
at: 173 PINE GROVE RD, SOUTH YARMOUTH,MA 02664
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.: BOHDGI4-0612,dated 06/22/2015.
I�staller:CAPEWIDE ENTERPRISES,LLC
Address:153 COMMERCIAL STREET MASHPEE,MA Inspector:AMY VON HONE,R.S.
02649
Designer:JC ENGINEERING,INC.
CondiHons
1.BOH to inspect soil removal.
2.Electrical Permit required.
3.MFC Variance: 1.Groundwater Separation
4.Proposed 1500 gal Septic TanW500 gal Pump Chamber Two Compartment Tank,DBox,20 ARC 36
Low Profile Units w/out Stone: 25' x 11.2' x 3.8"
�� ���
Bruce G. Murp , MP , R.S., CHO/Amy L. von Hone, R.S., CHO
Health Diredor/Assistant Health Director
The issuance of this permit shall not be construed as a guarantee that the system will function as designed.
BOH_Disposal_Construdion_CofC.rpt