HomeMy WebLinkAboutApp-Permit-ComplianceNo. DC—�S—�i✓® ` .77 FEE � G�
COMMONWEALTH Of MASSACHUSETTS
Board of Health, Y"MO U ild , MA.
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTI®N PERMIT
Application for a Permit to Construct( ) Repair( ) UpgradeV-*Abandon() - ❑ Complete System/d�Individual Components
.2: i/ t
Location
S
Owner's Name
Map/Parcel#
1 X 1
Address 7 /�G/L/L,'-'''i 1C`7 t �p
Lot#
Telephone#L4 13 S7 G
Installer's Name
IZ— ` (3roi-k-' d cook
Designer's Name S w .f Z,
Address
J?L
Address �� i34 S 10
Telephone#
Telephone# 36-S
Type of Building
Dwelling - No. of Bedrooms
Other - Type of Building _
Lot Size sq. ft.
Garbage grinder ( )
No. of persons Showers ( ), Cafeteria ( )
Other Fixtures
Design Flow (min. required) gpd Calculated design flow 39; Design flow provided gpd
Plan: Date 1 ' _ Number of sheets f Revision Date
Title P
Description of Soil(s) 1
Soil Evaluator Form No. Name of Soil Evaluator . Date of Evaluation
DESCRIPTION OF REPAIRS OR ALTERATIONS Se_ P/Ia
The undersigned agrees -to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and
further agrees t tato lace e n until a Certificate o ompliance has been issued by the Board of Health.
Signed 'v Date
r
Inspections 10115hs, Nd l 5 6K PQ
� - COMMONWEALTH OF MASSACHUSETTS
Board of Health, 46R�lOt3"i'1-I
CERTIFICATE Of COMPLIANCE
Description of Work,,�dividual Component(s) , O Complete System
The undeffr��sitg�ned hereby certify that the Sewage Disposal System; Constructed ( ), Repaired ( ), Upgraded ,(Abandoned ( )
by:
at
lJrJI T
has been installe to acco/cro dan with t e -,isions of_s-b
310 CMR 15.00 (Title 5) and the approved design plans/auilt plans relating to
application No. / dated ld—' Z. % Approved Design Flow (gpd)
Installer WAC% ap j` ! i AJ� A, CG %),O r s r .h ci
Designer: ector: }>�o %a�! 1 ,\ 4 ^ ,��t�. Date: f i
The issuance of this permit shall not be construed as a guarantee that the system will function as designed.
l,L�a�.(. ,. �. ..in:_-'"�=i•i)J<'cc,(`�•7 UYSC'ir`FA:yt=ltl: JC OQ:.J=Ly:..J 1+ r7c00 „OQ 7Co1JC:�G t ^[:C eJ'�o C?OE I�-U^CUO. r(i00 L,_U_!`VC: 10.
No. V '"I J `i i �� Ea -A4 5 FEE
COMMONWEALTH Of MASSACHUSETTS F
Board of Health, )( 4" T 4
DISPOSAL SYSTEM CONSTRUCTION PERMIT
Permission is hereby granted to; Construct( ) Repair( ) Upgrade Le< Abandon( ) an individual sewage disposal system
�a Y at 8 12' 0 S k L -f, r �/s r e , as described in the application for
s
Disposal System Construction Permit No. / s •,- dated /
Provided: Construction shall be
Form 1255 Rev. 5/96 A.M. Sulkin Co. Chadestown, MA
ompleted within turQ*-waft off�--the date of this permit. All local
/con�d'tions must be met.
