HomeMy WebLinkAboutApp-Permit-ComplianceNo. gco Dc—
COMMONWF-ALT14 Of MASSACHUSETTS
Board of Health, YAP -40 VM , MA. 11�-
APPLICATION FOR DISPOSAL SYSTEM C®NSTRUC,®N PERMIT
Application for a Permit to Construct( ) Repail Upgrade( ) Abandon( ) - ❑ Complete System.-tT-dividual Components
Location
`JlAq4z Owner's Name
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Map/Parcel# _
Address &2 Zt,)AAAO
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Lot#
Telephone# ! 2 ,
_ 6,6
Installer's Name
Designer's Name
AddressW4gg
1� Address
Telephone#
_ — Telephone#�Q
Type of Building M::541
Dwelling - No. of Bedrooms
Other - Type of Building
No. of persons
Lot Size sq. ft.
Garbage grinder ( )
Showers ( ), Cafeteria ( )
Other Fixtures
Design Flow (min. required) OX //6 gpd Calculated ,design flow 3--3O Design flow provided __y / gpd
Plan: Date 1v�o�57/9. O/Number of sheets / Revision Date
Description of Soil(s) _
Soil Evaluator Form No.
Name of Soil Evaluator
Date of Evaluation
DESCRIPTION OF REPAIRS OR ALTERATIONS (,�S-
TC)
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The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and
furth to not top a th system m operation until a Certificate f Compliance has been issued by the Board of Health.
Signed //� Date
Inspections
COMMONWEALT14 OF MASSACHUSETT5 %�,J3�3�1g
Board of Health, 1A;(ZMDV fly , MA. , �(� /V /� t
CERTIFICATE OF C®MPLIA CE � � � B!- /0-
Description of Work: L)Jl'idividual Component(s) ❑ Complete System
The undersigned hereby certify that the Sewage Disposal) System; Constructed ( ), Repaired ( ), Upgrade )<), Abandoned ( )
at
has been installecYiri a cc o1�daWe with fheS ,?6-6sw' ns of 310 CMR 15.00 (Title 5) and the ap proved design plans/as-built plans relating to
applicationNo. S~ �� > dated _� Y % Approved Design Flow , (gpd)
Designer:�/�'l7 f il�,�I7�/t!r/) Inspector: Q ( U �- x- � Date: 10 " 5
The issuance of this permit shall not be construed as a tee at the system will function as designed.
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2- CQMMONWEALTH OF MASSACHUSETTS 00
Board of Health, T AV-M0gT'A , MA.
DISPOSAL SYSTEM CONSTRUCTION PERMIT
Permission is hereby granted to; Construct( �) Repair( ) Upgrad Abandon( ) an individual sewage disposal system
at as described in the application for
Disposal System Construction Per tt No. �� --;?>(,), dated
Provided: Construction shall be completed withinn+ tkreejea/Yr,/-5 of the date of this permi local conditions must be met.
Form 1255 Rev. 5/96 A.M. Sulkin Co. Charlestown, MA Date 4 / CBoardWof HealthCIA�cozl
No.:BOHDC-15-4456
Commonwealth of Massachusetts Fee
• Ess.00
Board of Health, Yarmouth, MA
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT
Application for a Permit to:Upgrade-Individual Component(s)
Location: 37 LUMBERJACK TRAIL,WEST YARMOUTH, MA 02673 Owner:
NESKE GRAYCE N
Map/Parcedf: 074.44 37 LUMBERJACK TRAIL
WEST YARMOUTH,MA 02673
Phone:
Septic System Installer Designer
DAN A. SPEAKMAN DAN A. SPEAKMAN CONSTRUCTION
15 SPEAK WAY HARWICH, MA 02645 15 SPEAK WAY
PhO^e NORTH HARWICH,MA
508-432-5565
Type of Building:Dwelling Lot Size: 13,939.00 Acres
DwelGng-No.of Bedrooms:3 Garbage Grinder:
Other Type oYBuilding: No.of persons: Showers:
Other Fiatures:
Plan Date:08/12/2015 Number of Shcets: l Cafeteria:
Tit1e:5I1'E PLAN OF PROPOSED CONS7RUCT[ON 37 LIJMBERJACK TRAIL Revision Dah:
Design Flow(min.required):330 gpd Calculated design ilow:330 gpd Design flow provided:355.7 gpd
Descriptioo of Soi1s:SEE PLAN
Soil Evaluator Forro No.: Name of Soil Evaluator: Dah of Evaluatioo:08/OS/2015
DAVID B.MASON,R.S.
DESCRIPTION OF REPAIRS OR ALTERATIONS:SEPTIC DISPOSAL-REPAIR-EXISTING 1000 GAL SEPTIC TANK,DBOX,4
INFILTRATOR 3050 IJNITS W/STONE 3'SIDES,1'ENDS:3194'X 1025'X 1.85'
, The undersigned agrees to install the above descrlbed Individual3ewage Disposal System in accordance wifh the provislons of
TITLE 5 and turther aarees not to olace in ooendon untll a Cerfifitate of Comoliance has been issued 6v the Board of Heakh.
Signed Date
Inspections
Commonwealth of Massachusetts
' Board of Health, Yarmouth, MA F�
DISPOSAL SYSTEM CONSTRUCTION PERMIT sss.00
Permission is herby granted to;
DAN A. SPEAKMAN CONSTRUCTION, 15 SPEAK WAY, HARWICH, MA 02645
To perform:Upgrade an individual sewage disposal system.
Owner: NESKE GRAYCE N
37 LUMBERJACK TRAIL
WEST YARMOUTH,MA 02673
Location:37 LUMBERJACK TRAIL,WEST YARMOUTH,MA 02673
Disposal System Construction Permit No.: BOHDG1S4456,Dated: September 28,2015
Provided: Cons[ruc[ion shall be comple[ed within six months of the date of this permit. All local condi[ions mus[be met.
CONDITIONS:
1. SEPTIC DISPOSAL-REPAIR-EXISTING 1000 GAL SEPTIC TANK, DBOX,41NFILTRATOR 3050 UNITS W/
STONE 3'SIDES, 1'ENDS: 31.74'X 10.25'X 1.85'
2.ZONE II MAXIMUM 3 BEDROOM
CX{
Bruce G. Mu h , MPH, R.S., CHO/Amy L.von Hone, R.S., CHO
ealth Diredor/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 F�
CERTIFICATE OF COMPLIANCE E55.00
Description of Work:Individual Component(s)
The undersigned hereby certify that the Sewage Disposal System; Upgraded
by:DAN A. SPEAKMAN CONSTRUCTION
at:37 LUMBERJACK TRAIL,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-1S4456,dated 10/07/2015.
Installer: DAN A. SPEAKMAN CONSTRUCTION
Address:l5 SPEAK WAY HARWICH,MA 02645 Inspector:AMP VON HONE,R.S.
Designer:DAN A. SPEAKMAN CONSTRUCTION
�v ��I6�!/
Bruce G. � rp , MP , R.S., CHO/Amy L.von Hone, R.S.,CHO
Health Director/AssistaM Health Diredor
T6e issuance ot t6is permit shall not be construed as a guarantee that the system will function as designed.
BO H_Disposa I_Construdion_CofC.rpt