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Home My WebLink AboutApp-Permit-Compliance0 1). No. �1 � � G � FEE 7 COMMONWEALIH OF MASSACHUSETTS 4-7 0 Board of Health, VAP:LWDQT14 , MA. I *51 MPLICATION F®I, DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to Construct() Repair() Upgrade.�-<Abandon () - ❑ Complete System et Individual Components Location ©p Owner's Name Map/Parcel# t�/ 9 — Address 2 [:Y7 k, Lot# Telephone# % % 7 Installer's Name �( Designer's Name AddressAddress a Telephone# Telephone# Type of Building P-10 240 /a�t _ 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) 2 2-0 gpd Calculated design flow Design flow provided _Z- gpd Plan: Date Number of sheets Revision Date Title Description of Soil(s) _ Soil Evaluator Form No. Name of Soil Evaluator DESCRIPTION OF REPAIRS OR ALTERATIONS Ly LAf--, /) — Date of Evaluation The undersigned agr es to ins a above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further agrees ton t o la t in operation until a Certificate of Compliance has been issued by the Board of Health. Signed Date 01 Inspections✓—�'�/S No. 1 � "��%'" % � FEE .. �� 16;®�'INI®N I,TII OF MASSACHUSETTS I-2 0 00 —146 7 Board of Health, YAC mo yrH MA. r CERTIFICATE Of COMPLIANCE Description of Work: ❑ Individual Component(s) ❑ Complete System The undersigned hereby ce ' y that the Sewage Disposal System;,Constructed ( ), Repaired (-), Upgraded ( ), Abandoned ( ) by: at has been install application No. .Installer vt M,<A- M Designer: The issuance of this permit shall m `dInsions of 310 CMR 15.00 (Title 5) and the / Approved Design Flpw . Inspector: (gpd) design plans/as-built plans relating to be construed as a guarantee that the system will function as designed. ' .J.�.:KL..,.:,r'CC..r r^c ucv �:�:;r:. , Vit; c•�.-•. .:,�G..-t.._a-�a�-U-] ;r,->oJ a. _n_'s--_r �c<t.- =15a CxG�-o ]o .a'i�„',i�t.a V— . � t i (A—a2. FEE 15 5., QQ COMMONWEALT14 Of MASSACHUSETTS e�170 Board of Health, Y” M Q 1T1��1T•� 1111M. DISPOSAL SYSTEM CONSTRUCTION PERMIT Permission is hereby granted to; Construct( ) Repair( Upgrade( ) Abandon( ) an individual sewage disposal system at 11 %nr 7) _lt� as described in the application for Disposal System Construction Permit No. /C-4�7, dated ff J% Provided: Construction shall be completed wi in of the date of this perzxtit. All local conditions must be met. r� / �� /i Form 1255 Rev. 5/96 A.M. Sulkin Co. Chadeslown, Mn Date � r/ Board of Health No.: BOHDGIS-3078 Commonwealth of Massachusetts Fee $55.00 Board of Health, Yarmouth, MA APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to: Upgrade- Individual Compooent(s) Location: 128 CLEAR BROOK RD,WEST YARMOUTH, MA 02673 Owner: DENAPLESJOHN W Map/Parcel#: 049.196 128 CLEAR BROOK RD WEST YARMOUTH,MA 02673 Phone: Septic System Installer Designer RODNEY FISHER EAS SURVEY,INC. 440 MAIN STREET HARWICH, MA P.O. BOX 1729 02645 SANDWICH,MA 02563 Phone: 508-888-3619 Type of Building:Dwelling Lot Size: 17,860.00 Acres Dwelling-No.of Bedrooms:2 Garbage Grinder: Other Type of Building: No.of persons: Showers: Other Fixtures: Plan Date:07/27/2015 Number of Sheets:2 Cafeteria: Title:SEPTIC SYSTEM REPAIR PLAN 128 CLEAR BROOK ROAD Revision Date: Design Flow(min.required):220 gpd Calculated design Flow:220 gpd Design flow provided:227 gpd Description of Soi1s:SEE PLAN Soil Evaluator Form No.: Name of Soil Evaluator: Date of Evaluation:07/23/2015 EDWARD STONE,PLS DESCRIPTION OF REPAIRS OR ALTERATIONS:SEPTIC DiSPOSAL-REPAIR-EXISTING 1000 GAL SEPTIC TANK,EXISTING , PUMP CHAMBBR,DBOX,14'X 22'X 6"LEACH FIELD The undersignetl agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further aarees not to olace in ooeration until a CeKificate of Comoliance has heen issued hv the Board of Health. Signed Date [nspections ommonwea o assac use s � Board of Health, Yarmouth, MA Fee DISPOSAL SYSTEM CONSTRUCTION PERMIT sss.00 Permission is hereby granted to; RODNEY FISHER SEPTIC SERVICE, 440 MAIN STREET, HARWICH, MA 02645 To perform: Upgrade an individual sewage disposal system. Owner: DENAPLES JOHN W 128 CLEAR BROOK RD WEST YARMOUTH,MA 02673 Location: 128 CLEAR BROOK RD, WEST YARMOUTH, MA 02673 Disposal System Construction Permit No.: BOHDGIS-3078 , Dated: August 11, 2015 Provided: Construction shall be completed wiYhin six months of the date of this permit. All local conditions must be met. CONDITIONS: 1. SEPTIC DISPOSAL- REPAIR-EXISTING 1000 GAL SEPTIC TANK, EXISTING PUMP CHAMBER, PROPOSED DBOX, 14'X 22'X 6" LEACH FIELD 2. BOH TO INSPECT SOIL REMOVAL 3. CONTRACTOR TO CONFIRM DURING FINAL INSPECTION PUMP AND ALARM FLOAT FUNCTION WITH CLEAR WATER TEST 4. MAXIMUM 2 BEDROOM DEED RESTRICTION PER DESIGN RESTRICTIONS � V (�� ( � / � Bruce G. Murp M H, R.S., CHO/Amy L. von Hone, R.S., CHO ,�th Director/Assistant Health Director • The issuance of this permit shall not be construed as a guarantee that the system will funetion as designed.