Date /0 �2— Board of HeaealPh-
' No.:BOHDC-15-4450
• Commonwealth of Massachusetts Fee
555.00
Board of Health, Yarmouth, MA
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT
Application for a Permit to:Upgrade-Individual Component(s)
� Location: 168 EILEEN ST,YARMOUTH, MA 02675 Owner:
MCKINNEY LILLIAN A
Map/Parcel#: 125.118 168 EILEEN ST
YARMOU'1'H PORT,MA 02675
Phone:
Septic System Installer Designer
ELLIS BROTHERS S WEETSER ENGINEEffiNG
PO BOX 59 YARMOUTHPORT, MA P.O.BOX 713
02675 SOUTH DENNIS,MA 02660
Phone: 508-385-6900
Type of Building:Dwelling Lot Size: 19,602.00 Acres
Dwelling-No.of Bedrooms:2 Garbage Grinder:
� Other Type of Building: No.of persons: Showers:
, Ot6er Fixtures:
' Plan Date:08/20/2015 Number of Sheets: 1
Ghteria:
�� TitIe:PROPOSED SEPTIC DESIGN 168 EILEEN STREET Revision Dah:09/28/2015
Desigo Flow(min.required):220 gpd Calculated design ilow:220 gpd Desigo flow provided:351 gpd
Description of SoiIs:SEE PLAN �
Soil Evaluator Form No.: Name of Soil Evaluator. Date of Evaluation:08/20/2015
ROBIN WILCOX,PLS
• DESCRIPTION OF REPAIRS OR ALTERATIONS:SEPTIC DISPOSAL-REPAIR-EXISTING]000 GAL SEPTTC TANK,PROPOSED
DBOX,4 HIGH CAPACITY INFILTRATORS W/STONE:36'X 11'X 10"
The untle�signed agrees!o inatall the above describetl Intlivitlual Sewage Disposal System in aeeordanee wkh the provlslons of
� ' TITLE 5 and further aarees not to olace in ooeretion until a Cerdflcate of Comoliance has heen issued W the Boa�d of Nealth.
Signed Date
Inspections
Commonwealth of Massachusetts
Board of Health, Yarmouth, MA F�
DISPOSAL SYSTEM CONSTRUCTION PERMIT 555.00
Permission is herby granted to;
ELLIS BROTHERS CONSTRUCTION, PO BOX 59,YARMOUTHPORT, MA 02675
To perform:Upgrade an individual sewage disposal system.
Owner. MCKINNEY LILLIAN A
168 EILEEN ST
YARMOU'1'II PORT,MA 02675
i
� Location: 168 EILEEN ST,YARMOUTH,MA 02675
Disposal System Construction Permit No.: BOHDC-1S4450,Dated: October 02,2015
Provided:Construction shall be completed wi[hin six months of[he date of this permit. Ail local conditions must be met.
i
� CONDITIONS:
1.SEPTIC DISPOSAL-REPAIR-EXISTING 1000 GAL SEPTIC TANK, PROPOSED DBOX,4 HIGH CAPACITY
INFILTRATORS W/STONE:36'X 11'X 10"
2. BOH TO INSPECT SOIL REMOVAL
V
Bruce G. M h , PH, R.S.,CHO/Amy L.von 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.
i Commonwealth of Massachusetts
Board of Health, Yarmouth, i�lti Fee
CERTIFICATE OF COMPLIANCE ass.00
Description of Work: Individual Component(s)
The undersigned hereby certify thaz the Sewage Disposal System; Upgraded
by:ELLIS BROTHERS CONSTRUCTION
� at: 168 EILEEN ST,YARMOUTH,MA 02675
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.: BOHDG1S4450,dated 10/19/2015.
Installer:ELLIS BROTHERS CONSTRUCTION
� Address:PO BOX 59 YARMOUTHPORT,MA 02675 Inspector.PHILIP RENAUD
I
Designer: S WEETSER ENGINEERING
�U
, Bruce G. Murphy, , R.S., CHO/Amy L.von one, R.S.,CHO
Health Diredor/Assistant Health Diredor
i
The issuance ofYhis permit shall not be coostrued as a guarantee that t6e system will function as designed.
BOH_Dispasal_ConstrucUon_CofC.rpt
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